Comparison of Weight Loss and Improvement in Metabolic Comorbidities Between Endoscopic Gastroplasty and Lifestyle Modifications: A Meta-analysis

BACKGROUND: Endoscopic gastroplasty (EG) is a less invasive method for managing obesity compared with bariatric surgery. However, evidence on the use of EG is still scarce. This study aims to review existing evidence comparing EG with lifestyle modifications (LM) in terms of weight loss and improvement in metabolic syndrome. MATERIALS AND METHODS: A systematic search was performed on PubMed, Embase, and the Cochrane Library from inception to August 2023. Exclusion criteria were patients who received concomitant pharmacological therapy for weight loss, the use of other endoscopic interventions apart from EG, and patients with prior bariatric surgery. Based on the heterogeneity of included studies, meta-analysis was performed using either a fixed-effect model or a random-effect model. RESULTS: There were 5 studies (4 RCTs and 1 retrospective study) with 1007 patients included in the pooled analysis. Only a minority were males (n=199, 19.8%), and only 1 study included a Sham procedure in the LM group. Six-month percentage total body weight loss (%TBWL) (n=3 studies, MD: 6.34, 95% CI: 2.89, 9.78, P <0.01) and 12-month %TBWL (n=4 studies, MD: 6.43, 95% CI: 2.62, 10.25, P <0.01) were significantly higher in EG compared with LM. Patients in the EG group also had significant improvement in control of diabetes mellitus (n=2 studies, OR: 29.10, 95% CI: 5.84, 145.08) and hypertension (n=2 studies, OR: 2.35, 95% CI: 1.18, 4.70) compared with LM. Incidence of serious adverse events ranged from 2% to 5%. CONCLUSION: EG is effective for weight loss and improvement in metabolic comorbidities compared with LM alone but is suboptimal based on the Food and Drug Administration thresholds.