Laparoscopic Greater Curvature Plication versus Endoscopic Sleeve Gastroplasty: A Comparative Analysis of Outcomes at...

Obesity is a chronic disease associated with significant health risks. Minimally invasive, anatomy-preserving bariatric procedures such as Laparoscopic Greater Curvature Plication (LGCP) and Endoscopic Sleeve Gastroplasty (ESG) have emerged as alternatives to standard surgical techniques.

This retrospective cohort study compared perioperative and mid-term outcomes of LGCP and ESG performed between January 2018 and March 2022. The primary outcome was percent total body weight loss (%TBWL) at 1 and 3 years. Secondary outcomes included perioperative complications, gastroesophageal reflux disease (GERD), proton pump inhibitor (PPI) use, rates of revisional or conversional surgery, and procedural cost.

A total of 144 patients were included (ESG: n = 70; LGCP: n = 74). At 1 year, %TBWL was significantly greater in the LGCP group than in the ESG group (22.7% vs. 17.3%, p < 0.001), and this difference persisted at 3 years (18.1% vs. 11.3%, p < 0.001). Significantly more ESG patients required new PPI therapy compared with LGCP (30.0% vs. 16.2%, p = 0.049). Revisional or conversional surgery was more frequent after ESG than after LGCP (24.3% vs. 8.1%). Both procedures demonstrated a favorable safety profile with no mortality. Procedural cost was higher for ESG than for LGCP (USD 8,500 vs. USD 2,750, respectively).

Over a 3-year follow-up, LGCP was associated with greater observed weight loss, lower postoperative PPI use, and fewer revisional procedures compared with ESG. Both techniques were safe. LGCP was associated with lower procedural costs, while ESG remains a less invasive option for selected patients. However, these findings should be interpreted as exploratory due to baseline group differences and the retrospective study design and should not be interpreted as evidence of cost-effectiveness.