Comparison of the concomitant use of anti-obesity medications with endoscopic sleeve gastroplasty versus endoscopic sleeve gastroplasty alone: a systematic review and meta-analysis.

Endoscopic sleeve gastroplasty (ESG) is increasingly combined with anti-obesity medications (AOMs), but the incremental benefit of combination therapy over ESG alone remains uncertain METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251179747). Comparative studies evaluating ESG plus AOMs versus ESG alone in adults with overweight or obesity were included. Random-effects models were used for pooled analyses RESULTS: Ten studies comprising 578 participants met inclusion criteria. At approximately seven months, combination therapy showed a modest, non-significant advantage in total weight loss (mean difference +1.9% TWL; 95% CI - 1.22 to 4.99), with substantial heterogeneity (I2 ≈ 80-90%). For metabolic outcomes, the pooled mean difference in HbA1c change was minimal (- 0.04%; 95% CI - 0.37 to 0.28; p = 0.79), and individual studies reported inconsistent effects CONCLUSIONS: ESG combined with AOMs may enhance early weight loss in selected settings; however, current evidence does not support consistent long-term superiority over ESG alone for weight or glycemic outcomes. Although the available data remain limited and heterogeneous, concomitant therapy may be considered in selected patients rather than as a universally superior strategy. Multicenter randomized trials with standardized pharmacotherapy protocols, longer follow-up, and improved patient stratification are needed to clarify durability, cost-effectiveness, and the subgroups most likely to benefit.