S1297 Endoscopic Gastric Remodeling Plus GLP-1 Receptor Agonist versus Endoscopic Gastric Remodeling Alone for Weight Loss

Introduction: Endoscopic gastric remodeling (EGR), particularly endoscopic sleeve gastroplasty (ESG), is an effective minimally invasive procedure for weight loss. While EGR alone has shown significant benefits, the added value of combining it with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is still unclear. This study aims to evaluate and compare the effectiveness of EGR combined with GLP-1 RA therapy versus EGR alone in achieving weight loss. Methods: Online databases were searched up to May 2025 to identify eligible studies that reported quantitative weight loss outcomes following EGR with or without concomitant GLP-1 RA use. Random-effects models were used to estimate pooled mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the Higgins I² statistic. Results: This study comprised 4 studies with 1,526 participants. In the analysis of total body weight loss (TBWL), a numerical benefit was observed with combination therapy, approaching statistical significance (MD: 4.06%; 95% CI: -0.05 to 8.17; P = 0.05; I² = 93%). Similarly, for excessive weight loss (EWL), no significant difference was observed between groups (MD: 5.36%; 95% CI: -12.57 to 23.28; P = 0.56; I² = 93%). For body mass index (BMI) reduction, the pooled mean difference favored combination therapy but did not reach statistical significance (MD: 0.52 kg/m²; 95% CI: -1.63 to 2.68; P = 0.63; I² = 92%). Conclusion: EGR combined with GLP-1 RA therapy may provide incremental benefits in total body weight loss compared to EGR alone. However, the observed advantages in BMI and EWL were not statistically significant. Substantial heterogeneity across studies underscores the need for larger, well-designed randomized controlled trials to better define the synergistic potential of endoscopic and pharmacologic obesity treatments.