The Endoscopic Gastroplasty ESG – not to be confused with the Laparoscopic Sleeve Gastrectomy- was “endorsed” by the American Society for Metabolic and Bariatric Surgery (ASMBS) as an acceptable tool for treatment of obesity.

Patients need to understand that endoscopic gastroplasty ESG and sleeve gastrectomy LSG are not the same procedure and do not deliver the same outcome. Let’s not forget that we have seen this before with Fen Phen, Lap Band, Realize Band, Gastric balloon, GLP-1, and GIP, where low-risk, simple, and otherwise benign procedures and medications were found to be ineffective at best or to cause irreversible long-term complications at worst.

In EG, the stomach is folded, whereas in LSG, a significant portion of the stomach is removed.

In short, while ASMBS does not consider the ESG equivalent to metabolic and bariatric surgery

(e.g., sleeve gastrectomy, gastric bypass) when it comes to expected weight loss or metabolic

impact, it does fall within a treatment continuum that includes lifestyle therapy, obesity

management medications (OMMs), and metabolic and bariatric surgery and should be available

to patients through bariatric and metabolic surgeons.

In my opinion, as supported by the published literature and the summary of the ASMBS position statement, endoscopic gastroplasty may be an appropriate procedure for some patients with the understanding that the weight loss is slower and less than that of the sleeve gastrectomy.