{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:17:43Z","timestamp":1788362263101,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive option for weight reduction, but its effect on metabolic syndrome (MetS) and metabolic dysfunction-associated steatotic liver disease (MASLD) is less well characterized. Methods: Following PRISMA, we searched five databases to November 2025 (PROSPERO CRD420261283041) for adults with obesity undergoing ESG with \u22656-month follow-up. Continuous outcomes were pooled as mean differences (MDs) using DerSimonian\u2013Laird random-effects models with Hartung\u2013Knapp\u2013Sidik\u2013Jonkman sensitivity analysis. As MetS resolution was inconsistently defined, the primary outcome was post hoc operationalised as change in individual MetS components. Results: Of 858 records, 12 studies (4452 patients; two randomised) were included. At 12 months, ESG was associated with lower glycated haemoglobin (MD \u22120.33%), HOMA-IR (MD \u22123.52), triglycerides (MD \u221225.56 mg\/dL), low-density lipoprotein cholesterol (MD \u22126.94 mg\/dL), alanine aminotransferase, and non-invasive steatosis\/fibrosis indices; aspartate aminotransferase did not change significantly. Total body weight loss was 16.54% at 12 months and 14.21% at 36 months. Liver stiffness (two studies, differing windows) is described narratively, not pooled. Heterogeneity was often substantial; certainty was low to very low. Conclusions: ESG was associated with metabolic and hepatic improvements alongside substantial weight loss; a weight-independent hepatic effect cannot be established, and randomised trials with histological endpoints are needed.<\/jats:p>","DOI":"10.3390\/jcm15176633","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:47:13Z","timestamp":1787849233000},"page":"6633","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Weight Reduction: An Updated Systematic Review and Meta-Analysis of Metabolic Syndrome Components and Metabolic Dysfunction-Associated Steatotic Liver Disease Outcomes After Endoscopic Sleeve Gastroplasty"],"prefix":"10.3390","volume":"15","author":[{"given":"Alexander","family":"Herner","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Nennstiel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schlag","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9263-948X","authenticated-orcid":false,"given":"Andreas","family":"Kremer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0824-4125","authenticated-orcid":false,"given":"Luc","family":"Biedermann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1733-9188","authenticated-orcid":false,"given":"Gerhard","family":"Rogler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0396-5081","authenticated-orcid":false,"given":"Michael","family":"Doulberis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref_1","unstructured":"WHO (2025, November 06). 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