S814 Endoscopic Sleeve Gastroplasty Impact on Metabolic Syndrome: An Umbrella Review of Systematic Reviews and Meta-Analyses

Introduction: Endoscopic sleeve gastroplasty (ESG) results in total body weight loss of approximately 15%–20%, yet its impact on obesity-related metabolic comorbidities remains less well characterized. We conducted an umbrella review of systematic reviews and meta-analyses to evaluate the efficacy of ESG in managing metabolic syndrome. Methods: A comprehensive search of PubMed, MEDLINE, Web of Science, Scopus, and Embase was conducted to identify systematic reviews and meta-analyses reporting metabolic outcomes following ESG. Studies were included if they assessed either disease remission or objective laboratory measures. Disease remission was defined as the discontinuation of all antidiabetic medications. Outcomes were reported as risk differences (RD) and mean differences (MD), each with 95% confidence intervals (CI), using a random-effects model. Results: Six meta-analyses met the inclusion criteria. ESG was associated with significant disease remission compared to pre-procedure baseline: type 2 diabetes mellitus (T2DM) (RD = –61% [95% CI: –78, –44]; P < 0.00001), dyslipidemia (RD = –59% [95% CI: –67, –51]; P < 0.00001), and hypertension (RD = –61% [95% CI: –71, –52]; P < 0.00001). Laboratory outcomes also showed significant improvements: HbA1c (MD = –0.60% [95% CI: –0.84, –0.36]; P < 0.00001), triglycerides (MD = –36.67 mg/dL [95% CI: –52.53, –20.80]; P < 0.00001), and alanine aminotransferase (ALT) (MD = –14.07 U/L [95% CI: –23.99, –4.16]; P = 0.005). Conclusion: This umbrella review demonstrates that ESG leads to meaningful remission of T2DM, dyslipidemia, and hypertension, along with significant improvements in key metabolic lab markers. These findings highlight ESG’s potential role as a metabolic intervention beyond weight reduction alone.