Introduction The management of obesity and type 2 diabetes has rapidly evolved, with GLP-1 receptor agonists emerging as highly effective pharmacological options, while bariatric endoscopic therapies provide minimally invasive procedural alternatives. Traditionally, metabolic bariatric surgery has been the gold standard, but newer less invasive options are reshaping treatment paradigms.
Introduction
The management of obesity and type 2 diabetes has rapidly evolved, with GLP-1 receptor agonists emerging as highly effective pharmacological options, while bariatric endoscopic therapies provide minimally invasive procedural alternatives. Traditionally, metabolic bariatric surgery has been the gold standard, but newer less invasive options are reshaping treatment paradigms. Direct comparative evidence between GLP-1 therapies and endoscopic bariatric techniques remains limited, making clinical decision-making challenging.
Problem Statement
It is unclear whether GLP-1 receptor agonists or bariatric endoscopic therapies provide superior outcomes in weight loss and metabolic control in patients with obesity and type 2 diabetes.
Summary
This meta-analysis including eight studies with over 600 patients demonstrates that, in the short term (4–12 months), there is no significant difference between GLP-1–based therapies and bariatric endoscopic interventions in key outcomes such as weight loss, BMI reduction, glycemic control, or diabetes remission. These findings suggest that both approaches may offer comparable efficacy in early treatment phases.
However, important distinctions exist in safety profiles. GLP-1 therapies are associated predominantly with gastrointestinal side effects, whereas endoscopic bariatric therapies carry risks related to device intolerance and procedural complications.
A key limitation of the evidence is the high heterogeneity and predominance of retrospective data, along with short follow-up duration, which prevents firm conclusions regarding long-term durability and comparative effectiveness.
Clinically, this study supports a personalized approach—where treatment selection should be guided by patient preference, comorbidities, risk tolerance, and resource availability—while emphasizing the need for robust long-term randomized trials to define optimal strategies.
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