S785 Efficacy and Safety of Enhanced Endoscopic Sleeve Gastroplasty With Argon Plasma Coagulation vs Endoscopic Sleeve Gastroplasty Alone: A Systematic Review and Meta-Analysis

Introduction: Endoscopic sleeve gastroplasty (ESG), is a novel technique that reduces the gastric size reservoir using a full-thickness endoscopic suturing device. Its impact on weight loss has been significantly higher than lifestyle changes alone. There is a direct correlation between the integrity of the ESG and the achieved percentage of total body weight loss (%TBWL). Although, argon plasma coagulation (APC) is primarily used for the management of hemostasis by applying non-contact mucosal thermal ablation; its application before ESG could enhance wound healing and subsequent fibrosis, reducing suture dehiscence. Methods: Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine the impact of APC prior to ESG for weight loss. Primary outcomes were %TBWL at 6 and 12 months. Gray literature was included due to technique novelty. Data was analyzed using R version 4.2.2. The risk of bias was assessed by the Rob-2 and Robins-I tool. The quality of evidence was graded using the GRADE and Newcastle-Ottawa guidelines. Results: Two observational and one randomized clinical trial described the total weight loss at 6 and 12 months of ESG + APC vs ESG, totaling 231 patients. Meta-analysis test for overall effect showed no statistically significant difference between groups (SMD = 0.70; 95% CI = [-0.90; 2.30]; P = 0.20; and SMD = 0.77; 95% CI = [-0.57; 2.11]; P = 0.13, respectively). Similarly, there was no statistically significant difference in terms of rate of adverse events between groups (RR = 0.39; 95% CI = [0.13; 1.16]; P = 0.07). The risk of bias was moderate with moderate quality of evidence amongst the included studies. Conclusion: Our updated systematic review and meta-analysis demonstrated an absence of statistically significant difference in %TBWL loss at 6 to 12 months between ESG + APC compared to ESG alone. Further randomized studies are needed to confirm these findings.