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Improvement of Obesity-Related Comorbidities After Bariatric Procedures: A Network Meta-Analysis of Endoscopic Versus
Noppachai Siranart1,2, Panisara Fangsaard3, Patavee Pajareya4
1Division of Gastroenterology, Hepatology and Endoscopy, Brigham & Women's Hospital, Boston, MA, USA.
Background:
Recent advances in bariatric interventions have introduced innovative surgical and endoscopic techniques aimed at promoting weight loss and improving obesity-related comorbidities. This study compares the effectiveness of various bariatric procedures in managing metabolic conditions and optimizing clinical outcomes.
Method:
A systematic literature search through January 2025 identified comparative studies, including 16 randomized controlled trials (RCTs) and 39 observational studies (follow-up range: 6-120 months), evaluating diabetes mellitus (DM), hypertension (HTN), dyslipidemia (DLP), and obstructive sleep apnea (OSA) outcomes following bariatric surgery. Secondary outcomes included de novo gastroesophageal reflux disease (GERD) incidence and GERD improvement.
Results:
Fifty-five studies involving 61,154 patients were analyzed. For DM improvement, one-anastomosis gastric bypass (OAGB) was significantly superior to both Roux-en-Y gastric bypass (RYGB) (OR: 1.92; 95% CI: 1.18-3.13) and sleeve gastrectomy (SG) (OR: 2.47; 95% CI: 1.49-4.09). OAGB and RYGB also showed significantly greater HTN improvement compared to SG (OR: 1.84; 95% CI: 1.20-2.84 and OR: 1.30; 95% CI: 1.14-1.49, respectively). For de novo GERD, ESG (OR: 0.08; 95% CI: 0.01-0.72) and RYGB (OR: 0.29; 95% CI: 0.18-0.48) showed significantly lower odds than SG. For GERD improvement, OAGB (OR: 5.48; 95% CI: 1.52-19.76) and RYGB (OR: 3.82; 95% CI: 2.09-6.97) significantly outperformed SG. P-score rankings placed SADI highest for DM (0.932), OAGB for HTN (0.769) and DLP (0.731), and SASI for both de novo GERD (0.803) and GERD improvement (0.900).
Conclusion:
OAGB, SASI, SADI, and ESG demonstrate superior efficacy in improving obesity-related comorbidities and GERD outcomes, supporting their consideration as leading options in individualized bariatric care. However, evidence is limited with outcomes heterogenously defined across studies. Future RCTs are needed to provide comparative efficacy between these interventions.
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