Introduction: Minimally invasive endoscopic bariatric therapies (EBTs), such as intragastric balloons (IGBs) and endoscopic sleeve gastroplasty (ESG), along with pharmacotherapy using glucagon-like peptide-1 (GLP-1) agonists, have demonstrated promising longitudinal weight loss outcomes. However, comparative data between EBTs and pharmacotherapy remains limited. Therefore, this study aims to compare longitudinal weight loss outcomes following monotherapy with IGB, ESG, or GLP-1 agonists.

Methods: Retrospective chart review was utilized to identify patients between 2016-2022 who had received longitudinal monotherapy with IGB, ESG, or GLP-1 agonists at a single urban hospital. All patients received support from a dietitian. Independent samples t-tests were performed at 1, 2, and 3 years after initial therapy comparing mean change in body mass index (BMI), % change in BMI, total body weight loss (TBWL), % change in mean TBWL, and % excess body weight loss (EBWL).

Results:

Baseline characteristics: There were no significant differences in baseline age, gender, or BMI between groups. However, there were significantly more patients receiving GLP-1 agonists who had diabetes (50.0%) compared to those who underwent IGB or ESG (14.8% and 9.1% respectively, p=0.005). Serious adverse events per AGREE consensus were notable for one early IGB removal due to intolerance.

IGB vs. GLP-1 agonists: Post-IGB patients had significantly greater weight loss at 1 year compared to GLP-1 agonists (% TBWL: IGB 8.08% vs. GLP-1 3.72%, p=0.024). There were no significant differences in weight loss between groups in years 2 and 3.

ESG vs. GLP-1 agonists: Post-ESG patients had significantly greater weight loss at both 1 year (% TBWL: ESG 11.13% vs. GLP-1 3.72%, p=0.010) and 2 years (% TBWL: ESG 13.57% vs. GLP-1 3.81%, p<0.001) compared to GLP-1 agonists. At 3 years, patients receiving ESG had a greater mean change in BMI and % change in BMI compared to GLP-1 agonists (BMI change: ESG 3.95 kg/m² vs. GLP-1 1.28 kg/m², p=0.041; % BMI change: ESG 11.53% vs. GLP-1 3.45%, p=0.049).

IGB vs. ESG: The ESG group had significantly greater mean change in BMI, % change in BMI, % TBWL, and % EBWL at 2 years compared to the IGB group (BMI change: ESG 4.80 kg/m²vs. IGB 2.72 kg/m², p=0.011; % BMI change: ESG 13.55% vs. IGB 7.41%, p=0.002; % TBWL: ESG 13.57% vs. IGB 7.70%, p=0.009; % EBWL: ESG 48.17% vs. IGB 25.26%, p=0.001).

Discussion: Patients receiving treatment with IGB, ESG, and GLP-1 agonists achieved sustained weight loss over three years. Both IGB and ESG groups exhibited greater initial weight loss compared to GLP-1 agonists, with ESG demonstrating superior sustained weight loss at three years compared to GLP-1 agonists. Therefore, when choosing between treatments, patients and providers may consider factors such as the presence of diabetes, baseline weight, and desired amount of weight loss.

<b>Table 1.</b> Difference in means of weight loss outcomes at 1, 2, and 3 years between EBT monotherapy and GLP-1 agonist monotherapy.

Table 1. Difference in means of weight loss outcomes at 1, 2, and 3 years between EBT monotherapy and GLP-1 agonist monotherapy.

<b>Table 2.</b> Difference in means of weight loss outcomes at 1, 2, and 3 years between IGB monotherapy and ESG monotherapy.

Table 2. Difference in means of weight loss outcomes at 1, 2, and 3 years between IGB monotherapy and ESG monotherapy.

Jose Aleman

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