INTRODUCTION: Endoscopic sleeve gastroplasty (ESG) represents a novel endoscopic bariatric procedure. It is performed with an endoscope equipped with a suturing device; sutures are placed so that they create a tube-shaped stomach, thereby facilitating weight loss. The aim of this study was to conduct a systematic review evaluating the effectiveness and safety of ESG for treatment of obesity. METHODS: This review was conducted in accordance with the PRISMA guidelines; a protocol was registered with PROSPERO before the start of the study. MEDLINE, Embase and Clinicaltrials.gov were searched through 20 February 2020. RESULTS: A total of 1,088 articles were assessed. In all, 23 studies met the inclusion criteria. The average total weight loss at 12 months was 16.3%. ESG was associated with a significantly greater weight loss than both intragastric balloon insertion (21.3 ± 6.6 versus 13.9 ± 9.0% total weight loss (TWL) at 12 months, p < 0.05) and “high-intensity diet and lifestyle therapy” (20.6 ± 8.3 versus 14.3 ± 10.2% TWL at 12 months, p < 0.05). In contrast, ESG was associated with a significantly lower weight loss than laparoscopic sleeve gastrectomy (17.1 ± 6.5 versus 23.6 ± 7.6% TWL at six months, p < 0.05). ESG had a significantly lower rate of adverse events than both laparoscopic sleeve gastrectomy (5.2 versus 16.9%, p < 0.05) and intragastric balloon placement (5.2 versus 17%, p < 0.05). CONCLUSIONS: ESG is a safe method for treatment of obesity and facilitates a significant weight loss.