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Background <p>Endoscopic sleeve gastroplasty (ESG) is increasingly combined with anti-obesity medications (AOMs), but the incremental benefit of combination therapy over ESG alone remains uncertain</p> Methods <p>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</p> Results <p>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 −&#xa0;1.22 to 4.99), with substantial heterogeneity (I<sup>2</sup> ≈ 80–90%). For metabolic outcomes, the pooled mean difference in HbA1c change was minimal (−&#xa0;0.04%; 95% CI −&#xa0;0.37 to 0.28; <i>p</i> = 0.79), and individual studies reported inconsistent effects</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月24日

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  • Luiz Gustavo de Quadros,
  • Manoel Galvão Neto,
  • Caio Colturato Coimbra,
  • André Teixieira,
  • Admar Concon Filho,
  • Roberto Luiz Kaiser Junior,
  • Martins Fideles dos Santos Neto,
  • Carolina Colombelli Pacca,
  • Eduardo Grecco

摘要

Background

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.