Researchers reviewed studies on a newer weight loss procedure called endoscopic sleeve gastroplasty (ESG), which uses a camera and special tools to make your stomach smaller without surgery. Unlike traditional weight loss surgery, this procedure is less invasive, faster to recover from, and doesn’t permanently change your body. Studies show people lose about 15-20% of their body weight within two years, and many see improvements in weight-related health problems like diabetes. The procedure is safe, with serious complications happening in less than 2.5% of cases, and it costs less than traditional surgery while being more effective than diet alone.

The Quick Take

  • What they studied: How well a minimally invasive procedure called endoscopic sleeve gastroplasty works for weight loss compared to diet, medications, and traditional weight loss surgery
  • Who participated: This review analyzed multiple studies involving thousands of patients with mild to severe obesity, including people with various health conditions and different risk levels for surgery
  • Key finding: People who had this procedure lost 15-20% of their body weight within two years, and 50-80% experienced improvement in obesity-related health problems like diabetes and high blood pressure, with serious complications occurring in fewer than 1 in 40 cases
  • What it means for you: If you’re struggling with weight loss through diet and exercise alone, this procedure may be a safer, less invasive option than traditional weight loss surgery, though it’s not permanent and requires lifestyle changes to maintain results

The Research Details

This review examined research published between 2020 and 2025 about a procedure called endoscopic sleeve gastroplasty (ESG). Instead of cutting into your body like traditional surgery, doctors use a camera (endoscope) that goes down your throat to reach your stomach. They then use special stitching tools to make your stomach smaller and more tube-shaped, which helps you feel full faster and eat less.

The researchers looked at many different studies—including large case series (where doctors tracked many patients) and meta-analyses (studies that combine results from multiple research projects). They examined how much weight people lost, how their health improved, what side effects occurred, how much it cost, and how it compared to other weight loss methods like diet, medications, and traditional surgery.

This approach allowed the researchers to get a complete picture of what we currently know about this procedure from the most recent and reliable research available.

This type of review is important because it brings together all the recent evidence in one place, helping doctors and patients understand what really works. By comparing ESG to other options like diet alone, weight loss medications, and traditional surgery, people can make informed decisions about which approach might be best for their situation. The review also helps identify which patients benefit most and what improvements are being developed.

This is a semi-systematic review, meaning the researchers followed a structured approach to finding and analyzing studies, though not with the most rigid scientific standards. The review focuses on recent evidence (2020-2025), which means the information is current. The fact that multiple large studies and meta-analyses are included strengthens the findings. However, because this is a review of other studies rather than a new experiment, the quality depends on the quality of the original research being reviewed.

What the Results Show

Studies show that people who had endoscopic sleeve gastroplasty lost an average of 15-20% of their total body weight within 24 months. This is a meaningful amount of weight loss—for example, someone weighing 250 pounds might lose 37-50 pounds. The weight loss appears to continue for at least 5 years based on emerging data, though long-term studies are still being completed.

Beyond just weight loss, the procedure helped improve or resolve weight-related health problems in 50-80% of patients. This includes conditions like type 2 diabetes, high blood pressure, and sleep apnea. Some patients were able to reduce or stop medications they were taking for these conditions.

The procedure proved to be safe, with serious complications occurring in fewer than 2.5% of cases. Common minor side effects included nausea and vomiting in the first few weeks after the procedure, but these typically resolved on their own. The procedure takes about 60-90 minutes, and most people went home the same day or after an overnight stay.

The research showed that ESG works better when combined with lifestyle changes like diet and exercise, similar to other weight loss approaches. Some studies examined combining ESG with GLP-1 medications (like semaglutide), which showed promise for even greater weight loss. The procedure was found to be highly cost-effective compared to traditional weight loss surgery and significantly more effective than diet and exercise alone. Different patient groups—including older adults, people with multiple health conditions, and those at high surgical risk—all benefited from the procedure.

Compared to traditional weight loss surgery (laparoscopic sleeve gastrectomy), ESG offers several advantages: it’s less invasive (no cutting), has a faster recovery time (days instead of weeks), preserves the normal anatomy of your digestive system, and can be reversed if needed. However, traditional surgery typically produces slightly more weight loss. Compared to diet and exercise alone, ESG produces much better weight loss results. Compared to weight loss medications alone, ESG appears to produce more weight loss, though combining medications with ESG may work even better. This positions ESG as a middle-ground option between medical management and traditional surgery.

This review has several important limitations. First, most studies followed patients for only 2 years, so we don’t have complete long-term data beyond 5 years. Second, different studies used slightly different techniques and measured results differently, making exact comparisons difficult. Third, the review didn’t include all possible studies (it’s semi-systematic rather than fully systematic), so some relevant research might have been missed. Fourth, most studies were conducted in specialized centers with experienced doctors, so results might differ in less experienced hands. Finally, the procedure requires patient commitment to lifestyle changes, and results vary significantly between individuals.

The Bottom Line

ESG may be a good option (moderate confidence) for people with mild-to-moderate obesity who have failed to lose weight through diet and exercise alone, or for people with severe obesity who are too high-risk for traditional surgery. It should be combined with lifestyle changes including diet modification and physical activity. People considering ESG should discuss with their doctor whether they’re good candidates and what realistic weight loss expectations are for their situation. The procedure is not recommended as a standalone treatment without commitment to healthy lifestyle changes.

This research matters most for people struggling with obesity who want a less invasive option than traditional surgery. It’s particularly relevant for people with health conditions that make traditional surgery risky, people who are afraid of surgery, or those who want a reversible option. It’s less relevant for people with mild obesity who haven’t tried serious diet and exercise programs, or for people unwilling to make lifestyle changes. People should discuss with their doctor whether they’re candidates based on their specific health situation.

Most weight loss happens in the first 6-12 months after the procedure, with continued gradual weight loss up to 24 months. Health improvements like better blood sugar control can start within weeks to months. However, maintaining results requires ongoing healthy eating and exercise habits—weight can return if people return to old eating patterns. Realistic expectations are that this is a tool to help with weight loss, not a permanent solution.

Want to Apply This Research?

  • Track weekly weight and waist circumference measurements, plus a simple 1-10 hunger scale before and after meals to monitor how the procedure affects appetite and eating patterns
  • Use the app to log meals and portion sizes, set reminders for water intake, and track physical activity minutes—helping reinforce the lifestyle changes that make ESG effective
  • Create monthly check-ins to review weight trends, energy levels, and any digestive symptoms; track improvements in weight-related health conditions like blood sugar readings or blood pressure if applicable

This review summarizes research on endoscopic sleeve gastroplasty but is not medical advice. ESG is a medical procedure with potential risks and benefits that vary by individual. Anyone considering this procedure should consult with a qualified gastroenterologist or bariatric specialist to discuss whether it’s appropriate for their specific health situation, potential risks, expected outcomes, and alternatives. This information should not replace professional medical evaluation and personalized recommendations from your healthcare provider. Results vary significantly between individuals, and the procedure requires commitment to lifestyle changes for long-term success.