Efficacy of Endoscopic Interventions for the Management of Obesity: a Meta-analysis to Compare Endoscopic Sleeve Gastroplasty, AspireAssist, and Primary Obesity Surgery Endolumenal

  • Zubair Khan
  • Muhammad Ali Khan
  • Kaveh Hajifathalian
  • Shawn Shah
  • Mohamed Abdul
  • Monica Saumoy
  • Louis Aronne
  • Wade Lee
  • Reem Z. SharaihaEmail author
Original Contributions


Background and Aims

Novel endoscopic procedures (endoscopic sleeve gastroplasty (ESG), AspireAssist (AA), and primary obesity surgery endolumenal (POSE)) have been developed for treatment of obesity. We aimed to conduct a systematic review and meta-analysis to evaluate and compare the efficacy of these three endoscopic procedures.


Main outcomes of interest were percent excess weight loss (%EWL) and percent total body weight loss (%TBWL). Weighted pooled means (WPMs) were calculated and analyzed using random effects model. Mean differences (MDs) were calculated to compare these procedures.


Twelve studies with 1149 patients were included. WPMs for %EWL at 6 and 12 months with ESG were 49.67 (45.67, 53.66) and 52.75 (43.52, 61.98), respectively, while %TBWLs at 6 and 12 months with ESG were 16.01 (15.10, 16.92) and 17.41 (17.08, 17.74), respectively. WPMs for %EWL at 6 and 12 months with POSE were 43.79 (40.17, 47.42) and 44.91 (40.90, 48.92), respectively. WPM for %EWL at 12 months with AA was 50.85 (46.03, 55.68). While comparing ESG and POSE, at 6 months and 12 months, MD for %EWL was 6.17 (1.07, 11.26; P = 0.01) and 7.84 (− 2.05, 17.71; P = 0.06) in favor of ESG. No difference in %EWL was observed while comparing ESG with AA (P = 0.29). Likewise, MD for %EWL to compare AA and POSE was not significant (P = 0.68).


During a follow-up of 6–12 months, both AA and ESG had excellent efficacy in achieving significant and sustained weight loss; however, ESG was found to be superior in terms of weight loss when compared with POSE.


Bariatric endoscopy Obesity Sleeve gastroplasty POSE AspireAssist 


Compliance with Ethical Standards

Disclosures and Conflict of Interest

Reem Z. Sharaiha is a consultant of BSC and Apollo Endosurgery. All other authors have no financial disclosures or conflicts of interest relevant to this study.

Ethical Approval

Systematic review and meta-analysis does not require formal consent.

Informed Consent

Informed consent does not apply to this systematic review and meta-analysis.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of ToledoToledoUSA
  2. 2.Division of GastroenterologyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Division of GastroenterologyWeill Cornell College of MedicineNew YorkUSA

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