Comparative effectiveness of balloons, adjustable balloons, and endoscopic sleeve gastroplasty: A network meta-analysis of randomized trials

• Published in: Gastrointestinal endoscopy 2024-10
• Main Authors: Mrad, Rudy, Al Annan, Karim, Sayegh, Lea, Abboud, Donna Maria, Razzak, Farah Abdul, Kerbage, Anthony, Murad, Mohammad Hassan, Abu Dayyeh, Barham, Brunaldi, Vitor Ottoboni
• Format: Article
• Language: English
• Subjects: endoscopic sleeve gastroplasty; endoscopy; intragastric balloon; obesity
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2024.10.039

Individual randomized controlled trials (RCTs) and pairwise meta-analyses do not compare all commercially available endoscopic bariatric therapies (EBTs) head-to-head. Therefore, the choice among them is currently made by inference or indirect data. We aimed to assess the comparative efficacy and safety of EBTs through a network meta-analysis. We searched Medline, EMBASE, and Cochrane CENTRAL from inception for IGBs and from 2013 for ESG until May 2023. Only RCTs comparing any of the currently commercially available EBTs to controls were considered eligible. Outcomes included %total weight loss (%TWL), serious adverse events (SAEs), and intolerability. We identified 821 citations, of which 10 and 8 were eligible for the qualitative and quantitative analysis, respectively. Considering %TWL at the time of IGB removal, all EBTs were associated with statistically higher %TWL than controls. There were no significant differences among EBTs. However, considering the %TWL at the follow-up closest to 12 months, both ESG and Spatz3 were more effective than Orbera, with no statistical difference between ESG and Spatz3. For both outcomes, p-score and ranking score suggested that ESG was probably associated with a greater weight loss (0.889272 and 0.899469 respectively), followed by Spatz3 (0.822894 and 0.842773 respectively), and Orbera (0.536968 and 0.507165 respectively). All currently available FDA-approved EBTs are more effective than both diet plus lifestyle intervention and sham procedures with an acceptable safety profile. ESG seems the most effective and may be prioritized for patients fit for both ESG and IGB. Direct controlled trials between EBTs are warranted to confirm these findings.