Endoscopic sleeve gastroplasty, a game-changer for obesity

A new study reveals that endoscopic sleeve gastroplasty (ESG) as a standalone treatment offers significant and lasting benefits for individuals living with obesity and related health conditions.

The minimally invasive procedure has shown to provide sustained weight loss and improvement in key comorbidities over a five-year period.

The findings come from a five-year prospective cohort study involving 404 adults living with obesity who underwent ESG between August 2013 and July 2024. Participants, with a mean age of 45 years and predominantly women (76.2 per cent), had a body mass index (BMI) of ≥30 or ≥27 with comorbidities. All had either failed previous nonsurgical weight-loss attempts or opted against bariatric surgery despite being eligible.

The study tracked the effects of ESG on conditions such as diabetes, hyperlipidemia, metabolic dysfunction–associated steatotic liver disease (MASLD), and hypertension. Researchers measured key biomarkers, including hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) cholesterol, alanine aminotransferase (ALT) levels, and systolic blood pressure, at intervals of one, three, and five years post-procedure.

At the five-year mark, the procedure delivered impressive results including an improvement in diabetes by decreasing mean HbA1c levels from 5.80 per cent to 5.63 per cent, with 66.7 per cent of patients achieving diabetes resolution. Similar benefits were observed in those with prediabetes.

Researchers also found a reduction in cholesterol, LDL-C levels dropped significantly in patients with baseline levels over 100 mg/dL. Liver health was found to improve, ALT levels improved by 31 per cent in men and 20 per cent in women.

Key findings also highlighted a fall in blood pressure, with 51.7 per cent of patients achieving hypertension resolution and patients experienced an average total body weight loss of 11.8 per cent.

Only three moderate adverse events were reported, equating to a low complication rate of 0.7 per cent.

The authors highlight ESG’s role in addressing obesity-related comorbidities. "Substantial evidence shows that obesity management and modest weight loss significantly improve glycemic control, delay diabetes progression, and can even reverse diabetic status in some individuals," the researchers noted. "Our findings corroborate and extend these observations, demonstrating that the glycemic benefits of ESG are maintained for up to five years post-procedure."