Endoscopic sleeve gastroplasty (ESG) differs from Laparoscopic sleeve gastrectomy (LSG).

ESG (Endoscopic Sleeve Gastroplasty)  is promoted and advocated as a low-risk, equal alternative to the Laparoscopic Sleeve Gastrectomy, but it is not.

Anatomically speaking:

Endoscopic Sleeve Gastroplasty is an endoscopic procedure performed under general anesthesia. During this procedure, a specialized endoscope is inserted through the mouth into the stomach. Multiple plastic “H”-type anchors are used to create a fold in the stomach, thereby reducing its size. No part of the stomach is removed. Initial limited weight loss occurs as the patient feels full after consuming small volumes of food. This effect resembles what happens with the lap band and gastric balloon, and we know how the story ends with those.

LSG is performed laparoscopically with incisions on the abdomen under general anesthesia. Seventy-five to eighty-five percent of the stomach, along its greater curvature, is removed, eliminating the part of the stomach that produces the Ghrelin hormone, which controls and modulates hunger. This is why patients feel fuller with a smaller volume of food and experience significantly reduced hunger.

Results:

Please read the fine print

The summary results indicate

“Our results suggest that ESG is safe and effective for the treatment of obesity, with durable

long-term results for at least up to 5 years after the procedure. “

When you look at the details of the results, however, it states:

“At 5 years, mean TBWL was 15.9% (95% CI, 11.7-20.5, p < .001) and 90 and 61% of

patients maintained 5 and 10% TBWL, respectively.”

This means that five years after ESG, 90% of the patients have only lost 10% of their TBWL (total body weight loss), and 61% would have lost 10% of their TBW (Total Body Weight).

Let’s do that math: If a patient weighs 250 lbs. and has ESG, five years later, they would have lost only between 5-10% of their TBW. This means that five years after ESG, the patient who started at 250 lbs will weigh between 225 lbs. (250 – 25, 10%) and 235.25 lbs. (250 – 12.5, 5%). Can anyone say why this makes sense? Comparatively the Laparoscopic Sleeve Gastrectomy (LSG) at 5 years after patients typically experience a mean total body weight loss (TBWL) of around a mean of 16% ( 90% of patients). 8% of LSG patients had lost 30% or more of their total body weight TBWL.

This serves as an illustration of how actual outcomes are obscured within the fine print, resulting in a lack of attention from individuals seeking the optimal outcome devoid of perceived risk. The same principle applies to the ongoing discourse regarding GLP-1 medications. The genuine risk associated with ESG and PLG-1 is that patients have undergone alterations to their anatomy and physiology without demonstrable results. Several years into contemplating a treatment promising sustained outcomes, we find that the alterations have increased the overall risk.

As a surgeon, I encourage people to always ask questions and demand that scientific proof be provided. I am not opposed to progress; considering the nature of our practice, we have witnessed and have unrgone significant evolution over the past 30 years, transitioning from performing open cases necessitating a hospitalization period of 4 to 6 days to performing the same cases  laparoscopically and robotically in some cases outpatient procedures.