ESG vs. Traditional Bariatric Surgery: Pros and Cons

Published on: August 26, 2023

Table of Contents

ESG vs. Traditional Bariatric Surgery: Pros and Cons


Obesity, a health concern that has seen an alarming rise in recent decades, now affects a significant proportion of the global population [1]. This burgeoning epidemic not only compromises individual health but also burdens healthcare systems and economies at large. The need for practical, sustainable weight loss solutions has become paramount, especially for those where traditional diet and exercise regimens have fallen short. Consequently, the medical field has developed several surgical interventions to address severe obesity and its accompanying health complications [2].

One such intervention is the Endoscopic Sleeve Gastroplasty (ESG), a newer, less invasive procedure that has garnered attention for its promising results in weight loss surgery [3]. Contrasted against this is the realm of traditional bariatric surgeries, which includes procedures like gastric bypass and gastric sleeve, surgeries that have stood the test of time with established efficacy and results [4]. While ESG utilises an endoscopic approach to reduce stomach size, traditional bariatric surgeries involve more invasive methods, each with its own advantages and challenges.

The choice between ESG and traditional bariatric surgeries is multifaceted. It’s not just about the expected weight loss but also the potential risks, benefits, and long-term implications. As we delve deeper into this article, we will explore the specifics of ESG, compare it against traditional bariatric surgeries, and provide insights to help individuals make informed decisions about their health journey [5].


ESG (Endoscopic Sleeve Gastroplasty)

Definition and Description

Endoscopic Sleeve Gastroplasty (ESG) represents one of the latest advancements in the field of bariatric interventions. Unlike traditional surgical weight loss methods, ESG is a minimally invasive procedure that does not require external incisions. Using an endoscope inserted via the mouth, the procedure primarily aims to reduce the stomach’s size and capacity [6].

How ESG Works

The fundamental operation of ESG revolves around using an endoscope fitted with a suturing device. Once the endoscope reaches the stomach, a series of sutures are strategically placed to cinch the stomach’s size, making it resemble a tubular structure. Reducing the stomach’s volume limits the amount of food intake, thus fostering weight loss [7]. Notably, this procedure does not involve any removal of stomach tissue, which differentiates it from some traditional bariatric surgeries like the gastric sleeve. The outpatient nature of the procedure, combined with the absence of abdominal incisions, leads to a faster recovery period and minimal post-operative pain for most patients [8].

The novelty of ESG and its less invasive approach has made it an appealing option for many seeking weight loss solutions. However, it’s essential to consider its relatively recent emergence in the medical field and the necessity for more long-term studies to ascertain its efficacy and potential side effects over extended periods [9].

Traditional Bariatric Surgery

Types of Traditional Bariatric Surgery

Traditional bariatric surgeries have been the cornerstone for surgically addressing severe obesity for decades. Several types fall under this umbrella, including:

  1. Gastric Bypass (Roux-en-Y): This procedure involves creating a small stomach pouch and bypassing a portion of the small intestine. This results in reduced food intake and decreased absorption of calories and nutrients [10].
  2. Gastric Sleeve (Sleeve Gastrectomy): This involves removing a significant portion of the stomach, leaving behind a tubular structure. It primarily reduces stomach volume, limiting food intake [11].
  3. Adjustable Gastric Banding: A band is placed around the top portion of the stomach, creating a small pouch. The band’s tightness can be adjusted, controlling the rate of food passing to the rest of the stomach [12].
  4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS): One of the more complex procedures involves a combination of gastric sleeve and rerouting a significant portion of the small intestine [13].
How They Work

The primary objective of traditional bariatric surgeries is to either limit the amount of food the stomach can hold, reduce nutrient absorption, or both. Gastric bypass and BPD/DS are both restrictive and malabsorptive, as they limit food intake and reduce nutrient absorption. In contrast, the gastric sleeve and adjustable gastric banding mainly focus on food restriction [14].

These surgeries have seen continuous refinements over the years, enhancing safety profiles and improving outcomes. The established nature and longer track record of these procedures mean that their benefits, risks, and long-term effects are well-documented, helping patients make informed decisions.

Deciding Between ESG and Traditional Bariatric Surgery

Factors to Consider

Choosing between ESG and traditional bariatric surgeries requires a comprehensive understanding of one’s unique health needs and desired outcomes. Several crucial factors should be taken into account:

  1. Amount of Weight to Lose : ESG is generally recommended for those with a lower BMI, or those who might not qualify for traditional bariatric surgery but still need an intervention [15].
  2. Underlying Health Conditions : Some obesity-related health issues, such as type 2 diabetes, have been shown to resolve more consistently after specific traditional surgeries like gastric bypass [16].
  3. Age and General Health : The patient’s overall health can influence the surgery’s risk and the recovery process. Traditional bariatric surgeries might pose more significant risks for individuals with certain pre-existing conditions [17].
  4. Adaptation to New Dietary and Lifestyle Changes : Both ESG and traditional bariatric surgeries require long-term dietary adjustments. However, the malabsorptive nature of some traditional surgeries might require stricter adherence [18].
  5. Financial Considerations : While many insurance plans cover traditional bariatric surgeries due to their established nature, coverage for ESG might vary. Out-of-pocket costs and post-surgical care expenses should also be factored in [19].
Importance of Professional Consultation

Regardless of the factors mentioned, engaging in thorough consultations with healthcare professionals specialising in bariatric procedures is essential. A patient-specific approach ensures that the chosen procedure aligns with the individual’s health profile, goals, and lifestyle.


Addressing obesity requires a blend of precision, patience, and personalised care. Both ESG and traditional bariatric surgeries offer pathways to sustainable weight loss and improved health. While ESG provides a less invasive alternative with shorter recovery periods, traditional bariatric surgeries have stood the test of time, offering profound weight loss and potential resolution of associated comorbidities [20].

The decision between the two should be rooted in individual needs, health conditions, and desired outcomes. What remains clear is that surgery alone is not a magic bullet. Long-term success in managing obesity necessitates a holistic approach, combining surgical interventions with dedicated lifestyle, dietary, and behavioural changes [21].

Additionally, continued consultations with healthcare professionals ensure that patients remain on track and adapt to the evolving challenges post-surgery [22]. Ultimately, the journey toward a healthier life is a collaborative effort between patients, medical professionals, and support systems, all working in tandem to achieve the desired health outcomes [23].


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