Obesity Surgery

, Volume 29, Issue 9, pp 3021–3029 | Cite as

Endoscopic Gastric Plication for Morbid Obesity: a Systematic Review and Meta-analysis of Published Data over Time

  • Ben GysEmail author
  • Philip Plaeke
  • Bas Lamme
  • Thierry Lafullarde
  • Niels Komen
  • Anthony Beunis
  • Guy Hubens
Review Article


Endoscopic gastric plication or gastroplasty for morbid obesity is gaining worldwide recognition. Data concerning safety and efficacy are rather scarce. Furthermore, clear guidelines are yet to be established. The objective of this meta-analysis is to update the data and investigate the efficacy and safety of the procedure. An online comprehensive search using Cochrane, Google Scholar, PubMed, Web of Science, and Embase on endoscopic gastric plication was completed. The primary outcome was defined as weight loss at 6 months or more after the procedure. Secondary outcomes were defined as the occurrence of adverse events or complications including insufficient weight loss or regain. I2 statistic was used to define the heterogeneity across studies. Twenty-two cohort studies on 7 different devices met the inclusion criteria, with a total of 2475 patients. The mean baseline BMI was 37.8 ± 4.1 kg/m2 (median 37.9; range 28.0–60.2). Either a transoral endoluminal stapling or (suction based) (full-thickness) stitching and/or anchor device was used to obtain gastric volume reduction and/or alter gastric outlet. The mean follow-up was 13 months (median 12; range 6–24) for the specified outcomes of each study. Two active, FDA-approved devices were taken into account for meta-analysis: Endoscopic sleeve gastroplasty (ESG) and the primary obesity surgery endolumenal (POSE™). Average pooled %EWL at 6 months (p = 0.02) and 12 months (p = 0.04) in favor of ESG was 57.9 ± 3.8% (50.5–65.5, I2 = 0.0), 44.4 ± 2.1% (40.2–48.5, I2 = 0.0), and 68.3 ± 3.8% (60.9–75.7, I2 = 5.8), 44.9 ± 2.1% (40.9–49.0, I2 = N/A) for ESG and POSE respectively. Major adverse events without mortality were described in 25 patients (9 studies, p = 0.63). ESG and POSE are both safe and feasible procedures with good short-term weight loss. ESG seems to be superior in terms of weight loss at this point. Few major adverse events are reported and long-term results are awaited.


Endoscopic Sleeve Gastroplasty Bariatric Remodeling Meta-analysis Review ESG Pose 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
  2. 2.
    Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis. 2017;13(2):170–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Devière J, Ojeda Valdes G, Cuevas Herrera L, et al. Safety, feasibility and weight loss after transoral gastroplasty: first human multicenter study. Surg Endosc. 2008;22(3):589–98.CrossRefPubMedGoogle Scholar
  6. 6.
    Familiari P, Costamagna G, Bléro D, et al. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome. Gastrointest Endosc. 2011;74(6):1248–58.CrossRefPubMedGoogle Scholar
  7. 7.
    Moreno C, Closset J, Dugardeyn S, et al. Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study. Endoscopy. 2008;40(5):406–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Nanni G, Familiari P, Mor A, et al. Effectiveness of the Transoral Endoscopic Vertical Gastroplasty (TOGa®): a good balance between weight loss and complications, if compared with gastric bypass and biliopancreatic diversion. Obes Surg. 2012;22(12):1897–902.CrossRefPubMedGoogle Scholar
  9. 9.
    Schiefke I, Zabel-Langhennig A, Neumann S, et al. Long term failure of endoscopic gastroplication (EndoCinch). Gut. 2005;54(6):752–8. Scholar
  10. 10.
    Changela K, Ofori E, Duddempudi S, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: techniques and efficacy. World J Gastrointest Endosc. 2016;8(4):239–43.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fogel R, De Fogel J, Bonilla Y, et al. Clinical experience of transoral suturing for an endoluminal vertical gastroplasty: 1-year follow-up in 64 patients. Gastrointest Endosc. 2008;68(1):51–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Brethauer S, Chand B, Schauer PR, et al. Transoral gastric volume reduction as intervention for weight management: 12-month follow-up of TRIM trial. Surg Obes Relat Dis. 2012;8(3):296–303.CrossRefPubMedGoogle Scholar
  13. 13.
    Dayyeh A, Barham K, Acosta A, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15(1):37–43.e1.CrossRefPubMedGoogle Scholar
  14. 14.
    Graus Morales J, Crespo Pérez L, Marques A, et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc. 2018;32(9):3936–42.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kumar N, Abu Dayyeh BK, Lopez-Nava Breviere G, et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc. 2018;32(4):2159–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Lopez-Nava G, Galvão MP, Bautista-Castaño 1 d, et al. Endoscopic sleeve gastroplasty for the treatment of obesity. Endoscopy. 2015;47(5):449–52.Google Scholar
  17. 17.
    Lopez-Nava G, Sharaiha RZ, Vargas EJ, et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up. Obes Surg. 2017;27(10):2649–55.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sartoretto A, Sui Z, Hill C. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg 2018;28(7):1812–1821.CrossRefPubMedGoogle Scholar
  19. 19.
    Sharaiha RZ, Kumta NA, Saumoy M. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol. 2017;15(4):504–10.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Alqahtani A, Al-Darwish A, Mahmoud AE et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc 2018 . pii: S0016-5107(18)33363-7.Google Scholar
  21. 21.
    Espinós JC, Turró R, Mata A, et al. Early experience with the incisionless operating PlatformTM (IOP) for the treatment of obesity: the primary obesity surgery Endolumenal (POSE) procedure. Obes Surg. 2013;23(9):1375–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Espinós JC, Turró R, Moragas G, et al. Gastrointestinal physiological changes and their relationship to weight loss following the POSE procedure. Obes Surg. 2016;26(5):1081–97.CrossRefPubMedGoogle Scholar
  23. 23.
    López-Nava G, Bautista-Castaño I, Jimenez A, et al. The Primary Obesity Surgery Endolumenal (POSE) procedure: one-year patient weight loss and safety outcomes. Surg Obes Relat Dis. 2015;11(4):861–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Miller K, Turró R, Greve JW. MILEPOST multicenter randomized controlled trial: 12-month weight loss and satiety outcomes after pose SM vs. medical therapy. Obes Surg. 2017;27(2):310–22.CrossRefPubMedGoogle Scholar
  25. 25.
    Sullivan S, Swain JM, Woodman G, et al. Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: the ESSENTIAL trial. Obesity (Silver Spring). 2017;25(2):294–301.CrossRefGoogle Scholar
  26. 26.
    Verlaan T, Paulus GF, Mathus-Vliegen EM. Endoscopic gastric volume reduction with a novel articulating plication device is safe and effective in the treatment of obesity (with video). Gastrointest Endosc. 2015;81(2):312–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Huberty V, Ibrahim M, Hiernaux M, et al. Safety and feasibility of an endoluminal-suturing device for endoscopic gastric reduction (with video). Gastrointest Endosc. 2017;85(4):833–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Huberty V, Machytka E, Boškoski I, et al. Endoscopic gastric reduction with an endoluminal suturing device: a multicenter prospective trial with 1-year follow-up. Endoscopy. 2018;50(12):1156–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Seeras K, Prakash S. Laparoscopic Lap Band Placement. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan–2018 Jul 29.Google Scholar
  30. 30.
    Palermo MM, Acquafresca PA, Rogula T, et al. Late surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig. 2015;28(2):139–43.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kumar N, Thompson CC. Comparison of a superficial suturing device with a full-thickness suturing device for transoral outlet reduction (with videos). Gastrointest Endosc. 2014;79(6):984–9.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Khan Z, Khan MA, Hajifathalian K, et al. Efficacy of endoscopic interventions for the management of obesity: a meta-analysis to compare endoscopic sleeve gastroplasty, AspireAssist, and primary obesity surgery endolumenal. Obes Surg. 2019;29:2287–98. Scholar
  33. 33.
    Novikov AA, Afaneh C, Saumoy M, et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare? J Gastrointest Surg. 2018;22(2):267–73.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Itlaybah A, Elbanna H, Emile S, et al. Correlation between the number of ghrelin-secreting cells in the gastric fundus and excess weight loss after sleeve gastrectomy. Obes Surg. 2018;29:76–83. Scholar
  35. 35.
    Stimac D, Majanović SK. Endoscopic approaches to obesity. Dig Dis. 2012;30:187–95.CrossRefPubMedGoogle Scholar
  36. 36.
    Rogers CA, Reeves BC, Byrne J, et al. Adaptation of the By-Band randomized clinical trial to By-Band-Sleeve to include a new intervention and maintain relevance of the study to practice. La Br J Surg. 2017;104(9):1207–14.CrossRefGoogle Scholar
  37. 37.
    Kourkoulos M, Giorgakis E, ,Kokkinos C et al. Laparoscopic gastric plication for the treatment of morbid obesity: a review. Minim Invasive Surg 2012;2012:696348.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Grubnik VV, Ospanov OB, Namaeva KA, et al. Randomized controlled trial comparing laparoscopic greater curvature plication versus laparoscopic sleeve gastrectomy. Surg Endosc. 2016;30(6):2186–91.CrossRefPubMedGoogle Scholar
  39. 39.
    Ye Q, Chen Y, Zhan X, et al. Comparison of laparoscopic sleeve gastrectomy and laparoscopic greater curvature plication regarding efficacy and safety: a meta-analysis. Obes Surg. 2017;27(5):1358–64.CrossRefPubMedGoogle Scholar
  40. 40.
    Barrichello S, Minata MK, García Ruiz de Gordejuela A et al. Laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy treatments for obesity: systematic review and meta-analysis of short- and mid-term results. Obes Surg 2018;28(10):3199–3212.CrossRefPubMedGoogle Scholar
  41. 41.
    De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Ryou M, Ryan MB, Thompson CC. Current status of endoluminal bariatric procedures for primary and revision indications. Gastrointest Endosc Clin N Am. 2011;21(2):315–33.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Kumta NA, Doshi R, Aronne LJ, et al. Trimming the fat: endoscopic suturing for tightening of prior endoscopic sleeve gastroplasty. Gastrointest Endosc. 2017;85(1):253–25.CrossRefPubMedGoogle Scholar
  44. 44.
    Schweitzer M. Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Surg Tech A. 2004;14(4):223–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Brunaldi VO, Jirapinyo P, de Moura DTH, et al. Endoscopic treatment of weight regain following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg. 2018;28(1):266–76.CrossRefPubMedGoogle Scholar
  46. 46.
    Goyal V, Holover S, Garber S, et al. Gastric pouch reduction using StomaphyX in post Roux-en-Y gastric bypass patients does not result in sustained weight loss: a retrospective analysis. Surg Endosc. 2013;27(9):3417–20.CrossRefPubMedGoogle Scholar
  47. 47.
    Sczepaniak JP, Owens ML, Shukla H, et al. Comparability of weight loss reporting after gastric bypass and sleeve gastrectomy using BOLD data 2008-2011. Obes Surg. 2015;25(5):788–95.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Abdominal SurgeryUniversity Hospital AntwerpAntwerpBelgium
  2. 2.Department of SurgerySint-Dimpna HospitalGeelBelgium
  3. 3.Laboratory of Experimental Medicine and PediatricsUniversity of AntwerpAntwerpBelgium
  4. 4.Department of SurgeryAlbert Schweitzer HospitalDordrechtThe Netherlands

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