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CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1811546
Original Article

Efficacy and Safety of Endoscopic Gastroplasty versus Lifestyle Modification for Obesity: A Meta-Analysis of Randomized Controlled Trials with Technique-Specific Subgroup Analysis

Authors

  • Nitin Jagtap 

    1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

  • Aman Golchha

    1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

  • Saransh Jain

    2   Consultant Gastroenterologist, Jainamshree Multi-Speciality Hospital, Bhopal, Madhya Pradesh, India

  • Ivo Boskoski 

    3   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

  • Vincent Huberty

    4   Medical-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

  • Rakesh Kalapala

    1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

  • D. Nageshwar Reddy

    1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Funding None.
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Abstract

Background

Endoscopic gastroplasty (EG) offers a minimally invasive alternative to bariatric surgery for obesity management. While multiple randomized controlled trials (RCTs) have compared EG with lifestyle modification (LM), the extent of benefit and influence of procedural technique remain uncertain.

Materials and Methods

We conducted a meta-analysis restricted to RCTs comparing EG with LM in adults with obesity. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL and excess weight loss (EWL) at 6 months, and EWL at 12 months. Pooled mean differences (MDs) were estimated using a random-effects model. Subgroup analyses were performed based on techniques, such as OverStitch ESG, Endomina, and Primary Obesity Surgery Endoluminal (POSE). Trial sequential analysis (TSA) and assessment of adverse events and publication bias were also conducted.

Results

Five RCTs involving 696 participants were included. EG resulted in significantly greater TBWL at 12 months compared to LM (MD: 7.67%; 95% confidence interval [CI]: 4.38–10.96; I 2 = 92.5%). TSA confirmed the conclusiveness of this finding. EG also led to superior TBWL at 6 months (MD: 6.98%; 95% CI: 3.76–10.20) and greater EWL at 6 months (MD: 24.85%; 95% CI: 13.44–36.27) and 12 months (MD: 26.24%; 95% CI: 11.19–41.29). Subgroup analysis showed highest efficacy with OverStitch ESG (MD: 10.82%), followed by Endomina (6.50%) and POSE (5.61%). The pooled incidence of any adverse event was 10.8%, while serious adverse events were rare (2.9%).

Conclusion

EG is more effective than LM for weight loss at 6 and 12 months, with an acceptable safety profile. Among techniques, OverStitch ESG demonstrated the highest efficacy. These findings support the incorporation of EG into the obesity treatment algorithm, especially for patients unsuitable for surgery.

Keywords

endoscopic gastroplasty - obesity treatment - lifestyle modification - randomized controlled trials - weight loss - OverStitch - Endomina - POSE

Authors' Contributions

Concept and design: N.J., R.K., D.N.R. Supervision: R.K., D.N.R. Resources: V.H., I.B., R.K. Data collection and/or processing: N.J., A.G., S.J. Analysis and interpretation: N.J., A.. Literature search: A.G., S.J. Writing – original draft: N.J., A.G. Writing – review and editing: S.J., I.B., V.H. Critical review and final approval: All authors.


Supplementary Material



Publication History

Article published online:
08 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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