Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Nov;77(7):1915-1921.
doi: 10.1007/s13304-025-02097-1. Epub 2025 Jan 28.

Endoscopic sleeve gastroplasty (ESG): indications and results-a systematic review

Christine Karolina Stier  1 , Patrick Téoule  2 , Barham K Abu Dayyeh  3   4
Affiliations
Review

Endoscopic sleeve gastroplasty (ESG): indications and results-a systematic review

Christine Karolina Stier et al. Updates Surg. 2025 Nov.

Abstract

Obesity is a major global health problem and at the same time a financial burden for social security systems. For a long time, conventional lifestyle interventions have tried unsuccessfully to find a solution. It has been proven that only interventions that ultimately address the central control centers of hunger, appetite and satiety will lead to sustained weight loss. As a result, metabolic and bariatric surgery (MBS) has become the gold standard in the treatment of obesity and has been shown to be effective and safe in both the short and long term. Processed via the gut-brain axis, MBS not only leads to weight loss, but also-and, in addition, independently through the modification of the intestinal tract in bypass surgery-to a significant remission rate of type 2 diabetes mellitus, the typical co-morbidity of obesity. However, MBS is not suitable for all patients. Some patients are ineligible due to a high-risk profile or do not wish to undergo surgery, whilst others do not meet the criteria for MBS but still suffer from obesity. This treatment gap has been a driving force behind the development of endoscopic solutions such as endoscopic sleeve gastroplasty (ESG). ESG offers a less invasive, endoluminal and anatomy-sparing alternative that reduces gastric volume by suturing tissue folds along the greater curvature. Such a reduction in gastric volume, which is also one principle of action of MBS, can induce earlier satiety and lead to weight loss. The evidence behind this procedure, in particular its efficacy and safety, should be objectified through this review.

Keywords: Bariatric endoscopy; Endoscopic sleeve gastroplasty; Excess weight loss; Long-term results; Obesity; Primary weight loss procedure; Safety.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: BAD has served as a consultant for Boston Scientific, Metamodix, BFKW, DyaMx, and USGI Medical; has received research support for Boston Scientific, Apollo Endosurgery, USGI, Spatz Medical, GI Dynamics, Caim Diagnostics, Aspire Bariatrics, and Medtronic; and has been a speaker for Johnson & Johnson, Endogastric Solutions, and Olympus. CS has served as a consultant for Boston Scientific, USGI Medical, NovoNordisc, Johnson & Johnson, Lohmann & Rauscher, Morphic Medical, Trans.Duodenal.Concepts, and Cranax Medical Digestive. The other author declared no conflict of interest. Research involving human participants and/or animals and Informed consent: Not applicable.

Figures

Fig. 1
Fig. 1
Endoscopic sleeve gastroplasty (ESG), courtesy of IFSO
Fig. 2
Fig. 2
PRISMA flowchart for the literature screening and inclusion/exclusion process for the overall outcomes of ESG (non-comparative analysis)
Fig. 3
Fig. 3
Mean percentage of excess weight loss (%EWL) and total body weight loss (%TBWL) at specific time points following endoscopic sleeve gastroplasty (ESG). For context, the number of individuals and articles at each time point are included above the bars
See this image and copyright information in PMC

References

    1. Worldwide trends in body-mass index (2017) underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 390:2627–2642 - PMC - PubMed
    1. Finkelstein EA, Khavjou OA, Thompson H et al (2012) Obesity and severe obesity forecasts through 2030. Am J Prev Med 42:563–570 - PubMed
    1. Carlsson LMS, Sjöholm K, Jacobson P et al (2020) Life expectancy after bariatric surgery in the Swedish obese subjects study. N Engl J Med 383:1535–1543 - PMC - PubMed
    1. Eisenberg D, Shikora SA, Aarts E et al (2022) 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 18:1345–1356 - PubMed
    1. Ogden CL, Carroll MD, Kit BK et al (2014) Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311:806–814 - PMC - PubMed