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

Table 2 Risk of bias assessment, heterogeneity, and limitations in the included studies

Ref.	Country	Quality assessment/risk of bias	Author reported factors affecting the quality	Heterogeneity in the analysis	Author reported limitations in the review
Singh et al[9], 2020	United States	NOS; Score of 8	NR	Considerable	Limited quality of the included studies, lack of controlled ESG studies, lack of long-term follow-up data, lack of clarify the concomitant use of weight loss medication, considerable heterogeneity, lack of standardized definition for SAE
Jaruvongvanich et al[11], 2020	United States	RCTs: Cochrane Collaboration risk assessment tool; high quality (1), low to medium quality (2); Observational studies: National Institutes of Health quality assessment scale for pre-post Studies; high quality (7) and low to medium quality (6)	Reporting bias, inappropriate patient selection, blinding of personals and outcome assessors, loss to follow-up	High (0%-87%)	Small sample size, limited follow-up duration, small number of studies in each analysis, low to moderate methodological quality of the included studies, the small number of comparative trials between the 2 techniques, substantial heterogeneities, influence of concomitant pharmacotherapy, limiting generalizability of findings, reporting bias
Mohan et al[13], 2020	United States	NOS; 3 were high quality and the rest were medium quality	Included studies were not entirely representative of the general population and community practice, selection bias, inadequate follow-up	NR	Effect of additional confounding factors, included studies were not entirely representative of the general population and community practice, retrospective nature of studies, selection bias, lack of subgroup data based on the presence of comorbidities, lack of data on success/failure of procedure
Jalal et al[10], 2020	Australia	NR: Limited quality	High loss to follow-up rates	Low (19%)	Lack of studies, retrospective nature of cohort studies, lack of control groups, heterogeneity, lack of long-term study data, high loss to follow-up rates
Madruga-Neto et al[4], 2018	Brazil	JADAD quality score: 3; GRADE standards: Very low to moderate	Inappropriate randomization, inappropriate blinding	Moderate (I2: 50% to 68%)	Biases, heterogeneity, inadequate data
Brunaldi et al[14], 2018	Brazil	Joanna Briggs Institute Checklist; very low	Selection bias, unclear reporting of information	NR	Lack of RCT, bias, heterogeneity, low methodological quality, lack of comparative studies

ESG: Endoscopic sleeve gastroplasty; NR: Not reported; RCT: Randomized controlled trial; SAE: Serious adverse event.