S2246 POSE-2 for Obesity: A Systematic Review and Meta-Analysis of Efficacy, Safety, and Metabolic Outcomes

Introduction: Minimally invasive interventions for obesity are gaining prominence due to the limitations of bariatric surgery. POSE-2 (Primary Obesity Surgery Endoluminal 2) is a novel endoscopic bariatric procedure targeting gastric remodeling to promote weight loss. This study synthesizes the current evidence on POSE-2’s efficacy, safety, and metabolic effects. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases including PubMed, Embase, and Cochrane were searched through January 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts assessing POSE-2 outcomes in adults with obesity. Random-effects meta-analyses were performed to estimate pooled changes in total body weight loss percentage (TBWL%), excess weight loss percentage (EWL%), and metabolic markers (HbA1c, glucose, liver enzymes, serum cholesterol). Results: Four studies (1 RCT, 3 cohorts; N = 210) were included. Pooled TBWL% progressively increased post-intervention: 13.23% (95% CI: 9.24–17.21%) at 3 months, 16.22% (95% CI: 12.83–19.61%) at 6 months, and 16.17% (95% CI: 14.11–18.23%) at 12 months. EWL% at 12 months was 56.95% (95% CI: 35.75–78.15%). Significant reductions in HbA1c (SMD: –0.67; 95% CI: -1.15, -0.19) and serum cholesterol (SMD = -0.25; 95% CI: -0.32, -0.19) at 6 months were observed. No statistically significant changes were noted in fasting glucose or liver enzymes, though trends favored improvement. The overall adverse event rate was low and predominantly mild. Conclusion: POSE-2 achieves clinically meaningful and durable weight loss with minimal adverse events and potential glycemic benefit. While early results are encouraging, the limited evidence base necessitates larger, long-term RCTs. POSE-2 may emerge as a valuable tool in the endoscopic armamentarium for obesity management. ChatGPT (OpenAI) was used for language clarity and grammar refinement. All scientific content, data, and analysis are original and solely by the authors.