Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review

Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach's volume without the need for surgical incisions, ESG promotes weight loss and can improve obesity-related comorbidities. However, patient responses to ESG can vary significantly. Materials and Methods: A comprehensive search was performed on PubMed, Embase, and Cochrane for studies with endoscopic sleeve gastroplasty; the main outcomes of interest are BMI, weight loss, and postinterventional complications. The search strategy employed a combination of keywords and Medical Subject Heading (MeSH) terms, including "endoscopic sleeve gastroplasty," "endoscopy," and "overweight". To ensure the thoroughness of the review, additional manual searches of key journals and the reference lists of identified studies were performed. Grey literature, such as dissertations and conference abstracts, meta-analysis, and systematic reviews, was excluded to maintain a focus on peer-reviewed evidence. Duplicate records were identified and removed using Rayyan software to streamline the screening process. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. Results: Our literature search resulted in the inclusion of 38 studies. Endoscopic sleeve gastroplasty for weight loss is important since it is more effective than pharmacological treatments and lifestyle changes and presents lower adverse event rates compared to bariatric surgery. Long-term weight loss outcomes varied, with total body weight loss ranging from 16% to 20.9% over a period from 2 to 5 years, while excess weight loss ranged from 13% to 79%. Revisional procedures showed higher failure rates, with up to 34.3% of patients experiencing insufficient weight loss. Most interventions led to clinically significant and sustained weight loss, though variability in outcomes highlights the need for further research to optimize long-term weight management strategies. Conclusions: Endoscopic sleeve gastroplasty (ESG) emerges as a promising minimally invasive option for weight loss, offering significant improvements in both weight reduction and obesity-related comorbidities, such as diabetes, hypertension, and dyslipidemia.