Intragastric Balloon Versus Endoscopic Sleeve Gastroplasty for the Treatment of Obesity: a Systematic Review and Meta-analysis

Abstract

Background: We aimed to individually evaluate IGB and ESG procedures and compare the efficacy, durability, and safety of these procedures.

Methods: Bibliographic databases were systematically searched for studies investigating the use of IGB and ESG for the treatment of obesity. Studies reporting percent total weight loss (%TWL) or percent excess weight loss (%EWL) with at least 12 months of follow-up were included.

Results: A total of 28 studies were included in the final analysis. Only 1 study directly compared ESG to IGB, 9 studies evaluated ESG alone, while 18 studies evaluated IGB. At 12-month follow-up after ESG, mean %TWL was 17.51 (95% CI 16.44-18.58), and %EWL was 60.51 (95% CI 54.39-66.64). Mean %TWL and %EWL after IGB at 12 months was 10.35 (95% CI 8.38-12.32) and 29.65 (95% CI 25.40-33.91), respectively. Mean %TWL and %EWL after IGB were significantly decreased at 18 or 24 months compared to 6 months indicating weight regain after IGB removal. ESG achieved significantly superior weight loss compared to IGB, the difference in mean %TWL was 7.33 (95% CI 5.22-9.44, p value = 0.0001) at 12 months. Serious adverse events were observed in < 5% for both procedures.

Conclusion: Although ESG and IGB are safe and effective for weight loss, our study suggests that ESG results in more significant and sustained weight loss. Nevertheless, a variety of approaches are essential to care for this underserved population, and there are several factors other than weight loss that should be considered in selecting the ideal therapy for individual patients.

Keywords: ESG; Endoscopic and bariatric therapy; Endoscopic sleeve gastroplasty; Gastric balloon; IGB; Intragastric balloon; Obesity.

Conflict of interest statement

Conflict of Interest Shailendra Singh, Diogo Turiani Hourneaux de Moura, Ahmad Khan, Mohammad Bilal, Monica Chowdhry, Michele B. Ryan, Ahmad Najdat Bazarbashi declare that they have no conflict of interest. Christopher C Thompson is a consultant for Apollo Endosurgery, USGI medical, Fractyl, Boston Scientific, Medtronic, Olympus, and GI dynamics.

Figures

Fig. 1

PRISMA flow diagram detailing the process of study selection

Fig. 2

a, b Forest plot of studies reporting the percentage of percent total weight loss (%TWL) and percentage of excess weight loss (%EWL) after endoscopic sleeve gastroplasty (ESG)

Fig. 3

a–d Forest plot of studies reporting the percent total weight loss (%TWL) and percentage of excess weight loss (%EWL) after intragastric balloon (IGB)

Fig. 3

a–d Forest plot of studies reporting the percent total weight loss (%TWL) and percentage of excess weight loss (%EWL) after intragastric balloon (IGB)

Fig. 4

Comparison of endoscopic sleeve gastroplasty (ESG) and intragastric balloon (IGB) adverse events