Long-Term Outcomes of Endoscopic Sleeve Gastroplasty

Published on: August 22, 2023

Table of Contents

Long-Term Outcomes of Endoscopic Sleeve Gastroplasty


Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive, endoscopic bariatric procedure that offers a safer alternative to traditional surgical interventions for obesity [1]. By modifying the gastric structure, ESG facilitates weight loss by restricting food intake and slowing digestion [2]. Despite its growing popularity and evident short-term efficacy, there needs to be more comprehensive studies exploring the long-term outcomes of ESG.

This article aims to elucidate the long-term outcomes of ESG, emphasising its efficacy and safety profile over an extended period. Previous research has confirmed the effectiveness of ESG in the short term, with significant weight loss and improvements in obesity-related comorbidities observed in the initial years following the procedure [3]. However, understanding the durability of these outcomes is crucial, as the ultimate success of any weight loss intervention hinges not only on the initial results but also on sustained weight management and metabolic improvement.

Furthermore, we will examine the long-term complications associated with ESG alongside factors influencing these outcomes, such as patient selection, postoperative follow-up, and lifestyle modifications. Through this comprehensive analysis, we aim to offer clinicians, patients, and researchers an updated perspective on the long-term implications of ESG in managing obesity.

Given the ongoing obesity pandemic and the increasing use of ESG as a therapeutic option, it is paramount to investigate the long-term outcomes following this procedure [4,5]. In doing so, we aspire to bridge the existing gap in the literature, thereby contributing to the refinement of best practices and the optimal utilisation of ESG in obesity treatment.


Understanding Endoscopic Sleeve Gastroplasty

Endoscopic Sleeve Gastroplasty (ESG) is a weight loss procedure that offers a less invasive alternative to traditional bariatric surgeries. This section provides an in-depth understanding of the ESG procedure, its indications, benefits, and how it compares with other surgical options.

The ESG Procedure

ESG is performed using an endoscope, a flexible tube fitted with a camera and a suturing device [6]. The procedure involves placing a series of sutures in the stomach, altering its structure to resemble a tube, much like a sleeve, significantly reducing its volume [7]. This modification restricts food intake and slows digestion, thereby promoting weight loss.

Indications and Benefits

The primary indication for ESG is obesity, typically defined as a body mass index (BMI) of 30 or greater [8]. The benefits of ESG extend beyond weight loss, with improvements reported in obesity-associated comorbidities such as type 2 diabetes, hypertension, and sleep apnea [3,9]. ESG also provides the benefits of minimally invasive surgery, including reduced operative time, lower risk of complications, and faster recovery [10].

Comparison with Other Weight-Loss Surgeries

Compared to other bariatric procedures such as gastric bypass or sleeve gastrectomy, ESG is less invasive and does not require incisions or removal of any part of the digestive tract. Studies have shown that ESG may result in slightly less weight loss than these more invasive surgeries, but it offers comparable improvements in metabolic health and quality of life [7,10].

In conclusion, ESG is a promising intervention for obesity management, combining the efficacy of traditional bariatric surgeries with the safety of endoscopic procedures. However, long-term outcomes are crucial for evaluating its success, which will be the focus of the subsequent sections.

Review of Short-Term Outcomes

Endoscopic Sleeve Gastroplasty (ESG) ‘s short-term success has been widely reported in the medical literature. This section provides a comprehensive review of typical short-term outcomes post-ESG, including weight loss, complications, and improvements in quality of life.

Short-Term Weight Loss

In the initial months following ESG, patients typically experience significant weight loss. Several studies have reported an average excess weight loss (EWL) of around 50-60% at six months post-procedure [11,12]. This swift weight reduction, coupled with improvements in obesity-associated conditions like type 2 diabetes, hypertension, and sleep apnea, underscores the short-term effectiveness of ESG [9,13].

Complications and Their Management

Despite being minimally invasive, ESG is not without potential complications. Early post-procedure complications can include abdominal pain, nausea, and vomiting, typically managed conservatively [14]. More serious, albeit rare, complications like gastric perforation or bleeding require immediate medical attention [14,15].

Quality of Life

Patients often report significant improvements in their quality of life after ESG. As early as six months post-ESG, patients show enhanced mobility, reduced pain, and improved self-esteem [16]. The procedure’s ability to promote short-term weight loss while enhancing patients’ overall well-being supports its inclusion in obesity management strategies.

In conclusion, ESG is a robust intervention offering substantial weight loss and improved quality of life in the short term. However, as with any medical procedure, potential risks and complications should be discussed thoroughly with patients before the procedure.

Long-Term Outcomes of Endoscopic Sleeve Gastroplasty

Despite the evident short-term efficacy of Endoscopic Sleeve Gastroplasty (ESG), it is crucial to thoroughly examine its long-term outcomes to understand its effectiveness as a weight loss intervention. This section reviews these outcomes, including weight loss maintenance, complications, and quality of life over an extended period.

Weight Loss Maintenance

Studies have shown that weight loss following ESG is sustained in the long term. Patients commonly maintain an excess weight loss (EWL) of about 50% at two years post-procedure, with some studies even reporting held EWL of up to 60% at 3-5 years [17,7].

Long-Term Complications and Their Management

Long-term complications following ESG are infrequent but may include suture dehiscence, gastroesophageal reflux disease (GERD), and nutritional deficiencies [19]. Most of these complications can be managed conservatively or with endoscopic intervention, while surgical intervention is rarely needed [3].

Quality of Life and Comorbidity Resolution

Improved quality of life and resolution of obesity-associated comorbidities have been reported to persist long-term. Studies have demonstrated that weight loss from ESG contributes to sustained improvements in conditions such as type 2 diabetes, hypertension, and sleep apnea [21,22]. Moreover, patients report sustained enhancements in physical function and self-esteem, further reinforcing the long-term benefits of ESG [14].

In conclusion, ESG provides durable weight loss and improves comorbidities and quality of life in the long term, making it a viable option for long-term obesity management. Nonetheless, further research is needed to fully understand the predictors of success and the exact mechanisms leading to sustained weight loss and metabolic improvements.


Factors Influencing Long-Term Outcomes

It is crucial to optimise its benefits to understand the factors influencing Endoscopic Sleeve Gastroplasty’s long-term outcomes (ESG). This section examines the patient, technical, and post-procedure factors that may impact the success of ESG.

Patient Factors

Certain patient-related factors have been identified as potential influencers of ESG outcomes. A lower initial body mass index (BMI) and the absence of type 2 diabetes have been associated with better long-term weight loss [24]. Patients’ adherence to diet and lifestyle changes also significantly affects weight loss maintenance [25].

Technical Factors

Technical factors related to the ESG procedure, such as the number and pattern of sutures placed, can influence the degree of weight loss and maintenance [26]. Moreover, the experience and skill of the endoscopist performing the procedure have also been reported to affect the outcomes [24].

Post-Procedure Factors

The importance of post-procedure follow-up and support must be considered. Regular follow-ups enable early identification and management of complications, nutritional deficiencies, and weight regain [25]. Comprehensive post-procedure programs that include dietary and psychological counselling are associated with improved long-term outcomes [26].

In conclusion, the long-term success of ESG is influenced by many factors, which should be considered when selecting patients and planning their follow-up. Careful patient selection, meticulous procedure execution, and robust post-procedure support are integral to maximising the benefits of ESG.

Limitations and Gaps in Current Knowledge

Despite promising data supporting the long-term efficacy of Endoscopic Sleeve Gastroplasty (ESG), certain limitations and gaps in current knowledge remain. These include the need for more extensive studies, long-term data beyond five years, and a better understanding of mechanisms of action.

Limited Size and Duration of Studies

Most studies on ESG are limited by small sample sizes and short duration of follow-up, which restricts the ability to generalise findings [27]. More prominent multicenter studies with a follow-up period beyond five years are needed to provide more robust evidence on the long-term outcomes of ESG [1].

Understanding Mechanisms of Action

While ESG is known to cause weight loss by reducing stomach size, the exact mechanisms that lead to long-term weight loss and improvements in obesity-associated conditions are not fully understood [28]. Further research exploring the physiological and metabolic changes post-ESG is needed to optimise its efficacy.

Comparative Studies with Other Bariatric Procedures

Few studies compare ESG with other bariatric procedures, such as laparoscopic sleeve gastrectomy and gastric bypass, regarding long-term weight loss, comorbidity resolution, and complication rates [7]. Comparative studies will help establish the relative benefits and risks of ESG.

Predictors of Success

Lastly, while some factors influencing long-term outcomes have been identified, predictive models that help clinicians select the most suitable ESG candidates still need improvement [22].

In conclusion, while ESG shows excellent promise as a minimally invasive obesity treatment, more research is needed to address these limitations and gaps, thereby improving patient selection, refining the procedure, and enhancing post-procedure care.


Endoscopic Sleeve Gastroplasty (ESG) has emerged as a promising minimally invasive intervention for obesity. Studies show substantial weight loss and improvement in obesity-associated comorbidities in the short term, and these benefits persist for a long time [15,7]. Patient factors, technical aspects, and comprehensive post-procedure support significantly influence the success of ESG [23]. 

However, the evidence has limitations, including small study sizes and short follow-up durations. Understanding the precise mechanisms leading to weight loss and metabolic improvements post-ESG and developing predictive models for patient selection warrant further research [29,22]. Comparative studies with other bariatric procedures will further define the place of ESG in the armamentarium against obesity [20].

In conclusion, ESG offers a valuable addition to the weight loss strategies available today, with the potential for long-term efficacy. Continued research and refinement of this procedure are essential to fully realise its potential and ensure the best outcomes for patients struggling with obesity.


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