Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure worldwide, while endoscopic sleeve gastroplasty (ESG) has emerged as a less invasive alternative. This study compared their effectiveness and postoperative outcomes.

METHODS

A systematic search of PubMed, Scopus, and Cochrane Central was conducted up to June 2025. Non-randomized studies comparing ESG with LSG were included. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed with I². Analyses were performed in R (version 4.4.2), and the risk of bias was evaluated using the ROBINS-I tool.

RESULTS

Nine studies, including 7,468 patients, were analyzed. Compared to LSG, ESG was associated with significantly lower total body weight loss (TBWL) at 6 months (MD = − 8.3%; 95% CI − 10.3 to − 6.3; p < 0.01), 1 year (MD = − 12.5%; 95% CI − 14.9 to − 10.1; p < 0.01), and 2 years (MD = − 10.2%; 95% CI − 15.3 to − 5.1; p < 0.01). ESG also showed lower excess weight loss (EWL) at 6 months (MD = − 11.6%; 95% CI − 15.3 to − 7.8; p < 0.01) and 1 year (MD = − 18.0%; 95% CI − 19.1 to − 16.8; p < 0.01), shorter hospital stay (MD = − 36.8 h; 95% CI − 66.9 to − 6.8; p = 0.02). No significant differences were found in readmissions, bleeding, or operative time.

CONCLUSION

ESG achieved less weight loss than LSG but offered shorter hospitalization and comparable safety outcomes. It may serve as a less invasive alternative for selected patients.