GIE Associate Editor Thiruvengadam Muniraj, MD, highlights this article from the July issue: “Improvement in obesity-related comorbidities 5 years after endoscopic sleeve gastroplasty: a prospective cohort study” by Ali Lahooti, BS, et al.

As the global obesity epidemic intensifies, the demand for durable, effective, and less-invasive interventions continues to rise. Although bariatric surgery remains the reference standard, its uptake is often limited by access barriers, safety concerns, and patient hesitancy. Endoscopic sleeve gastroplasty (ESG) has emerged as a promising bridge between pharmacotherapy and surgery, offering an incisionless outpatient alternative.

In this issue of GIE, a 5-year prospective study from Weill Cornell Medicine, New York, New York, United States, demonstrates the long-term efficacy of ESG as a standalone intervention for obesity. ESG achieved a mean total body weight loss of 11.8% at 60 months, accompanied by sustained improvements in key metabolic comorbidities—including type 2 diabetes, hypertension, hyperlipidemia, and metabolic dysfunction–associated steatotic liver disease. Most notably, two-thirds of patients with diabetes experienced resolution without the need for adjuvant pharmacotherapy.

In an era dominated by glucagon-like peptide-1 receptor agonists, ESG offers a durable alternative for patients who are ineligible for, intolerant of, or simply unwilling to pursue chronic pharmacologic therapy. With U.S. Food and Drug Administration authorization, a favorable safety profile, and outpatient feasibility, ESG is well-positioned for broader clinical adoption.

Flow of patient recruitment and follow-up. ESG, Endoscopic sleeve gastroplasty; RYGB, Roux-en-Y gastric bypass.

Read the full article online.

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