S3154 Long-Term Metabolic Outcomes of Endoscopic Sleeve Gastroplasty in Patients With Type 2 Diabetes: A Systematic Review

Introduction: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that reduces gastric volume by approximately 70% using endoscopic suturing. It has shown short-term metabolic benefits in patients with obesity and type 2 diabetes mellitus (T2DM), including improved glycemia, weight, blood pressure, liver enzymes, and lipid profiles. However, most data are limited to 6-24 months, and the long-term durability of these effects in T2DM remains unclear. The objective of this study is to determine the sustained impact of ESG on metabolic outcomes thereby contributing to a more complete understanding of ESG’s long-term role in the management of T2DM. Methods: We conducted a systematic review following PRISMA guidelines, searching PubMed, Embase, and Scopus from inception through March 2025. Inclusion criteria were prospective or retrospective studies reporting ≥3-year outcomes after ESG in adults with T2DM. We excluded studies involving non-adult populations, non-ESG bariatric therapies, follow-up <36 months, absence of extractable T2DM metabolic data, case series <10 patients, reviews or duplicates, and non-English papers without accessible full text. Primary outcomes included changes in glycemic control, diabetes remission rates, and total body weight loss (TBWL). Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Out of 161 records identified, 118 unique studies were screened after de-duplication. Three studies met inclusion criteria, with follow-up durations of 4 to 5 years and T2DM subgroups ranging from 14% to 44% of each cohort. Diabetes remission or improvement ranged from 51.2% to 66.7%. Only 1 study reported granular metabolic data, including a 0.42% absolute HbA1c reduction and improvement in insulin resistance. TBWL at 5 years ranged from 11.8% to 12.2% in 2 studies; a third reported 18.2% TBWL at 4 years. Risk of bias was low in 1 study and moderate in the other 2. Conclusion: Our study demonstrates that ESG is associated with sustained improvements in glycemic control, insulin resistance, and weight loss in patients with T2DM. Despite the limited number of long-term studies, available evidence indicates that the metabolic benefits of ESG can be maintained over time.