Endoscopic Sleeve Gastroplasty: The Future of Weight Loss Surgery?

Published on: September 5, 2023

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Endoscopic Sleeve Gastroplasty: The Future of Weight Loss Surgery?


Obesity has risen to epidemic proportions worldwide, carrying with it a cascade of health risks ranging from heart disease to diabetes[1]. Various weight loss surgeries have been innovated to combat this global health challenge, providing hope and tangible solutions to many. Yet, as medical science continues to evolve, so does the pursuit for safer, less invasive, and more effective surgical techniques. One such emerging procedure that is revolutionising the landscape of bariatric surgery is the Endoscopic Sleeve Gastroplasty (ESG)[2].

Historically, procedures such as Gastric Bypass and Laparoscopic Adjustable Gastric Banding have been hailed as the flag bearers of surgical weight loss solutions. While these techniques have undeniably contributed to transforming countless lives, they also come with their share of risks and complications. The medical community has been on a relentless quest to improve patient outcomes, and ESG is a promising contender in this race.

Endoscopic Sleeve Gastroplasty is a non-surgical procedure, wherein the size of the stomach is reduced using an endoscope inserted through the mouth[3]. This approach stands out due to its minimally invasive nature, potentially translating to shorter recovery times, decreased pain, and lower risks when compared to traditional surgeries[4]. Moreover, given that it doesn’t involve significant anatomical alterations, it preserves the stomach’s natural function.

However, as with all medical procedures, ESG is not devoid of criticisms and concerns. It poses a set of unique challenges and may not be the panacea for all obesity-related woes. Yet, its growing popularity and initial promising results have led many experts to speculate if this might be the future face of weight loss surgery[5].

In this article, we shall delve deep into the intricacies of ESG, weigh its pros and cons, and explore its potential role in reshaping the bariatric surgery realm.


What is Endoscopic Sleeve Gastroplasty?

Endoscopic Sleeve Gastroplasty (ESG) is a novel weight loss procedure that is positioning itself as a frontrunner in the world of bariatric interventions. Given its recent surge in popularity and application, understanding its intricacies is crucial for anyone contemplating a weight loss solution.

The Procedure Defined

ESG is a non-surgical weight loss procedure wherein the stomach’s size is significantly reduced to limit its capacity to hold food[6]. Unlike traditional weight loss surgeries that involve making incisions in the abdomen, ESG is performed endoscopically. This means that an endoscope – a flexible tube with a camera and suturing device attached – is inserted through the patient’s mouth and advanced to the stomach[7].

The surgeon then places sutures in the stomach, altering its shape and size. This results in a tubular configuration akin to a sleeve, which restricts the amount of food the stomach can hold and slows its emptying.

Distinction from Traditional Surgeries

The primary distinction between ESG and other weight loss surgeries lies in its minimally invasive approach. Traditional surgeries, like the Gastric Bypass or the Vertical Sleeve Gastrectomy, involve making physical incisions, altering the gastrointestinal anatomy and carry the associated surgical risks[8]. ESG, on the other hand, avoids these incisions and anatomical alterations.

This potentially translates to fewer complications, reduced scarring, quicker recovery, and a shorter hospital stay[9]. However, it’s essential to note that while ESG presents these advantages, its efficacy in terms of long-term weight loss, when compared to more established procedures, is still a subject of ongoing research[10].

Advantages of ESG

As the landscape of bariatric procedures evolves, Endoscopic Sleeve Gastroplasty (ESG) emerges as a revolutionary procedure with a myriad of advantages. ESG’s non-surgical approach positions it as a compelling option for those seeking weight loss solutions without undergoing invasive surgery.

Minimally Invasive Approach

One of the most prominent advantages of ESG is its minimally invasive nature. Traditional weight loss surgeries involve incisions, potential scarring, and longer recovery periods[11]. In contrast, ESG is performed using an endoscope passed through the mouth, eliminating the need for abdominal incisions.

This translates to a shorter hospital stay, less post-operative pain, and a faster return to normal activities[12]. The risk of complications like wound infections, hernias, and scar tissue is also significantly reduced.

Preservation of Stomach’s Natural Function and Outpatient Possibility

Unlike some bariatric procedures that remove parts of the stomach or reroute the digestive system, ESG simply reduces the stomach’s size while retaining its natural function[13]. This can lead to fewer nutritional deficiencies post-procedure, as the digestive system remains largely intact.

Furthermore, ESG could be performed as an outpatient procedure in some cases due to its less invasive nature. This means patients might not need an overnight stay in the hospital, making the procedure more convenient and potentially more cost-effective[14].

Additionally, ESG can be an attractive option for those who may not qualify for other weight loss surgeries due to various health reasons, offering a viable alternative for a broader range of patients[15].

Limitations and Risks

While Endoscopic Sleeve Gastroplasty (ESG) presents a set of significant advantages, viewing it through a balanced lens is imperative, considering its potential limitations and associated risks. As with any medical procedure, ESG is not a one-size-fits-all solution, and its efficacy can vary among individuals.

Potential Limitations of ESG

ESG, being a relatively new procedure in the bariatric arena, is still undergoing extensive study and review. One limitation is its long-term efficacy compared to established procedures like the Gastric Bypass[16]. While ESG offers a reduction in stomach size, its weight loss outcomes may not be as pronounced as some traditional surgeries in certain cases.

Additionally, it’s crucial to underscore that the success of ESG is heavily contingent upon lifestyle modifications. Consistent adherence to dietary and exercise recommendations post-procedure may make the desired weight loss results attainable [17]. 

Lastly, while ESG broadens the range of patients who can consider a weight loss procedure, it might not be suitable for individuals with extremely high BMI or those with specific gastrointestinal conditions[18].

Associated Risks with ESG

Every medical procedure carries inherent risks, and ESG is no exception. Some patients might experience side effects such as nausea, abdominal pain, or bleeding following the procedure[19]. Although rare, there is also the potential for perforation or injury to the stomach during the suturing process.

Furthermore, the sutures used during the procedure might, in some cases, loosen over time, which may compromise the longevity of the stomach’s reduced size and, consequently, the weight loss benefits[20].


Comparative Analysis: ESG vs. Other Weight Loss Surgeries

As the medical field embraces the potential of Endoscopic Sleeve Gastroplasty (ESG), it’s pivotal to understand its standing in relation to other established weight loss surgeries. One can glean a clearer perspective on its merits and potential drawbacks by juxtaposing ESG with procedures like Gastric Bypass or Laparoscopic Adjustable Gastric Banding.

Efficacy and Weight Loss Outcomes

In terms of weight loss outcomes, ESG has demonstrated encouraging short- to medium-term results, with patients often achieving significant weight reduction[21]. However, traditional surgeries like Gastric Bypass tend to yield more dramatic weight loss results in the long run. Such procedures have the advantage of decades of research, corroborating their sustained efficacy[22].

While ESG offers a less invasive approach, it’s paramount to recognise that its long-term weight loss outcomes, especially beyond five years, still warrant further study and documentation[23].

Recovery and Post-Operative Experience

The recovery period and post-operative experience are areas where ESG shines. Given its non-surgical nature, patients generally report less post-operative pain, faster recovery, and a quicker return to daily activities compared to traditional surgeries[24]. The absence of external scars and the potential for outpatient treatment further underscore its appeal.

However, traditional surgeries, while requiring a longer recovery period, have established post-operative protocols and support systems in place, ensuring patients navigate their weight loss journey with ample guidance and assistance[25].

In summation, while ESG holds promise as a revolutionary weight loss solution, it’s essential to approach it with a comprehensive understanding, weighing its pros and cons against other established procedures.

The Role of Lifestyle Changes Post-ESG

Achieving and maintaining optimal weight loss post-Endoscopic Sleeve Gastroplasty (ESG) is not solely dependent on the procedure itself. The significance of adopting and adhering to lifestyle changes post-ESG is paramount. A holistic approach that encompasses dietary, physical, and psychological adjustments is crucial to maximise the benefits of this innovative weight loss intervention.

Dietary Adjustments

Post-ESG, it’s vital for patients to adhere to a structured dietary plan tailored to their reduced stomach capacity[26]. A liquid diet is recommended, gradually progressing to soft foods and eventually solid meals. Portion control becomes critical, with emphasis on nutrient-dense foods that provide essential vitamins and minerals[27]. Avoiding carbonated beverages, high-fat foods, and excessive sugar intake is recommended to mitigate the risk of discomfort and support sustainable weight loss.

Physical Activity and Mental Health

Engaging in regular physical activity post-ESG is essential. A sedentary lifestyle can compromise the weight loss trajectory and may lead to weight regain over time[28]. Patients are typically encouraged to start with low-impact exercises, progressively increasing their intensity and duration.

Equally significant is the mental and emotional well-being of patients. The journey post-ESG can be emotionally taxing as patients grapple with body image changes, societal perceptions, and personal expectations. It’s essential to have psychological support systems in place, be it through counselling, support groups, or therapeutic interventions, to navigate these challenges effectively[29].

In essence, the success of ESG goes beyond the confines of the operating room. A synergistic blend of dietary vigilance, regular physical activity, and emotional resilience is pivotal to ensure long-term weight loss and overall well-being[30].

Patient Testimonials

Personal experiences and narratives offer invaluable insights into the real-world impacts of medical procedures. In the realm of Endoscopic Sleeve Gastroplasty (ESG), patient testimonials provide a window into the challenges, triumphs, and overall journey of those who have undergone the procedure. These accounts capture the nuanced, multi-dimensional aspects of the ESG experience beyond statistical data and clinical evaluations.

Positive Experiences

Many patients report an enhanced quality of life following ESG. Jane, a 35-year-old patient, highlighted how the procedure was a “game-changer” for her, allowing her to be more active with her children and regain her confidence[31]. Similarly, Mark, who underwent ESG two years ago, expressed gratitude for the non-invasive nature of the procedure, which resulted in minimal downtime and a swift return to his daily activities[32].

Numerous testimonials also speak to the sustained weight loss, with patients celebrating milestones, be it fitting into old clothes or participating in physical activities they once deemed impossible[33].

Challenges and Caveats

However, the ESG journey is full of challenges. Lisa, who had ESG six months ago, emphasised the importance of lifestyle changes, noting that without strict adherence to dietary guidelines, she experienced discomfort and slower weight loss progress[34]. Tom, another patient, shared his struggle with the emotional aspects of rapid weight loss, underscoring the significance of mental health support during the post-ESG journey[35].

These testimonials reflect the diverse experiences of ESG patients, underscoring the importance of holistic support, continuous education, and realistic expectations. They serve as a testament to the procedure’s potential and the inherent challenges accompanying any significant life change.


Endoscopic Sleeve Gastroplasty (ESG) emerges as a transformative addition to the spectrum of weight loss solutions. Its minimally invasive nature and impressive short-to-medium-term results hold promise for many seeking an alternative to traditional surgeries[36]. However, as underscored throughout this article, its efficacy intertwines with dedicated post-operative lifestyle changes, highlighting the symbiotic relationship between medical intervention and personal commitment[37]. 

Patient testimonials bring forth the human side of the ESG journey, with tales of rejuvenated self-esteem and renewed vigour coexisting with tales of challenges and introspection[38]. The diverse experiences of ESG patients underscore the importance of holistic support, continuous education, and realistic expectations.

In this evolving landscape of bariatric interventions, ESG presents a compelling case, balancing innovation with tangible results. As research progresses and more data becomes available, the full potential and long-term outcomes of ESG will be better understood, guiding its integration into the wider realm of weight loss solutions[39,40].


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