P5690 - Endoscopic Sleeve Gastroplasty Complications Comparison With Other Bariatric Procedures: An Umbrella Review

Zane Gouda, MD¹, Muhammad Usman Baig, MBBS¹, Kate E. Johnson, BA¹, Ali Lahooti, MD¹, Hakan Gelincik, MD², Sean Rangwani, MD¹, Zuhair Osamah Zuhair Al-Bakaeen, MBBS³, Chino Aneke-Nash, MD¹, Mohannad Bisher Zuhair Al-Bakain, MBBS³, Sanad Tarick Haddad, MBBS⁴, Carolyn Newberry, MD⁵, Mark Hanscom, MD¹, Kartik Sampath, MD¹, SriHari Mahadev, MD¹, David Carr-Locke, MD, FACG¹, Reem Z.. Sharaiha, MD, MSc⁶
1Weill Cornell Medicine, New York, NY; 2NYC Health + Hospitals/Woodhull, Brooklyn, NY; 3Jordan University of Science and Technology, Irbid, Irbid, Jordan; 4University of Jordan, Amman, 'Amman, Jordan; 5NewYork-Presbyterian / Weill Cornell Medical Center, New York, NY; 6Weill Cornell Medical College, New York, NY

Introduction: Endoscopic sleeve gastroplasty (ESG) has demonstrated efficacy in obesity management, but comparative data on adverse events (AEs) versus other bariatric interventions remains limited. We performed an umbrella review to aggregate and evaluate existing meta-analyses assessing AEs associated with ESG, intra-gastric balloon (IGB) placement, and laparoscopic sleeve gastrectomy (LSG).

Methods: We systematically searched PubMed, MEDLINE, Web of Science, Scopus, and Embase for systematic reviews with meta-analyses that included ESG, IGB, and/or LSG. Eligible studies reported AEs using mean differences (MD), risk ratios (RR), or risk differences (RD) with 95% confidence intervals (CIs). A random‐effects model was applied to pool estimates across meta-analyses.

Results: Fifteen meta-analyses met the inclusion criteria. Compared with other bariatric procedures, ESG was associated with a significantly lower overall AE rate (MD = 1.65%; 95% CI: 0.92–2.37; P < 0.00001), a reduced bleeding risk (MD = 0.94%; 95% CI: 0.67–1.21; P < 0.00001), and fewer instances of abdominal pain (RD = 0.60; 95% CI: 0.47–0.74; P < 0.00001) (Figures 1a–1c). When ESG was compared with IGB, there was no significant difference in overall AEs (RR = 0.66; 95% CI: 0.30–1.44; P = 0.29). In contrast, ESG showed a lower risk of AEs compared with LSG (RR = 0.43; 95% CI: 0.30–0.62; P < 0.00001) (Figures 2a–2b).

Discussion: In aggregate meta‐analytic data, ESG presents a lower rate of AEs compared to LSG, while demonstrating a comparable safety profile to IGB. These findings support the favorable safety profile of ESG relative to surgical sleeve gastrectomy, without a significant difference when compared with intragastric balloon placement.


Figure: Figure 1a. Forest plot for overall ESG complications
Figure 1b. Forest plot for post-op ESG bleeding risk
Figure 1b. Forest plot for post-op ESG bleeding risk


Figure: Figure 2a. Forest plot for ESG vs IGB complications comparison
Figure 2b. Forest plot for ESG vs LSG complications comparison

Disclosures:
Zane Gouda indicated no relevant financial relationships.
Muhammad Usman Baig indicated no relevant financial relationships.
Kate Johnson indicated no relevant financial relationships.
Ali Lahooti indicated no relevant financial relationships.
Hakan Gelincik indicated no relevant financial relationships.
Sean Rangwani indicated no relevant financial relationships.
Zuhair Osamah Zuhair Al-Bakaeen indicated no relevant financial relationships.
Chino Aneke-Nash indicated no relevant financial relationships.
Mohannad Bisher Zuhair Al-Bakain indicated no relevant financial relationships.
Sanad Tarick Haddad indicated no relevant financial relationships.
Carolyn Newberry: Eli Lilly & Co – Consultant.
Mark Hanscom indicated no relevant financial relationships.
Kartik Sampath: CONMED – Consultant.
SriHari Mahadev: Boston scientific – Consultant. Conmed – Consultant.
David Carr-Locke: Boston Scientific – Consultant. Steris Corporation – Royalties.
Reem Sharaiha: Boston Scientific – Consultant. Cook Medical – Consultant. Olympus – Consultant. Surgical Intuitive – Consultant.

Zane Gouda, MD¹, Muhammad Usman Baig, MBBS¹, Kate E. Johnson, BA¹, Ali Lahooti, MD¹, Hakan Gelincik, MD², Sean Rangwani, MD¹, Zuhair Osamah Zuhair Al-Bakaeen, MBBS³, Chino Aneke-Nash, MD¹, Mohannad Bisher Zuhair Al-Bakain, MBBS³, Sanad Tarick Haddad, MBBS⁴, Carolyn Newberry, MD⁵, Mark Hanscom, MD¹, Kartik Sampath, MD¹, SriHari Mahadev, MD¹, David Carr-Locke, MD, FACG¹, Reem Z.. Sharaiha, MD, MSc⁶. P5690 - Endoscopic Sleeve Gastroplasty Complications Comparison With Other Bariatric Procedures: An Umbrella Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.