S1635 Comparative Effectiveness of Surgical and Endoscopic Interventions in Obesity Management: A Network Meta-Analysis

Introduction: Obesity is a global health issue of epidemic proportions. Surgical interventions have traditionally served as the standard of care for managing obesity. However, the past decade has witnessed a surge in the development and utilization of endoscopic interventions for obesity management, broadening the range of available treatments. Despite these advancements, the comparative evidence between surgical and endoscopic procedures is insufficient. Methods: We systematically searched electronic databases for randomized controlled trials (RCTs) evaluating the comparing efficacy of surgical and endoscopic interventions for obesity management. We extracted percentage weight loss (mean and SD). A network meta-analysis using frequentist methods with a random-effect model was conducted. The P-score was calculated to obtain treatment ranking to identify preferred intervention to achieve maximal percentage reduction in weight change. A league table provided network estimates of each possible comparison of surgical and endoscopic interventions. Results: A total of 10 studies comprising 907 participants with obesity (defined as BMI ranging from 30 to >40 kg/m^2) seeking weight loss intervention were included in the analysis. Total body weight loss was included as a primary or secondary outcome. The network meta-analysis incorporated 2 endoscopic interventions (Endoscopic Sleeve Gastroplasty [ESG] and Intragastric balloon placement [IGB]) and 4 surgical interventions (Laparoscopic sleeve gastrectomy [LSG], Roux-en-Y gastric bypass [RYGB], laparoscopic plication, laparoscopic adjusted gastric band [LAGB]) with some studies using lifestyle interventions as comparator (Figure 1A). RYGB was associated with 4%, 5.5%, 10%, 11%, 15% and 19% reduction in percentage weight compared to LSG, ESG, laparoscopic plication, LAGB, IGB and lifestyle modification (Figure 1B). ESG, RYGB, and LSG all had more than 15% reduction in body weight percentage compared to lifestyle modification (Figure 1B). RYGB was the first-ranked treatment for weight loss at a probability of 100% (Figure 1C). On network comparison with placebo, all surgical and endoscopic interventions were associated with reduction in body weight percentage compared to lifestyle modifications except for IGB (Figure 1D). Conclusion: RYGB remains a preferred intervention to achieve maximum weight loss at a 12-month time point. ESG has the potential to reach similar results, but additional trials are needed to explore comparative efficacy.Figure 1.: A: Network graph demonstrating the comparisons made between the included intervention types. B: League table (pairwise comparisons) of the evaluated bariatric interventions (demonstrated as relative effect and [95% Credible Interval]). C: Ranking of weight-loss interventions based on P-score. D: Forest Plot (random effects model) comparing weight changes in the examined weight-loss interventions vs 'lifestyle changes'.