Understanding Endoscopic Gastroplasty: A Review of Recent Studies

Murat Üstün
May 20, 2024By Murat Üstün

Endoscopic gastroplasty has emerged as a promising minimally invasive procedure for weight loss. Recent studies have highlighted its effectiveness, safety, and potential as an alternative to traditional bariatric surgeries. In this blog post, we will delve into the latest research on endoscopic gastroplasty, exploring its mechanisms, benefits, outcomes, and future prospects.

Introduction to Endoscopic Gastroplasty

Endoscopic gastroplasty, specifically Endoscopic Sleeve Gastroplasty (ESG), is a non-surgical weight loss procedure that uses an endoscope to reduce the size of the stomach. This technique involves the placement of sutures in the stomach, which creates a sleeve-like effect, limiting food intake and promoting weight loss. Unlike traditional bariatric surgeries, ESG does not require incisions, making it less invasive and reducing recovery time.

Mechanisms of Endoscopic Gastroplasty

The primary mechanism of ESG involves the endoscopic placement of sutures to create a smaller gastric pouch. This is achieved using a specialized device inserted through the mouth, which allows the gastroenterologist to access the stomach without making external incisions. The sutures are placed in a specific pattern to reduce the stomach’s volume, mimicking the effect of a surgical sleeve gastrectomy. This procedure not only restricts the amount of food the stomach can hold but also slows down the digestive process, leading to early satiety and reduced calorie intake.

Recent Studies on Endoscopic Gastroplasty

Several recent studies have provided valuable insights into the effectiveness and safety of ESG. These studies have involved a variety of populations and methodologies, contributing to a comprehensive understanding of the procedure.

1. Effectiveness in Weight Loss: A study published in The Lancet Gastroenterology & Hepatology in 2023 examined the outcomes of ESG in a large cohort of patients. The study reported an average excess weight loss of 18-20% at one year post-procedure. This is significant compared to traditional weight loss methods, positioning ESG as an effective intervention for obesity.

 2. Safety Profile: Research has consistently shown that ESG has a favorable safety profile. A meta-analysis published in Gastrointestinal Endoscopy in 2022 reviewed data from multiple studies and found a low incidence of adverse events. The most common complications were mild and included nausea, abdominal pain, and temporary dysphagia. Severe complications were rare, reinforcing the procedure’s safety.

3. Long-term Outcomes: Long-term studies are crucial to understanding the sustainability of weight loss and the overall health benefits of ESG. A study published in Obesity Surgery in 2023 followed patients for three years and found that most maintained significant weight loss, with improvements in comorbidities such as diabetes, hypertension, and sleep apnea. This suggests that ESG not only promotes weight loss but also contributes to the management of obesity-related conditions.

clinic, profession, people, health care and medicine concept - happy group of medics or doctors at hospital corridor

Comparative Studies: ESG vs. Traditional Bariatric Surgery

Comparing ESG to traditional bariatric surgeries such as laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) is essential for evaluating its place in weight management strategies.

 1. Weight Loss Comparison: Studies have shown that while ESG results in less weight loss compared to LSG and RYGB, it still offers substantial benefits. For instance, a comparative study in Surgical Endoscopy in 2022 reported that patients undergoing ESG experienced an average of 20-25% total body weight loss at one year, whereas LSG patients lost around 30-35%. However, the reduced invasiveness and quicker recovery time make ESG an attractive option for many patients.

 2. Recovery and Complications: One of the significant advantages of ESG is the shorter recovery period. Patients typically return to normal activities within a few days, compared to several weeks for traditional surgeries. Additionally, the risk of complications is lower with ESG. While traditional surgeries carry risks such as leaks, infections, and nutritional deficiencies, ESG’s minimally invasive nature reduces these risks substantially.

Blonde female doctor and patient talking in hospital office. Health care and client service in medicine

Patient Selection and Suitability

Identifying suitable candidates for ESG is crucial for achieving optimal outcomes. Recent guidelines and studies emphasize the importance of patient selection criteria:

1. Body Mass Index (BMI): ESG is typically recommended for patients with a BMI of 30-40 who have not had success with diet and exercise alone. It is also considered for patients with a BMI over 40 who are seeking a less invasive option than traditional surgery.

2. Comorbidities: Patients with obesity-related comorbidities such as type 2 diabetes, hypertension, and obstructive sleep apnea may benefit significantly from ESG. The procedure can help improve these conditions, contributing to overall health improvement.

3. Previous Weight Loss Efforts: ESG is often recommended for patients who have tried and failed to achieve significant weight loss through conventional methods. It is also considered for those who are not candidates for or do not want traditional bariatric surgery.

Future Prospects and Ongoing Research

The future of ESG looks promising, with ongoing research exploring ways to enhance its effectiveness and broaden its application. Some key areas of focus include:

1. Technological Advancements: Innovations in endoscopic devices and techniques are continually improving the safety and efficacy of ESG. New suturing devices and methods are being developed to create more durable and effective gastric sleeves.
2. Combination Therapies: Researchers are investigating the potential of combining ESG with other weight loss treatments, such as pharmacotherapy and lifestyle interventions, to enhance outcomes. This multimodal approach could offer more comprehensive and sustained weight loss.
3. Long-term Studies: Continued research on the long-term effects of ESG is essential. Studies tracking patients over five to ten years will provide valuable data on weight maintenance, metabolic improvements, and quality of life.
4. Expanding Indications: There is interest in exploring the use of ESG for patients with lower BMIs and those with metabolic disorders. This could expand the procedure’s applicability and benefit a broader range of patients.


Endoscopic gastroplasty represents a significant advancement in the field of weight loss interventions. Recent studies underscore its effectiveness, safety, and potential as a minimally invasive alternative to traditional bariatric surgeries. As research continues and technology advances, ESG is poised to play a crucial role in the management of obesity and its related conditions. For patients seeking a less invasive, yet effective weight loss solution, endoscopic gastroplasty offers a promising option with encouraging long-term outcomes.