Systematic Review and Meta-Analysis of Endoscopic Sleeve Gastroplasty with Comparison to Laparoscopic Sleeve Gastrectomy
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REVIEW
Systematic Review and Meta-Analysis of Endoscopic Sleeve Gastroplasty with Comparison to Laparoscopic Sleeve Gastrectomy Md Asif Jalal 1,2 & Qiuye Cheng 1,2 & Michael B. Edye 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Endoscopic sleeve gastroplasty (ESG) has grown in popularity as a potential minimally invasive bariatric procedure with acceptable short- and medium-term outcomes. This review aims to assess the safety and weight loss outcomes of ESG and compare it with laparoscopic sleeve gastrectomy (LSG). Material and Methods A comprehensive search of MEDLINE, EMBASE, Cochrane and World Wide Web was conducted. Results Five studies were reviewed, three ESG cohort studies and two case-matched cohort studies comparing ESG with LSG. Total unique ESG and LSG patients were 1451 and 203, respectively. All papers demonstrated a modest short-term total body weight loss (TBWL%) at 6 months ranging from 13.7 to 15.2% for ESG. Comparably, the two LSG papers demonstrated a superior TBWL% of 23.5 and 23.6% at 6 months, with one paper reporting a 12-month TBWL% of 29.3%. Two ESG papers reported medium-term results at 18 and 24 months of 14.8% and 18.6%, respectively. Excluding Clavien-Dindo 1 complications, ESG had a complication rate between 2.0 and 2.7%, while comparatively, LSG had a complication rate between 9.2 and 16.9% (current literature reported as 8.7%). In both procedures, there were no grade IV or V complications. Conclusion ESG when compared with LSG has lower short-term weight loss outcomes with fewer complications. Weight loss results for ESG appear to plateau after the 1-year mark. The future and uptake of ESG as a minimally invasive bariatric procedure will be determined by its long-term data on potential weight loss sustainability. Keywords Endoscopic sleeve gastroplasty . Laparoscopic sleeve gastrectomy
Introduction Advances in endoscopic technology and skill have led to the development of novel endoscopic bariatric procedures. Endoscopic sleeve gastroplasty (ESG) has emerged as a promising alternative to traditional bariatric surgery by utilising similar principles of gastric restriction in reducing the gastric reservoir to help curb appetite while initiating early satiety and fullness through slower gastric transit [1–4]. Obesity is an epidemic that carries a major health and economic burden worldwide [5, 6]. On an individual level,
* Md Asif Jalal [email protected] 1
Department of Surgery, Blacktown Hospital, 14 Blacktown Rd, Blacktown, NSW 2148, Australia
2
Discipline of Surgery, University of Western Sydney, Sydney, Australia
obesity is associated with increased morbidity and mortality as a result of long-term multisystem dysfunction secondary to diseases like diabetes, hypertension and hypercholesterolemia [7]. Lifestyle modifications and pharmacological treatments have so far been shown to be ineffective in maintaining adequate long-term weight loss [8, 9]. As a result, bariatric surgery has gained popularity in being the only effecti
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