Is endoscopic approach superior to laparoscopic surgery for gastric plication in terms of complications and efficacy? A systematic review including meta-analysis.

Introduction: Metabolic surgery is a more effective manner to manage weight loss for morbidly obese patients than conservative therapy. There are many surgical and endoscopic modalities to choose which represents a real challenge for bariatric surgeons. LGCP is a restrictive procedure, the greater curvature of stomach is folded into the gastric lumen in one or two layers. Endoscopic bariatric and metabolic therapies (EBMTs) are evolving methods in metabolic interventions' inventory. There are two methods imitating LGCP (endoscopic sleeve gastroplasty and primary obesity surgery endoluminal).

Evidence Acquisition: We have conducted wide literature searches in Pubmed database in order to perform meta-analysis comparing endoscopic and surgical treatment modalities (EBMTs vs. LGCP). Safety and weight-loss outcomes were measured.

Evidence Synthesis: A number of 3585 patients for EBMTs and 2350 cases for LGCP were enrolled to final analysis. Comparison of complications (Clavien Dindo grade 1-5) showed almost equal risk. Percent of excess of weight loss was well matched at all follow-up timepoints, however, percent of total weight loss was in favor of LGCP. Changes of BMI were compared and showed similar efficacy for both methods.

Conclusions: EBMTs appeared to be superior to LGCP regarding safety but differences did not reach statistical threshold. Weight loss outcomes were favorable after each method. EBMTs imitating LGCP are promising safe and effective methods.