# Meta regression of endoscopic sleeve gastroplasty versus intragastric balloon investigating influence of duration and baseline body mass index

## TL;DR

This study compares two weight loss treatments, finding that endoscopic sleeve gastroplasty leads to greater weight loss over time, especially in patients with higher obesity.

## Contribution

The study introduces a meta-regression approach to assess how treatment duration and baseline BMI influence the efficacy of endoscopic bariatric therapies.

## Key findings

- ESG resulted in significantly greater weight loss than IGB, with increasing benefit over time.
- Higher baseline BMI was associated with greater efficacy of ESG compared to IGB.
- Adverse event rates were comparable, but IGB showed higher device intolerance and early removal rates.

## Abstract

Endoscopic sleeve gastroplasty (ESG) and intragastric balloon (IGB) are established endoscopic bariatric therapies (EBTs) for obesity, but their comparative efficacy and safety remain uncertain. We conducted a systematic review and meta-analysis of comparative studies evaluating ESG versus IGB. The primary outcome was percentage of total body weight loss (%TBWL), assessed at the longest available follow-up and stratified timepoints (1, 3, 6, and 12 months). To explore temporal trends, we performed a meta-regression using follow-up duration as a continuous moderator. Secondary outcomes included a meta-regression based on baseline BMI differences and a pooled analysis of adverse events. Six comparative studies (n = 5330) were included. ESG was associated with significantly greater %TBWL than IGB (mean difference: 2.541; 95% CI 0.754 to 4.327; p = 0.005), with increasing benefit over time. Meta-regression confirmed a significant positive association between follow-up duration and treatment effect (p = 0.0006). A separate meta-regression revealed greater efficacy of ESG in patients with higher baseline BMI (p = 0.0001). Overall adverse event rates were comparable between the two groups (p = 0.20) ; however, IGB showed observed trends toward higher device intolerance and early removal rates in individual cohorts. Our findings suggest that ESG may offer a therapeutic advantage over IGB regarding weight loss efficacy, a trend that appears more pronounced in cohorts with higher obesity severity and across extended follow-up periods. ESG offers a comparable safety profile to IGB and may represent a more durable endoscopic bariatric option with potential advantages in procedural tolerability. Long-term trials are needed to validate its metabolic and clinical advantages beyond 12 months.

The online version contains supplementary material available at 10.1038/s41598-026-38374-1.