Introduction: Endoscopic gastroplasty has emerged as an effective minimally invasive treatment for obesity, offering an alternative to bariatric surgery. Multiple endoscopic techniques are currently available, but comparative evidence has been limited.
Introduction:
Endoscopic gastroplasty has emerged as an effective minimally invasive treatment for obesity, offering an alternative to bariatric surgery. Multiple endoscopic techniques are currently available, but comparative evidence has been limited. This randomized pragmatic trial compared the efficacy and safety of endoscopic sleeve gastroplasty (ESG), endoluminal vertical gastroplasty (EVG), and primary obesity surgery endoluminal-2 (POSE-2).
Why was this study needed?
. Several endoscopic gastroplasty techniques are available without robust head-to-head comparisons.
. Clinicians need evidence to guide the selection of the most effective endoscopic bariatric procedure.
. Comparative data on metabolic outcomes, safety, and quality of life are limited.
. Establishing equivalence between techniques could increase procedural flexibility based on expertise and device availability.
Results:
In this randomized single-center trial involving 184 patients with obesity, all three endoscopic gastroplasty techniques achieved comparable weight loss during medium-term follow-up, with no significant differences in total body weight loss or excess weight loss. Technical success was achieved in all procedures, while serious adverse events were uncommon, confirming an excellent safety profile. Beyond weight reduction, all techniques produced meaningful improvements in body composition, metabolic parameters, fatty liver disease, hyperlipidemia, and obesity-related quality of life. Despite declining follow-up over time, the consistency of outcomes across treatment groups supports similar effectiveness of ESG, EVG, and POSE-2.
Clinical Impact:
The study suggests that procedural choice may be guided more by operator expertise, institutional experience, and device availability than by differences in clinical efficacy. Endoscopic gastroplasty represents a safe and effective minimally invasive option for obesity management, delivering meaningful weight loss together with metabolic and quality-of-life benefits without favoring one specific technique over another.
Bottom Line:
ESG, EVG, and POSE-2 provide comparable weight loss, metabolic improvement, and safety, supporting all three as effective minimally invasive endoscopic therapies for obesity.
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