Efficacy and safety of endoscopic gastroplasty for treatment of obesity: An overview of comparative meta-analyses

Table 1 Characteristics of included studies

No.	Ref.	Country	Eligibility/inclusion criteria	Search characteristics		Number of studies and total number of patients
				Databases searched	Search period and limitations
14	Singh et al[9], 2020	United States	Inclusion criteria: P: Patients underwent EBMT for obesity; I: ESG; C: IGB; O: %TWL, %EWL and adverse events; SD: All RCTs and observational studies with a minimal follow-up of 12 months; studies with more than one treatment arm, patients who underwent ESG or IGB alone with or without lifestyle modification	MEDLINE (PubMed), Scopus, Cochrane Register of Controlled Trials, and Web of Science databases	Inception to August 2019; restricted to observational and RCTs	28 studies; 1 study with direct comparison (n = 58)
			Exclusion criteria: Patients with prior or sequential EBMTs or bariatric surgery; Case reports and study with < 25 patients; studies with endoscopic gastroplasty techniques using devices other than the OverStitch endoscopic suturing system; studies with IGBs not approved by the United States Food and Drug Administration; Letters, editorials, expert opinions, and reviews without original data and studies with overlapping patient cohorts
42	Jaruvongvanich et al[11], 2020	United States	Inclusion criteria: P: Adults aged 18 years or older with obesity; I: ft-TORe or APMC-TORe to manage weight regain after RYGB; C: Any; O: TBWL; SD: case-control studies, cohort studies, RCTs	Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus	Inception to February 10, 2020, limited to the English language and excluding animal studies	16 studies; 1625 participants
43	Mohan et al[13], 2020	United States	Inclusion criteria: P: Patients with moderate to severe obesity; I: ESG; C: LSG on published 2013; O: Pooled and difference in %TWL, %EWL and BMI with ESG at 1, 6, and 12 months; and adverse events; SD: All studies were included irrespective of the study sample-size, inpatient/outpatient setting, and geography as long as they provided data needed for the analysis	PubMed, EMBASE, Google-Scholar, Scopus, and Web of Science databases	Inception to August 2019; restricted to studies in human subjects and published in English language in peer-reviewed journals	15 studies; 3994 patients
			Exclusion criteria: Studies on LSG published until December 31, 2012; studies on LSG published as abstracts; studies on robot-assisted LSG; studies that did not report outcomes on weight loss, in terms of total weight loss and/or excess weight loss and/or BMI; studies that did not report first 12 months’ outcome data; studies done exclusively in elderly and/or geriatric population (age > 60 years); studies done in a pediatric population (age < 18 years); and studies not published in English language
50	Jalal et al[10], 2020	Australia	Inclusion criteria: P: Adult patient study populations greater or equal to 20 with obesity; I: ESG; C: LSG; O: Weight loss potential of ESG, ESG complications, rates of conversion to surgery and cost; SD: English studies as Case-control, cohort and RCTs	PubMed/MEDLINE, Cochrane Library, EMBASE/OVID, and the World Wide Web	NR	2 studies; 348 participants
			Exclusion criteria: Case reports or case series; Articles that did not have extractable ESG data; Same centre studies or studies with cross over patient populations; Patient cohort less than 20
56	Madruga-Neto et al[4], 2018	Brazil	Inclusion criteria: P: Patients with obesity (BMI > 30 kg/m2); I: EG with full-thickness suture or plication devices; C: sham or diet and lifestyle changes; O: AWL, %EWL, responder rate (%TWL ≥ 5%), and potential complications in 6 and 12 months; SD: Only RCTs without restrictions on language or publication year	MEDLINE [PubMed], Embase, Cochrane Central, and LILACS/BIREME	Inception to November 2017	3 studies; 459 patients
			Exclusion criteria: studies with follow-up periods < 1 month, those involving revision endoscopic procedures after bariatric surgery, and those involving patients who were overweight (BMI: 25-30 kg/m2)
57	Brunaldi et al[14], 2018	Brazil	Inclusion criteria: P: Patients with RYGB who presented with weight regain; I: Endoscopic therapy for weight regain following RYGB; C: Any comparator; O: AWL, EWL, and TBWL; SD: RCT, observational cohort studies, and case series and Conference abstracts if they met the eligibility criteria	MEDLINE, Embase, Scopus, Web of Science, Cochrane, OVID, CINAHL/EBSCo, LILACS/Bireme, and gray literature	Inception to October 31, 2016	15 studies; 882 patients
			Exclusion criteria: Reviews, editorials, case-control studies, studies using non-human subjects, articles without English translation, did not describe the endoscopic method clearly; follow-up weight or BMI less than 1 month; with endoscopic treatment for other indications besides weight regain, such as dumping syndrome or fistula closure; did not report baseline BMI; included patients with weight regain who had already undergone other endoscopic or surgical treatment of weight regain

APMC-TORe: Argon plasma mucosal coagulation alone; AWL: Absolute weight loss; BMI: Body mass index; C: Comparator; EBMT: Endoscopic bariatric and metabolic therapies; EG: Endoscopic gastroplasty; ESG: Endoscopic sleeve gastroplasty; EWL: Excess weight loss; I: Intervention; ft-TORe: Full-thickness suturing plus argon plasma mucosal coagulation; IGB: Intragastric balloon; LSG: Laparoscopic sleeve gastroplasty; NR: Not reported; O: Outcome; P: Participants; RCT: Randomized controlled trial; RYGB: Roux-en-Y Gastric Bypass; SD: Study design; TORe: Endoscopic transoral outlet reduction; TWL: Total weight loss.