Endoscopic sleeve gastroplasty versus intragastric balloon insertion as bridge-to-surgery procedures for patients with BMI ≥50 kg/m2 or contraindications to primary metabolic bariatric surgery
- Journal
- Therapeutic advances in gastroenterology (Q1)
- Published
- 8 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Sandra Nagl, Susanne Wasserberg, Bernd Geißler, Anna Muzalyova, Helmut Messmann, Cora Aubele, et al.
- PMID
- 42718935
- DOI
- 10.1177/17562848261489119
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 13 September 2026): Endoscopic sleeve gastroplasty vs intragastric balloon as bridge‑to‑surgery
Abstract
BACKGROUND: Metabolic bariatric surgery is the most effective obesity treatment, but high body mass index (BMI) and associated medical problems often pose surgical risks. OBJECTIVES: This study compares the safety, feasibility, and efficacy of endoscopic sleeve gastroplasty (ESG) versus intragastric balloon (IGB) as bridge-to-surgery (BTS) procedures in patients with BMI ≥50 kg/m2 and/or contraindications to primary metabolic bariatric surgery. DESIGN: A retrospective analysis (2017 - 2024) included patients with BMI ≥50 kg/m2 undergoing ESG or IGB as a BTS procedure in a two-step approach at two German centers. METHODS: The primary outcome was total body weight loss (TBWL, %) at 6 months. Secondary outcomes included absolute weight loss, BMI reduction, excess body weight loss (EBWL, %), and adverse events between the two BTS procedures. RESULTS: Fourteen patients underwent ESG, 15 underwent IGB insertion as an intended BTS procedure. At 6 months, median %TBWL and %EBWL were significantly higher in the ESG group (17.8% (IQR, 14.5 - 22.1) vs. 8.99% (IQR, 4.6 - 14.0), p = 0.018; and 28.0% (IQR, 22.8 - 40.0) vs. 16.7% (IQR, 10.8 - 22.4), p = 0.035, respectively). IGB insertion was performed significantly faster (25 (IQR, 20.0 - 30.0) minutes (min) vs. 76 (IQR, 63.2 - 80.8) min; p < 0.01) but was associated with more mild-to-moderate adverse events (60.0% vs. 0%; p < 0.01). CONCLUSION: In this retrospective cohort, ESG was associated with greater short-term weight loss and fewer mild-to-moderate adverse events than IGB as a BTS procedure for patients with BMI ≥50 kg/m2 and/or contraindications to primary metabolic bariatric surgery (MBS).
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.