Understanding the Risks and Benefits of Endoscopic Sleeve Gastroplasty (ESG)

Published on: September 1, 2023

Table of Contents

Understanding the Risks and Benefits of Endoscopic Sleeve Gastroplasty (ESG)


In recent decades, the escalating global rates of obesity have emerged as a significant public health concern. With the World Health Organization reporting that obesity has nearly tripled since 1975[1], there’s an increasing demand for effective weight management solutions. One innovative procedure catching the attention of both medical professionals and those seeking weight loss is Endoscopic Sleeve Gastroplasty (ESG). As an alternative to traditional bariatric surgeries, ESG provides a less invasive avenue for weight reduction[2]. Unlike conventional weight loss surgeries such as gastric bypass or sleeve gastrectomy, which involve surgical alterations to the stomach, ESG is endoscopic. This means it uses an endoscope – a flexible tube with a camera – inserted through the patient’s throat, thus avoiding external incisions[3]. 

The appeal of ESG doesn’t stop at its non-surgical nature. Preliminary studies indicate promising weight loss outcomes and improvements in obesity-related health conditions[4]. However, as with any medical procedure, ESG is not without its risks. Patients and the medical community must weigh the potential benefits against the inherent risks to determine its overall viability as a weight loss solution.

In this article, we’ll delve deeper into the world of ESG, exploring the full spectrum of its benefits and risks. Drawing on scientific research, expert opinions, and patient experiences, our goal is to equip readers with a comprehensive understanding of ESG, helping them make informed decisions about their health and well-being[5].

Background: ESG as an Innovative Procedure

Description of the ESG Procedure

Endoscopic Sleeve Gastroplasty (ESG) represents the frontier of less invasive weight loss procedures. Unlike surgical interventions requiring incisions and removing or rearranging stomach parts, ESG employs a specialised endoscope. This endoscope is equipped with a camera and suturing device, which is inserted through the patient’s mouth and down into their stomach. The suture device is then used to cinch the stomach, effectively reducing its size without any external incisions. This results in a tubular or “sleeved” stomach, akin to the shape achieved in surgical sleeve gastrectomy, but without the associated surgical scars and recovery time[6].

Historical Context: Evolution of Weight Loss Surgeries

The journey towards developing ESG is rooted in the history of bariatric interventions. Traditional bariatric surgeries, including gastric bypass and sleeve gastrectomy, have long been the hallmark for morbidly obese patients seeking significant weight reduction. These procedures, while effective, come with potential surgical complications and longer recovery periods[7]. The 21st century saw the emergence of endoscopic approaches as potential alternatives, offering comparable outcomes with less invasiveness[8]. ESG emerged from this wave of innovation, establishing itself as a promising option for patients desiring weight loss benefits without the extensive surgical process. Its increasing popularity is a testament to medicine’s evolving landscape, where procedures are continually refined to prioritise patient comfort, safety, and efficacy[9].

Benefits of Endoscopic Sleeve Gastroplasty (ESG)

Non-surgical Nature

One of the most prominent benefits of Endoscopic Sleeve Gastroplasty (ESG) is its non-surgical approach to weight loss. This procedure markedly reduces the inherent risks associated with open or laparoscopic surgeries, such as wound infections or hernias[10].

Because ESG is performed endoscopically, patients typically experience a more rapid recovery. The absence of external incisions minimises post-operative pain and significantly reduces the appearance of surgical scars. This aesthetic advantage can have profound psychological implications for patients who are conscious of their post-operative appearance[11].

Weight Loss Outcomes

ESG has exhibited notable results in the realm of weight loss. Research indicates that, on average, patients undergoing ESG can expect to lose approximately 15-20% of their total body weight within the first year following the procedure[12].

Furthermore, many patients maintain a substantial proportion of this weight loss even several years post-operatively, especially when combined with lifestyle and dietary modifications. The benefits extend beyond mere weight reduction. A significant proportion of ESG patients also witness remarkable improvements in obesity-associated conditions, such as type 2 diabetes, hypertension, and sleep apnea[13].

This holistic impact underscores the potential of ESG not just as a weight loss tool but as a comprehensive intervention for improving overall health. Moreover, the psychological uplift experienced by patients, stemming from improved body image and associated health benefits, can’t be understated. This often leads to enhanced quality of life, bolstered self-confidence, and a renewed zest for life[14].

Risks and Limitations of Endoscopic Sleeve Gastroplasty (ESG)

Procedural Complications

While ESG is less invasive than traditional bariatric surgeries, it is not devoid of potential complications. There’s a risk of bleeding, infection, or even gastric perforation during the procedure. These complications, although rare, can be serious and may require urgent medical attention or surgical intervention[15]. Additionally, since the procedure requires sedation or anaesthesia, there are inherent risks associated with those as well, including adverse reactions or respiratory issues[16].

Post-Operative Complications

Post-procedure, some patients might experience discomfort, manifesting as nausea, pain, or vomiting. A fraction of patients might also face reflux issues or have difficulty swallowing, resulting from how the stomach was sutured during ESG[17]. There are also concerns related to inadequate weight loss or, in some cases, weight regain after an initial drop. Factors contributing to such outcomes could be diverse, ranging from individual metabolic rates to adherence to post-operative dietary recommendations[18]. Moreover, in a few cases, the sutures might loosen over time, necessitating repeat or additional interventions. These potential complications underscore the importance of thorough post-operative monitoring and adherence to medical advice for optimal outcomes.

Another noteworthy aspect is the financial consideration. While ESG might be less expensive upfront compared to surgical alternatives, potential costs for managing complications or repeat procedures must be accounted for when evaluating its overall cost-effectiveness[19].

Factors to Consider Before Opting for ESG

Personal Health Profile

Every individual’s health status is unique, and what might work seamlessly for one might be less effective for another. Before undergoing ESG, getting a thorough health assessment is crucial. Factors such as age, current weight, obesity-related conditions, and overall physical health can influence the outcomes of the procedure[20]. Patients with certain gastrointestinal conditions or previous stomach surgeries may not be suitable candidates for ESG. Furthermore, those with specific metabolic disorders may not achieve the desired weight loss even after the procedure, emphasising the importance of a detailed medical evaluation[21].

Commitment to Lifestyle Changes

ESG is not a one-stop solution; it’s a stepping stone that can be exponentially effective when combined with a healthy lifestyle. Post-procedure, patients are usually recommended a specific diet and physical activity regime[22]. The success of ESG, to a large extent, hinges on adherence to these guidelines. Those who revert to unhealthy dietary habits or do not engage in regular physical activity might not achieve optimal weight loss or may even regain weight. Moreover, ongoing post-operative consultations and monitoring are crucial for identifying and managing potential complications early[23]. Before opting for ESG, one must introspect about their readiness to commit to the requisite post-procedure lifestyle adjustments. A robust support system, including family, friends, and support groups, can also play a pivotal role in post-ESG success[24].


Endoscopic Sleeve Gastroplasty (ESG) stands at the forefront of minimally invasive bariatric interventions, offering a compelling alternative to traditional surgical procedures. Its appeal stems from its non-surgical nature, faster recovery time, and promising weight loss outcomes[25]. However, as with any medical procedure, ESG is not without its risks. Potential complications, both during and post-procedure, require careful consideration and thorough medical evaluation to determine candidacy[26]. 

Beyond the procedure itself, the success of ESG is intertwined with a patient’s commitment to post-operative dietary and lifestyle changes. It’s not a singular solution but a significant step that necessitates ongoing effort[27]. Ultimately, ESG offers a renewed chance at better health and improved quality of life for those deemed suitable candidates, reinforcing the importance of informed decision-making and dedicated post-procedure adherence[28][29].


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