Mixed
Endoscopic Sleeve Gastroplasty (ESG) using full-thickness suturing produces durable weight loss (mean 64-67% Excess Weight Loss at 12 months) and significant improvement/remission of metabolic comorbidities (T2DM, hypertension, NAFLD) in patients with BMI 30-50 kg/m2, outperforming lifestyle modifications and intragastric balloons.
ESG is a minimally invasive endoscopic procedure that reduces stomach volume and delays emptying to promote satiety. It is suitable for adults with BMI 30-50 who want a durable alternative to lifestyle changes or balloons, with high success rates for weight loss and metabolic improvement. It requires general anesthesia and has a low risk of serious complications.
Among these EBMTs, gastric remodeling interventions have demonstrated superior efficacy as primary endoscopic therapies for achieving weight loss at the 12-month mark... The largest cohort to date involved 1,000 patients who underwent ESG, achieving a mean EWL of 64.3% at 6 months, 67.5% at 12 months... The MERIT trial... showed that at 52 weeks, the ESG group had significantly higher mean EWL (49.2% vs. 3.2%) and TWL (13.6% vs. 0.8%) compared to the lifestyle-only group... ESG appears to be more effective, durable, and better tolerated than IGB placement.
Why this rating
Supported by large cohort studies (n=1000), multicenter RCTs (MERIT trial), and meta-analyses, though long-term (>5 years) data is still emerging.
Source
Endoscopic gastric remodeling procedures for obesity treatment: a comprehensive review
Stephen Ka Kei Ng et al. · Metabolism and Target Organ Damage · 2025
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