Short‐Term Versus Long‐Term Efficacy of Endoscopic Sleeve Gastroplasty in 8880 Obese Patients: A Systematic Review and Meta‐Analysis

ABSTRACT Background Endoscopic sleeve gastroplasty (ESG), a natural orifice transluminal endoscopic procedure, is increasingly integrated into multidisciplinary obesity care. We performed a systematic review and meta‐analysis to quantify the durability of ESG‐associated weight loss and metabolic outcomes across short‐ and long‐term follow‐up. Methods Databases were searched from inception to September 2, 2025 (PROSPERO: CRD420251139333). Peer‐reviewed studies reporting ESG outcomes were included; primary outcomes were % total body weight loss (%TBWL), % excess body weight loss (%EBWL), and BMI reduction, stratified by follow‐up (≤ 6 months vs. ≥ 1 year). Random‐effects models were used; heterogeneity ( I 2 ), publication bias (Egger's test), GRADE assessment, sensitivity analyses, and meta‐regression for baseline BMI were performed. Results Thirty‐three studies (8880 patients; 31 cohorts, 2 RCTs) were included. %TBWL increased from 8.66% (1 month) to 16.13% (6 months) and was 17.88% at 1 year. Long‐term pooled %TBWL declined modestly over time (17.88% at 1 year to 15.67% at 3 years). Remission rates were 62% for type 2 diabetes, 43% for hypertension, and 43% for dyslipidaemia. Weight regain occurred in 6%. Baseline BMI predicted higher %TBWL but lower %EBWL. Conclusion ESG is associated with clinically meaningful weight loss maintained beyond 6 months with modest attenuation over longer follow‐up, alongside favourable metabolic remission rates and low reported weight regain.