Comparative Safety of Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis of over 1.1 Million Patients

Comparative Safety of Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis of over 1.1 Million Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Safety of Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis of over 1.1 Million Patients Muhammad Hamza, Aizaz Anwar Khalid, FNU Kritika, Adil Ahmed, Hafsa Younus This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8662397/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Apr, 2026 Read the published version in Obesity Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Endoscopic Sleeve Gastroplasty (ESG) has emerged as a less invasive bariatric option compared to Laparoscopic Sleeve Gastrectomy (LSG). However, direct comparisons of their safety profiles remain limited. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines. Comparative studies evaluating short-term (≤ 30 days) safety outcomes of ESG versus LSG in adults with obesity were included. Primary outcomes were major and overall adverse events. Secondary outcomes included procedure-related complications, readmission, mortality, and organ-specific adverse events. Results: Eleven observational studies encompassing 1,117,309 patients (ESG: 11,890; LSG: 1,105,419) were included. Major adverse events showed no significant difference between ESG and LSG (RR = 1.11; 95% CI: 0.94–1.31; p = 0.22). ESG was associated with significantly lower risk of gastric leak (RR = 0.06; 95% CI: 0.01–0.47; p = 0.007), GERD (RR = 0.10; 95% CI: 0.02–0.53; p = 0.006), and hospital stay (MD = − 0.90 days; 95% CI: −0.93 to − 0.87; p < 0.00001). However, ESG had a higher risk of sepsis (RR = 2.49; 95% CI: 1.21–5.13; p = 0.01) and readmission (RR = 1.37; 95% CI: 1.22–1.53; p < 0.00001). Mortality did not differ significantly. Conclusion: ESG demonstrates a comparable short-term safety profile to LSG, with advantages in reduced gastric leak, GERD, and length of hospital stay. ESG may serve as a viable, less invasive alternative to LSG in appropriately selected patients. Further randomized studies are warranted to assess long-term outcomes. Endoscopic sleeve gastroplasty laparoscopic sleeve gastrectomy bariatric surgery meta-analysis complications safety outcomes Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Apr, 2026 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 15 Feb, 2026 Reviews received at journal 04 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers invited by journal 27 Jan, 2026 Editor assigned by journal 27 Jan, 2026 Submission checks completed at journal 27 Jan, 2026 First submitted to journal 21 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8662397","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581428126,"identity":"c8ee0a97-011f-4361-b997-348148bb277b","order_by":0,"name":"Muhammad Hamza","email":"","orcid":"","institution":"Muzaffarabad General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"","lastName":"Hamza","suffix":""},{"id":581428127,"identity":"c446fca4-ac2c-4be1-9955-b8365c793eae","order_by":1,"name":"Aizaz Anwar Khalid","email":"","orcid":"","institution":"Peshawar Medical College","correspondingAuthor":false,"prefix":"","firstName":"Aizaz","middleName":"Anwar","lastName":"Khalid","suffix":""},{"id":581428128,"identity":"9701585b-78f4-4231-b6bc-ece16f55d395","order_by":2,"name":"FNU Kritika","email":"","orcid":"","institution":"Indra Gandhi Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"FNU","middleName":"","lastName":"Kritika","suffix":""},{"id":581428129,"identity":"0cad6b0e-767b-43d1-b781-422248ef3afd","order_by":3,"name":"Adil Ahmed","email":"","orcid":"","institution":"Northwest School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Adil","middleName":"","lastName":"Ahmed","suffix":""},{"id":581428130,"identity":"2f554b02-d508-4fff-8869-82d222346e93","order_by":4,"name":"Hafsa Younus","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACAyD+AGUzPmBsIE4L4wwom9kAooWZeC1sEkRpMWc//rDhZ5tN4naJ9GfVhTvqgCL9B/BqsezJMWzsbUtL3Dkjx+z2zDOHgSKHCTjsQA77A962w4kbbuSw3eZtO8BgcCOZgJbzzx82/gVrSX9WzNtWx2Bw/zEBLTcSDJshtiSYMfO2MQNFCIXYjTeGzTLn0ow3nHljLA3Uy2NwJtmAgMPSHza+KbOR3XA8/eFnoMPkDI4ffIDfGhBgZEOweQgrB4M/RKobBaNgFIyCkQkAgkJOL8AGPT0AAAAASUVORK5CYII=","orcid":"","institution":"University College London","correspondingAuthor":true,"prefix":"","firstName":"Hafsa","middleName":"","lastName":"Younus","suffix":""}],"badges":[],"createdAt":"2026-01-21 17:23:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8662397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8662397/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-026-08619-z","type":"published","date":"2026-04-18T15:59:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":107351056,"identity":"8a816085-a6b4-4971-a664-fdad3f772c44","added_by":"auto","created_at":"2026-04-20 16:08:34","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":776556,"visible":true,"origin":"","legend":"","description":"","filename":"FinalManuscriptESGvsLSG3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8662397/v1_covered_43752ed8-0a34-4328-8452-e4a23634b27e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparative Safety of Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis of over 1.1 Million Patients\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, bariatric surgery, meta-analysis, complications, safety outcomes","lastPublishedDoi":"10.21203/rs.3.rs-8662397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8662397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eEndoscopic Sleeve Gastroplasty (ESG) has emerged as a less invasive bariatric option compared to Laparoscopic Sleeve Gastrectomy (LSG). However, direct comparisons of their safety profiles remain limited.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines. Comparative studies evaluating short-term (\u0026le;\u0026thinsp;30 days) safety outcomes of ESG versus LSG in adults with obesity were included. Primary outcomes were major and overall adverse events. Secondary outcomes included procedure-related complications, readmission, mortality, and organ-specific adverse events.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eEleven observational studies encompassing 1,117,309 patients (ESG: 11,890; LSG: 1,105,419) were included. Major adverse events showed no significant difference between ESG and LSG (RR\u0026thinsp;=\u0026thinsp;1.11; 95% CI: 0.94\u0026ndash;1.31; p\u0026thinsp;=\u0026thinsp;0.22). ESG was associated with significantly lower risk of gastric leak (RR\u0026thinsp;=\u0026thinsp;0.06; 95% CI: 0.01\u0026ndash;0.47; p\u0026thinsp;=\u0026thinsp;0.007), GERD (RR\u0026thinsp;=\u0026thinsp;0.10; 95% CI: 0.02\u0026ndash;0.53; p\u0026thinsp;=\u0026thinsp;0.006), and hospital stay (MD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.90 days; 95% CI: \u0026minus;0.93 to \u0026minus;\u0026thinsp;0.87; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). However, ESG had a higher risk of sepsis (RR\u0026thinsp;=\u0026thinsp;2.49; 95% CI: 1.21\u0026ndash;5.13; p\u0026thinsp;=\u0026thinsp;0.01) and readmission (RR\u0026thinsp;=\u0026thinsp;1.37; 95% CI: 1.22\u0026ndash;1.53; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). Mortality did not differ significantly.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eESG demonstrates a comparable short-term safety profile to LSG, with advantages in reduced gastric leak, GERD, and length of hospital stay. ESG may serve as a viable, less invasive alternative to LSG in appropriately selected patients. Further randomized studies are warranted to assess long-term outcomes.\u003c/p\u003e","manuscriptTitle":"Comparative Safety of Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis of over 1.1 Million Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 22:51:37","doi":"10.21203/rs.3.rs-8662397/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-15T18:20:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T07:06:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-02T00:18:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60458094631373753566940060320258518604","date":"2026-02-02T00:05:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263764770440258440628702704359881146115","date":"2026-01-29T17:44:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-27T23:38:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-27T18:43:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-27T11:26:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2026-01-21T17:13:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"935f1007-c563-4b88-9678-37f20b23cf02","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:06:38+00:00","versionOfRecord":{"articleIdentity":"rs-8662397","link":"https://doi.org/10.1007/s11695-026-08619-z","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2026-04-18 15:59:20","publishedOnDateReadable":"April 18th, 2026"},"versionCreatedAt":"2026-01-29 22:51:37","video":"","vorDoi":"10.1007/s11695-026-08619-z","vorDoiUrl":"https://doi.org/10.1007/s11695-026-08619-z","workflowStages":[]},"version":"v1","identity":"rs-8662397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8662397","identity":"rs-8662397","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}