Short-Term Versus Long-Term Efficacy of Endoscopic Sleeve Gastroplasty in 8880 Obese Patients: A Systematic Review and Meta-Analysis.

BACKGROUND

Endoscopic sleeve gastroplasty (ESG), a natural orifice transluminal endoscopic procedure, is increasingly integrated into multidisciplinary obesity care. We performed a systematic review and meta-analysis to quantify the durability of ESG-associated weight loss and metabolic outcomes across short- and long-term follow-up.

METHODS

Databases were searched from inception to September 2, 2025 (PROSPERO: CRD420251139333). Peer-reviewed studies reporting ESG outcomes were included; primary outcomes were % total body weight loss (%TBWL), % excess body weight loss (%EBWL), and BMI reduction, stratified by follow-up (≤ 6 months vs. ≥ 1 year). Random-effects models were used; heterogeneity (I 2), publication bias (Egger's test), GRADE assessment, sensitivity analyses, and meta-regression for baseline BMI were performed.

RESULTS

Thirty-three studies (8880 patients; 31 cohorts, 2 RCTs) were included. %TBWL increased from 8.66% (1 month) to 16.13% (6 months) and was 17.88% at 1 year. Long-term pooled %TBWL declined modestly over time (17.88% at 1 year to 15.67% at 3 years). Remission rates were 62% for type 2 diabetes, 43% for hypertension, and 43% for dyslipidaemia. Weight regain occurred in 6%. Baseline BMI predicted higher %TBWL but lower %EBWL.

CONCLUSION

ESG is associated with clinically meaningful weight loss maintained beyond 6 months with modest attenuation over longer follow-up, alongside favourable metabolic remission rates and low reported weight regain.