Endoscopic Sleeve Gastroplasty for Type 2 Diabetes: A Systematic Review and Meta-Analysis Focusing on Diabetes Remission, Glycemic Control and Body Weight Loss.

OBJECTIVE

To systematically evaluate metabolic outcomes of endoscopic sleeve gastroplasty (ESG) in patients with type 2 diabetes mellitus (T2DM), focusing on T2DM remission, T2DM improvement, glycated hemoglobin (HbA1c), and percentage of total body weight loss (%TBWL).

METHODS

PubMed, Embase, Web of Science, Cochrane Library, and MEDLINE were searched for cohort studies through December 2025. Two investigators independently performed screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Primary outcomes were T2DM remission, T2DM improvement, HbA1c change, and %TBWL. Meta-analyses used random- or fixed-effects models. Subgroup and sensitivity analyses and Egger's test assessed stability and publication bias.

RESULTS

Seven observational cohort studies involving 519 patients with T2DM were included. The pooled Freeman-Tukey transformed effect size for T2DM remission after ESG was 1.89 (95% confidence interval [CI]: 1.71, 2.06, P < 0.001), corresponding to a raw pooled diabetes remission rate of 62.3%; the pooled transformed effect size for T2DM improvement was 1.65 (95% CI [1.04, 2.26], P < 0.001), with an overall raw improvement rate of 59.1%. The pooled mean difference for HbA1c was 0.60% (95% CI [0.23, 0.97], P = 0.001), and for %TBWL was 10.89% (95% CI [6.24, 15.54], P < 0.001). Subgroup analyses showed %TBWL of 12.84% (95% CI [10.86, 14.82]) at 12 months and 14.00% (95% CI [11.76, 16.24]) at 3 years. Patients with baseline HbA1c ≥ 7.0% had greater HbA1c reduction than those with baseline HbA1c < 7.0% (-1.00% vs -0.50%).

CONCLUSION

ESG improves T2DM remission, glycemic control, and weight loss, with effects sustained up to 3 years. Patients with higher baseline glycemic levels derived greater benefits. ESG may represent an effective minimally invasive treatment option for T2DM, although further randomized trials are needed to confirm this finding.