Post written by Vitor Brunaldi, MD, MSc, PhD, from Hospital de Amor, Barretos Cancer Center, Barretos, Ribeirao Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil, and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

We aimed to generate head-to-head comparisons among different endoscopic bariatric therapies (EBTs) available in the United States. Although we have several randomized trials against controls (sham procedures or open-label diet plus lifestyle interventions), no controlled studies compare those different treatment modalities among themselves.

The indications for EBTs usually overlap. Currently, the decision whether to proceed with an intragastric balloon (IGB) or endoscopic sleeve gastroplasty (ESG) is based on inference, availability, and costs (soft data) rather than effectiveness and safety (hard data). Therefore, we decided to conduct a network meta-analysis of randomized trials to create objective controlled data to help clinicians and patients make a more informed, evidence-based decision when choosing the best EBT.

This study conducted a network meta-analysis to compare the efficacy and safety of U.S. Food and Drug Administration—approved EBTs: adjustable and nonadjustable IGBs and ESG for weight loss in patients with obesity. The results demonstrated that all EBTs were significantly more effective than sham procedures or diet/lifestyle interventions, with ESG showing the highest total weight loss at both device removal and 12-month follow-up.

Spatz3 (Spatz Medical, Fort Lauderdale, Fla, USA), an adjustable IGB, also performed well, likely because of its upward adjustment capability, and Orbera (Apollo Endosurgery, Austin, Tex, USA), a nonadjustable IGB, ranked lower. In addition, ESG showed superior improvements in obesity-related comorbidities and quality of life, with a favorable safety profile and lower intolerability rates compared with IGBs.

This study adds to existing knowledge by providing the first comprehensive comparison of all Food and Drug Administration—approved EBTs, offering evidence-based rankings to guide clinical decision-making. It highlights ESG as the most effective EBT for sustained weight loss and comorbidity improvement while underscoring the limitations of diet/lifestyle interventions and the placebo effect of sham procedures. However, the small number of included studies and variability in follow-up times limit the robustness of the findings.

Future research should focus on direct head-to-head trials among EBTs, long-term outcomes, and comparisons with emerging therapies such as glucagon-like peptide-1 receptor agonists. Moreover, exploring the integration of EBTs with multidisciplinary weight loss programs could optimize outcomes. This study reinforces the role of EBTs as effective, minimally invasive options for obesity management, with ESG emerging as a leading choice.

Inclusion flowchart. ESG, Endoscopic sleeve gastroplasty; IGB, intragastric balloon.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.