Endoscopic Sleeve Gastroplasty for Type 2 Diabetes: A Systematic Review and Meta-Analysis Focusing on Diabetes...

To systematically evaluate metabolic outcomes of endoscopic sleeve gastroplasty (ESG) in patients with type 2 diabetes mellitus (T2DM), focusing on T2DM remission, T2DM improvement, glycated hemoglobin (HbA1c), and percentage of total body weight loss (%TBWL).

PubMed, Embase, Web of Science, Cochrane Library, and MEDLINE were searched for cohort studies through December 2025. Two investigators independently performed screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Primary outcomes were T2DM remission, T2DM improvement, HbA1c change, and %TBWL. Meta-analyses used random- or fixed-effects models. Subgroup and sensitivity analyses and Egger's test assessed stability and publication bias.

Seven observational cohort studies involving 519 patients with T2DM were included. The pooled Freeman-Tukey transformed effect size for T2DM remission after ESG was 1.89 (95% confidence interval [CI]: 1.71, 2.06, P < 0.001), corresponding to a raw pooled diabetes remission rate of 62.3%; the pooled transformed effect size for T2DM improvement was 1.65 (95% CI [1.04, 2.26], P < 0.001), with an overall raw improvement rate of 59.1%. The pooled mean difference for HbA1c was 0.60% (95% CI [0.23, 0.97], P = 0.001), and for %TBWL was 10.89% (95% CI [6.24, 15.54], P < 0.001). Subgroup analyses showed %TBWL of 12.84% (95% CI [10.86, 14.82]) at 12 months and 14.00% (95% CI [11.76, 16.24]) at 3 years. Patients with baseline HbA1c ≥ 7.0% had greater HbA1c reduction than those with baseline HbA1c < 7.0% (-1.00% vs -0.50%).

ESG improves T2DM remission, glycemic control, and weight loss, with effects sustained up to 3 years. Patients with higher baseline glycemic levels derived greater benefits. ESG may represent an effective minimally invasive treatment option for T2DM, although further randomized trials are needed to confirm this finding.