Beyond Weight Reduction: An Updated Systematic Review and Meta-Analysis of Metabolic Syndrome Components and Metabolic Dysfunction-Associated Steatotic Liver Disease Outcomes After Endoscopic Sleeve Gastroplasty
In brief
Endoscopic sleeve gastroplasty cuts HbA1c by about a third of a percent
In 12-month follow-up of 4,452 obese adults, ESG produced an average 0.33% drop in glycated haemoglobin, along with modest improvements in insulin resistance, triglycerides, LDL cholesterol and liver enzyme scores, while achieving roughly 16% weight loss. Evidence quality was low and the liver benefit may be weight-dependent, so larger randomized trials with biopsy endpoints are still needed.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 27 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Alexander Herner, Simon Nennstiel, Christoph Schlag, Andreas Kremer, Luc Biedermann, Gerhard Rogler, et al.
- PMID
- 42739639
- DOI
- 10.3390/jcm15176633
Why clinicians should know about it
- Picked for Histology (top studies of the week, 20 September 2026).
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 20 September 2026): Systematic review, ESG metabolic outcomes
- Picked for Gastroenterology (top studies of the week, 20 September 2026): AI‑assisted colonoscopy improves adenoma detection rates
Abstract
Background: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive option for weight reduction, but its effect on metabolic syndrome (MetS) and metabolic dysfunction-associated steatotic liver disease (MASLD) is less well characterized. Methods: Following PRISMA, we searched five databases to November 2025 (PROSPERO CRD420261283041) for adults with obesity undergoing ESG with ≥6-month follow-up. Continuous outcomes were pooled as mean differences (MDs) using DerSimonian-Laird random-effects models with Hartung-Knapp-Sidik-Jonkman sensitivity analysis. As MetS resolution was inconsistently defined, the primary outcome was post hoc operationalised as change in individual MetS components. Results: Of 858 records, 12 studies (4452 patients; two randomised) were included. At 12 months, ESG was associated with lower glycated haemoglobin (MD -0.33%), HOMA-IR (MD -3.52), triglycerides (MD -25.56 mg/dL), low-density lipoprotein cholesterol (MD -6.94 mg/dL), alanine aminotransferase, and non-invasive steatosis/fibrosis indices; aspartate aminotransferase did not change significantly. Total body weight loss was 16.54% at 12 months and 14.21% at 36 months. Liver stiffness (two studies, differing windows) is described narratively, not pooled. Heterogeneity was often substantial; certainty was low to very low. Conclusions: ESG was associated with metabolic and hepatic improvements alongside substantial weight loss; a weight-independent hepatic effect cannot be established, and randomised trials with histological endpoints are needed.
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.