Post written by Ali Lahooti, MD, and Reem Z. Sharaiha, MD, MSc, from the Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.

Our study aimed to prospectively evaluate the long-term effectiveness of endoscopic sleeve gastroplasty (ESG) as a standalone therapy for treating obesity and its related comorbidities over a period of 5 years.

The continued rise and prevalence of obesity and its associated comorbid conditions negatively impact both the fiscal health of our healthcare system and the quality of life of our patients. Today, the main options for managing obesity usually revolve around lifestyle changes, medications, or bariatric surgery. Although lifestyle adjustments sound simple in theory, maintaining long-term results is surprisingly challenging with most patients regaining the weight they lost within 5 years.

Unfortunately, many patients do not receive surgical treatment because of concerns about safety, invasiveness, or access. Even medications, such as the popular glucagon-like peptide-1 receptor agonists, are not perfect; real-world studies show that more than half of patients stop these drugs within a year and, by 2 years, nearly three-quarters have discontinued. This leaves a real need for less-invasive, yet effective, obesity treatments. We wanted to assess whether ESG, a minimally invasive option, could bridge this gap by providing sustained weight loss and durable improvements in obesity-related comorbidities.

Our findings showed that ESG resulted in sustained improvement in diabetes control, hypertension, liver function, and cholesterol levels at 5 years. Patients maintained significant weight loss, achieving nearly 12% total body weight reduction, and nearly two-thirds of the patients with diabetes had resolution of their disease. These results confirm ESG’s long-term efficacy as a viable alternative to traditional bariatric surgery and pharmacological treatments, especially for patients hesitant about invasive procedures or those who experience challenges maintaining medication adherence. Future studies should explore combined therapies, such as ESG with pharmacological treatments, to potentially enhance outcomes.

We hope our findings continue to encourage wider consideration and use of ESG, expanding the treatment options available to patients with obesity.

The effects of endoscopic sleeve gastroplasty on comorbidities by body system. HbA1c, Hemoglobin A1c; HOMA-IR, Homeostatic Model Assessment of Insulin Resistance; LDL, low-density lipoprotein; ALT, alanine aminotransferase.

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