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Background and Objective <p>Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive alternative to laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity. However, comparative evidence regarding their effectiveness and safety remains limited and heterogeneous. This systematic review aimed to synthesize available comparative data on weight-loss outcomes, safety, and metabolic effects of ESG versus LSG in adults with obesity.</p> Methods <p>A systematic search of PubMed, Embase, Scopus, and Web of Science was performed to identify studies directly comparing ESG and LSG. Thirteen comparative studies met the inclusion criteria. Outcomes were summarized narratively, and meta-analyses were conducted when sufficient data were available. Evaluated outcomes included percentage total body weight loss (%TBWL), percentage excess weight loss (%EWL), change in body mass index (ΔBMI), adverse events, readmissions, and selected metabolic outcomes. Random-effects models were applied to account for between-study variability.</p> Results <p>Thirteen comparative studies, including 1,136,657 patients (ESG: 14,227; LSG: 1,122,430), were included in the analysis. LSG was associated with greater weight loss than ESG across all pooled outcomes, including %TBWL (MD − 9.63%, 95% CI − 11.21 to − 8.05), %EWL (MD − 17.99%, 95% CI − 19.29 to − 16.68), and ΔBMI (MD − 4.63&#xa0;kg/m², 95% CI − 6.13 to − 3.13). Subgroup analyses by follow-up duration showed a consistent pattern favoring LSG at both 6 and 12 months. ESG was associated with a slightly higher risk of overall adverse events (RR 1.16, 95% CI 1.01–1.33); however, this finding was sensitive to the inclusion of large registry datasets and was no longer statistically significant after exclusion of the largest study (RR 1.13, 95% CI 0.93–1.36). Readmission rates were also higher following ESG (RR 1.44, 95% CI 1.29–1.59). Diabetes remission favored LSG (RR 0.79, 95% CI 0.68–0.91), while no significant difference was observed for hypertension improvement (RR 1.04, 95% CI 0.82–1.33).</p> Conclusions <p>LSG provides greater weight-loss efficacy compared with ESG; however, these findings should be interpreted with caution due to baseline differences between study populations and the potential for residual confounding. ESG remains a less invasive option and is generally associated with predominantly minor adverse events; however, comparative safety findings remain uncertain and appear to be influenced by study design and data source. ESG may be appropriate for selected patients seeking a less invasive approach, whereas LSG appears to achieve greater weight reduction. Further comparative studies with longer follow-up are warranted.</p>

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Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: comparative effectiveness, safety, and metabolic outcomes: A Systematic Review and Evidence Synthesis

  • 期刊论文

  • 发表日期：

    2026年4月18日

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  • Reem Shadaid Alqahtani,
  • Mahdi A Abdulrasoul,
  • Haytham Haj Khalil

摘要

Background and Objective

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive alternative to laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity. However, comparative evidence regarding their effectiveness and safety remains limited and heterogeneous. This systematic review aimed to synthesize available comparative data on weight-loss outcomes, safety, and metabolic effects of ESG versus LSG in adults with obesity.

Methods

A systematic search of PubMed, Embase, Scopus, and Web of Science was performed to identify studies directly comparing ESG and LSG. Thirteen comparative studies met the inclusion criteria. Outcomes were summarized narratively, and meta-analyses were conducted when sufficient data were available. Evaluated outcomes included percentage total body weight loss (%TBWL), percentage excess weight loss (%EWL), change in body mass index (ΔBMI), adverse events, readmissions, and selected metabolic outcomes. Random-effects models were applied to account for between-study variability.

Results

Thirteen comparative studies, including 1,136,657 patients (ESG: 14,227; LSG: 1,122,430), were included in the analysis. LSG was associated with greater weight loss than ESG across all pooled outcomes, including %TBWL (MD − 9.63%, 95% CI − 11.21 to − 8.05), %EWL (MD − 17.99%, 95% CI − 19.29 to − 16.68), and ΔBMI (MD − 4.63 kg/m², 95% CI − 6.13 to − 3.13). Subgroup analyses by follow-up duration showed a consistent pattern favoring LSG at both 6 and 12 months. ESG was associated with a slightly higher risk of overall adverse events (RR 1.16, 95% CI 1.01–1.33); however, this finding was sensitive to the inclusion of large registry datasets and was no longer statistically significant after exclusion of the largest study (RR 1.13, 95% CI 0.93–1.36). Readmission rates were also higher following ESG (RR 1.44, 95% CI 1.29–1.59). Diabetes remission favored LSG (RR 0.79, 95% CI 0.68–0.91), while no significant difference was observed for hypertension improvement (RR 1.04, 95% CI 0.82–1.33).

Conclusions

LSG provides greater weight-loss efficacy compared with ESG; however, these findings should be interpreted with caution due to baseline differences between study populations and the potential for residual confounding. ESG remains a less invasive option and is generally associated with predominantly minor adverse events; however, comparative safety findings remain uncertain and appear to be influenced by study design and data source. ESG may be appropriate for selected patients seeking a less invasive approach, whereas LSG appears to achieve greater weight reduction. Further comparative studies with longer follow-up are warranted.