Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(01): E87-E95
DOI: 10.1055/a-1300-1085
Review

Laparoscopic sleeve gastrectomy versus endoscopic sleeve gastroplasty: a systematic review and meta-analysis

Giuseppe Marincola‡
1   Bariatric and Metabolic Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Camilla Gallo‡
2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
3   Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
,
Cesare Hassan
4   Digestive Endoscopy Unit, Nuovo Regina Margherita, Rome, Italy
,
Luca Sessa
1   Bariatric and Metabolic Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Marco Raffaelli
1   Bariatric and Metabolic Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Guido Costamagna
2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
3   Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
,
Vincenzo Bove
2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
3   Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
,
Valerio Pontecorvi
2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
3   Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
,
Beatrice Orlandini
2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
3   Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
,
Ivo Boškoski
2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
3   Centre for Endoscopic Research Therapeutics and Training (CERTT), Catholic University of Rome, Italy
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Correction to:

Laparoscopic sleeve gastrectomy versus endoscopic sleeve gastroplasty: a systematic review and meta-analysisEndosc Int Open 2021; 09(01): C1-C1
DOI: 10.1055/a-1379-5528

Abstract

Background and study aims Laparoscopic sleeve gastrectomy (LSG) is the current standard for bariatric surgery, but it is affected by several postoperative complications. Endoscopic sleeve gastroplasty (ESG) was created as a less invasive alternative to LSG. However, its efficacy and safety compared with LSG is unclear.

Materials and methods Relevant publications were identified in MEDLINE/Cochrane/EMBASE/OVID/ PROSPERO and NIH up to January 2020. Studies were selected that included obese patients with a baseline body mass index (BMI) between 30 and 40 kg/m² with a minimum of 12 months of follow-up and with reported incidence of complications. The mean difference in percentage of excess weight loss (%EWL) at 12 months between LSG and ESG represented the primary endpoint. We also assessed the difference in pooled rate of adverse events. The quality of the studies and heterogeneity among them was analyzed.

Results Sixteen studies were selected for a total of 2188 patients (LSG: 1429; ESG: 759) with a mean BMI 34.34 and 34.72 kg/m² for LSG and ESG, respectively. Mean %EWL was 80.32 % (± 12.20; 95 % CI; P = 0.001; I² = 98.88) and 62.20 % (± 4.38; 95 % CI; P = 0.005; I² = 65.52) for the LSG and ESG groups, respectively, corresponding to an absolute difference of 18.12 % (± 0.89; 95 % CI, P = 0.0001). The difference in terms of mean rate of adverse events was 0.19 % (± 0.37; 95 %CI; χ 2  = 1.602; P = 0.2056).

Conclusions Our analysis showed a moderate superiority of LSG versus ESG. No difference in terms of safety was shown between the two groups. ESG is a less-invasive, repeatable and reversable and acceptable option for mild-moderate obese patients.



Publication History

Received: 26 May 2020

Accepted: 05 October 2020

Article published online:
01 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 World Health Organization. Obesity and overweight. Available at (Accessed December 6, 2019): https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
    PubMedGoogle Scholar
  • 2 ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy. A pathway to endoscopic bariatric therapies. Surg Obes Relat Dis 2011; 7: 672-682
    CrossrefPubMedGoogle Scholar
  • 3 American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers 2011-2018. 26.06.2018 Available at (Accessed December 6, 2019): https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers
    PubMedGoogle Scholar
  • 4 Kheirvari M, Dadkhah Nikroo N. et al. The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review. Heliyon 2020; 6: e03496
    CrossrefPubMedGoogle Scholar
  • 5 Boškoski I, Pontecorvi V, Gallo C. et al. Redo endoscopic sleeve gastroplasty: technical aspects and short-term outcomes. Ther Adv Gastroenterol 2020; 13: 1756284819896179
    CrossrefPubMedGoogle Scholar
  • 6 Storm AC, Abu Dayyeh BK. Endoscopic sleeve gastroplasty for obesity: defining the risk and reward after more than 1600 procedures. Gastrointest Endosc 2019; 89: 1139-1140
    CrossrefPubMedGoogle Scholar
  • 7 The Cochrane Collaboration. 6.4.11.1 The Cochrane Highly Sensitive Search Strategies in MEDLINE. Available at (Accessed December 12, 2019): https://handbook-5-1.cochrane.org/chapter_6/6_4_11_1_the_cochrane_highly_sensitive_search_strategies_for.htm
    PubMedGoogle Scholar
  • 8 Moher D, Liberati A, Tetzlaff J. et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar
  • 9 The Cochrane Collaboration. New Cochrane Handbook for Systematic Reviews of Interventions. Available at (Accessed December 12, 2019): news/new-cochrane-handbook-systematic-reviews-interventions
    PubMedGoogle Scholar
  • 10 The Cochrane Collaboration. Data extraction forms. Available at (Accessed December 12, 2019): https://dplp.cochrane.org/data-extraction-forms
    PubMedGoogle Scholar
  • 11 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188 DOI: 10.1016/0197-2456(86)90046-2.
    CrossrefPubMedGoogle Scholar
  • 12 Altman DG. Practical Statistics for Medical Research. Boca Raton, Fla: Chapman & Hall/CRC; 1999
    Google Scholar
  • 13 Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med 2007; 26: 3661-3675
    CrossrefPubMedGoogle Scholar
  • 14 Richardson JT. The analysis of 2 × 2 contingency tables--yet again. Stat Med 2011; 30: 890-892
    CrossrefPubMedGoogle Scholar
  • 15 Bolliger M, Kroehnert J-A, Molineus F. et al. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg 2018; 50: 256-261
    CrossrefPubMedGoogle Scholar
  • 16 The Cochrane Collaboration. RoB 2: A revised Cochrane risk-of-bias tool for randomized trials. Available at (Accessed December 6, 2019): bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials
    PubMedGoogle Scholar
  • 17 National Heart, Lung, and Blood Institute. Study Quality Assessment Tools. Available at (Accessed December 6, 2019): https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
    PubMedGoogle Scholar
  • 18 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedGoogle Scholar
  • 19 Peterli R, Wölnerhanssen BK, Peters T. et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-En-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 2018; 319: 255-265
    CrossrefPubMedGoogle Scholar
  • 20 Kehagias I, Karamanakos SN, Argentou M. et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI <50 kg/m2. Obes Surg 2011; 21: 1650-1656
    CrossrefPubMedGoogle Scholar
  • 21 Saumoy M, Schneider Y, Zhou XK. et al. A single-operator learning curve analysis for the endoscopic sleeve gastroplasty. Gastrointest Endosc 2018; 87: 442-447
    CrossrefPubMedGoogle Scholar
  • 22 Espinet Coll E, López-Nava Breviere G, Nebreda Durán J. et al. Spanish consensus document on bariatric endoscopy part 1. general considerations. . Rev Espanola Enfermedades Dig 2018; 110: 386-399
    PubMedGoogle Scholar
  • 23 Sartoretto A, Sui Z, Hill C. et al. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg 2018; 28: 1812-1821
    CrossrefPubMedGoogle Scholar
  • 24 Fayad L, Adam A, Schweitzer M. et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc 2019; 89: 782-788
    CrossrefPubMedGoogle Scholar
  • 25 Lee W-J, Ser K-H, Chong K. et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery 2010; 147: 664-669
    CrossrefPubMedGoogle Scholar
  • 26 Shen D, Ye H, Wang Y. et al. Comparison of short-term outcomes between laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy. Surg Endosc 2013; 27: 2768-2774
    CrossrefPubMedGoogle Scholar
  • 27 Berry MA, Urrutia L, Lamoza P. et al. Sleeve gastrectomy outcomes in patients with BMI between 30 and 35-3 years of follow-Up. Obes Surg 2018; 28: 649-655
    CrossrefPubMedGoogle Scholar
  • 28 James TW, McGowan CE. The descending gastric fundus in endoscopic sleeve gastroplasty: implications for procedural technique and adverse events. VideoGIE Off Video 2019; 4: 254-255
    CrossrefPubMedGoogle Scholar
  • 29 Bhandari M, Jain S, Mathur W. et al. Endoscopic sleeve gastroplasty is an effective and safe minimally invasive approach for treatment of obesity: First Indian experience. Dig Endosc 2019; DOI: 10.1111/den.13508.
    CrossrefPubMedGoogle Scholar
  • 30 Cheskin LJ, Hill C, Adam A. et al. Endoscopic sleeve gastroplasty versus high-intensity diet and lifestyle therapy: a case-matched study. Gastrointest Endosc 2020; 91: 342-349.e1
    CrossrefPubMedGoogle Scholar
  • 31 Zhang Y, Zhao H, Cao Z. et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg 2014; 24: 1617-1624
    CrossrefPubMedGoogle Scholar
  • 32 Noun R, Chakhtoura G, Nasr M. et al. Laparoscopic sleeve gastrectomy for mildly obese patients (body mass index of 30 < 35 kg/m2): operative outcome and short-term results. . J Obes 2012; 2012: 813650
    CrossrefPubMedGoogle Scholar
  • 33 Ismail M, Nagaraj D, Rajagopal M. et al. Seven-year outcomes of laparoscopic sleeve gastectomy in Indian patients with different classes of obesity. Obes Surg 2019; 29: 191-196
    CrossrefPubMedGoogle Scholar
  • 34 Hans PK, Guan W, Lin S. et al. Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China. Asian J Surg 2018; 41: 285-290
    CrossrefPubMedGoogle Scholar
  • 35 Park YH, Kim SM. Short-term outcomes of laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy in patients with a body mass index of 30 to 35 kg/m2. Yonsei Med J 2017; 58: 1025-1030
    CrossrefPubMedGoogle Scholar
  • 36 Maiz C, Alvarado J, Quezada N. et al. Bariatric surgery in 1119 patients with preoperative body mass index < 35 kg/m2: results at 1 year. Surg Obes Relat Dis 2015; 11: 1127-1132
    CrossrefPubMedGoogle Scholar
  • 37 Lakdawala M, Agarwal A, Dhar S. et al. Single-incision sleeve gastrectomy versus laparoscopic sleeve gastrectomy. A 2-year comparative analysis of 600 patients. . Obes Surg 2015; 25: 607-614
    CrossrefPubMedGoogle Scholar
  • 38 Alqahtani A, Al-Darwish A, Mahmoud AE. et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc 2019; 89: 1132-1138
    CrossrefPubMedGoogle Scholar
  • 39 Lopez-Nava G, Sharaiha RZ, Vargas EJ. et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up. Obes Surg 2017; 27: 2649-2655
    CrossrefPubMedGoogle Scholar
  • 40 Barrichello S, Hourneaux de Moura DT, Hourneaux de Moura EG. et al. Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study. Gastrointest Endosc 2019; 90: 770-780
    CrossrefPubMedGoogle Scholar
  • 41 Abu Dayyeh BK, Acosta A, Camilleri M. et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol Off Clin Pract 2017; 15: 37-43.e1
    CrossrefPubMedGoogle Scholar
  • 42 Graus Morales J, Crespo Pérez L, Marques A. et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc 2018; 32: 3936-3942
    CrossrefPubMedGoogle Scholar