Comparison of the concomitant use of anti-obesity medications with endoscopic sleeve gastroplasty versus endoscopic sleeve gastroplasty alone: a systematic review and meta-analysis
In brief
Adding anti-obesity drugs to endoscopic sleeve gastroplasty yields about 2% extra weight loss
A meta-analysis of ten studies (578 patients) found that combining anti-obesity medication with endoscopic sleeve gastroplasty produced a modest, statistically non-significant increase of roughly 2% total body weight loss at seven months, with high study heterogeneity. No meaningful improvement in HbA1c was seen, and current data are insufficient to endorse routine combined therapy.
- Journal
- Surgical endoscopy (Q1)
- Published
- 24 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Luiz Gustavo de Quadros, Manoel Galvão Neto, Caio Colturato Coimbra, André Teixieira, Admar Concon Filho, Roberto Luiz Kaiser Junior, et al.
- PMID
- 42498866
- DOI
- 10.1007/s00464-026-12936-w
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 26 July 2026): Meta‑analysis of ESG plus anti‑obesity meds vs ESG alone
- Picked for Health Policy (top studies of the week, 26 July 2026).
- Picked for Surgery (top studies of the week, 26 July 2026).
Abstract
Endoscopic sleeve gastroplasty (ESG) is increasingly combined with anti-obesity medications (AOMs), but the incremental benefit of combination therapy over ESG alone remains uncertain METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251179747). Comparative studies evaluating ESG plus AOMs versus ESG alone in adults with overweight or obesity were included. Random-effects models were used for pooled analyses RESULTS: Ten studies comprising 578 participants met inclusion criteria. At approximately seven months, combination therapy showed a modest, non-significant advantage in total weight loss (mean difference +1.9% TWL; 95% CI - 1.22 to 4.99), with substantial heterogeneity (I2 ≈ 80-90%). For metabolic outcomes, the pooled mean difference in HbA1c change was minimal (- 0.04%; 95% CI - 0.37 to 0.28; p = 0.79), and individual studies reported inconsistent effects CONCLUSIONS: ESG combined with AOMs may enhance early weight loss in selected settings; however, current evidence does not support consistent long-term superiority over ESG alone for weight or glycemic outcomes. Although the available data remain limited and heterogeneous, concomitant therapy may be considered in selected patients rather than as a universally superior strategy. Multicenter randomized trials with standardized pharmacotherapy protocols, longer follow-up, and improved patient stratification are needed to clarify durability, cost-effectiveness, and the subgroups most likely to benefit.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.