Background There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS). Methods We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration. Results At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4% [standard deviation (SD) 15.3%] vs. 31.2% [SD 13.9%], P =0.001; 54.7% [SD 19.2%] vs. 37.7% [SD 17.3%], P <0.001; 65.3% [SD 21.1%] vs. 40.6% [SD 23.5%], P <0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n=2; 2.0%) and ESG-FS (n=4; 2.6%; P >0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P <0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P <0.001). Conclusion ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.
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