S2314 Endoscopic Sleeve Gastroplasty Complications Comparison With Other Bariatric Procedures: An Umbrella Review

Introduction: Endoscopic sleeve gastroplasty (ESG) has demonstrated efficacy in obesity management, but comparative data on adverse events (AEs) versus other bariatric interventions remains limited. We performed an umbrella review to aggregate and evaluate existing meta-analyses assessing AEs associated with ESG, intra-gastric balloon (IGB) placement, and laparoscopic sleeve gastrectomy (LSG). Methods: We systematically searched PubMed, MEDLINE, Web of Science, Scopus, and Embase for systematic reviews with meta-analyses that included ESG, IGB, and/or LSG. Eligible studies reported AEs using mean differences (MD), risk ratios (RR), or risk differences (RD) with 95% confidence intervals (CIs). A random‐effects model was applied to pool estimates across meta-analyses. Results: Fifteen meta-analyses met the inclusion criteria. Compared with other bariatric procedures, ESG was associated with a significantly lower overall AE rate (MD = 1.65%; 95% CI: 0.92–2.37; P < 0.00001), a reduced bleeding risk (MD = 0.94%; 95% CI: 0.67–1.21; P < 0.00001), and fewer instances of abdominal pain (RD = 0.60; 95% CI: 0.47–0.74; P < 0.00001). When ESG was compared with IGB, there was no significant difference in overall AEs (RR = 0.66; 95% CI: 0.30–1.44; P = 0.29). In contrast, ESG showed a lower risk of AEs compared with LSG (RR = 0.43; 95% CI: 0.30–0.62; P < 0.00001). Conclusion: In aggregate meta‐analytic data, ESG presents a lower rate of AEs compared to LSG, while demonstrating a comparable safety profile to IGB. These findings support the favorable safety profile of ESG relative to surgical sleeve gastrectomy, without a significant difference when compared with intragastric balloon placement.