# Endoscopic Sleeve Gastroplasty: A Qualitative Narrative Review of Outcomes, Safety, and Clinical Applications

## TL;DR

Endoscopic sleeve gastroplasty is a minimally invasive obesity treatment that reduces stomach volume and offers weight loss with fewer risks than surgery.

## Contribution

This paper provides a comprehensive narrative review of ESG's outcomes, safety, and evolving clinical applications.

## Key findings

- ESG offers clinically meaningful weight loss and metabolic improvement with a favorable safety profile.
- ESG can be used as a bridge to surgery for high-risk patients or for revisional strategies after prior non-resective procedures.
- ESG is a versatile, low-risk alternative to traditional bariatric surgeries like laparoscopic sleeve gastrectomy.

## Abstract

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive intervention for obesity, bridging the gap between conservative medical therapy and surgical bariatric procedures. ESG reduces gastric volume through endoscopic suturing, creating a tubular gastric sleeve without gastric resection and with the preservation of native anatomy. This approach offers clinically meaningful weight loss, metabolic improvement, and a favorable safety profile while minimizing procedural risk and recovery time. This qualitative narrative review provides a comprehensive evaluation of ESG, including its historical development, procedural technique, patient selection criteria, mechanisms of action, clinical outcomes, and safety considerations. The comparative efficacy of ESG relative to established bariatric surgeries, including laparoscopic sleeve gastrectomy (LSG) and open sleeve gastrectomy (OSG), is discussed, highlighting ESG’s unique balance between effectiveness and minimally invasive design. Evolving applications are also explored, including combination with pharmacologic therapy, use as a bridge to surgery for high-risk patients, and revisional strategies for weight regain after prior non-resective procedures, where preserved gastric anatomy allows safe and effective volume modification. Future directions focus on procedural refinement, optimizing patient selection, combining with adjunct therapies, and integrating into multidisciplinary obesity management. ESG represents a versatile, patient-centered tool that complements existing treatment paradigms, expands therapeutic options, and offers a practical, low-risk alternative for patients seeking minimally invasive treatment for obesity. Its growing adoption underscores its potential to play a central role in contemporary obesity management strategies.