As a board-certified Gastroenterologist and Obesity Medicine specialist with extensive experience performing endoscopic sleeve gastroplasty (ESG), I have observed the growing body of evidence supporting this minimally invasive weight loss procedure as a transformative option for patients struggling with obesity. ESG involves endoscopic suturing to reduce stomach volume, promoting satiety and facilitating sustainable weight reduction without surgical incisions. This blog summarizes pivotal clinical studies on ESG, highlighting its efficacy, safety, and role in obesity management. These investigations underscore ESG as a viable non-surgical bariatric procedure for individuals seeking effective weight loss solutions in Central Ohio and beyond.
The MERIT Trial: A Landmark Randomized Study
The Multicenter ESG Randomized Interventional Trial (MERIT) represents a cornerstone in ESG research, evaluating its efficacy against lifestyle modifications alone for patients with class I and II obesity (BMI 30-40 kg/m²). This prospective, multicenter, randomized trial enrolled 209 adults aged 21-65 years across nine U.S. centers. Participants were randomized to ESG plus moderate-intensity lifestyle therapy or lifestyle therapy alone, with the primary endpoint being excess weight loss (%EWL) at 52 weeks.
Results demonstrated superior weight loss with ESG: mean %EWL of 49.2% versus 3.2% in controls, and total body weight loss (%TBWL) of 13.6% versus 0.8%. At 104 weeks follow-up for responders (those achieving ≥25% EWL at 52 weeks), 68% maintained or exceeded this threshold. Additionally, 80% of ESG patients experienced improvements in at least one metabolic comorbidity, such as type 2 diabetes, hypertension, or dyslipidemia. Safety was favorable, with a 1.4% rate of serious adverse events and no procedure-related deaths. This study affirms ESG as a safe, effective non-surgical weight loss option for moderate obesity, bridging the gap between lifestyle interventions and more invasive bariatric surgery.
Five-Year Outcomes: Demonstrating Long-Term Durability
A key longitudinal study by Sharaiha et al. assessed the durability of ESG over five years in a cohort of consecutive patients treated from 2013 to 2019 at a single U.S. center. Involving patients with obesity undergoing ESG as a minimally invasive bariatric procedure, the analysis focused on %TBWL, BMI changes, and safety profiles.
Findings revealed an average %TBWL of 15.9% at five years post-procedure, with 90% of patients maintaining at least 5% TBWL. Early weight loss at one month post-ESG was identified as a strong predictor of long-term success. The procedure exhibited a favorable safety profile, with low rates of complications and no mortality. These results highlight ESG's potential for sustained weight management and position it as a reliable alternative to traditional weight loss surgeries like gastric sleeve or gastric bypass, particularly for those preferring non-surgical options.
Performance Across Obesity Classes: Real-World Insights
A large retrospective analysis of 1,506 U.S. patients examined ESG outcomes stratified by obesity class (I: BMI 30-34.9, II: 35-39.9, III: ≥40 kg/m²). Conducted across seven sites from 2013 to 2022, this real-world study evaluated %TBWL, BMI reductions, and adverse events up to 24 months.
Overall %TBWL was 17.1% at 12 months and 15.3% at 24 months, with 83.2% achieving ≥10% TBWL at one year. Notably, class III patients attained the highest %TBWL (18.4% at 12 months, >20% at 24 months), reducing BMI to the class II range by six months. Safety was consistent across classes, with 2.6% serious adverse events, primarily managed conservatively. This evidence supports ESG as an effective obesity treatment for severe cases, expanding its applicability beyond moderate obesity and reinforcing its role in comprehensive weight loss programs.
ESG Versus Semaglutide: Cost-Effectiveness and Long-Term Benefits
An economic evaluation compared ESG with semaglutide (a GLP-1 agonist) for class II obesity over five years, using data from the MERIT and STEP 1 trials. Employing a Markov model, the study assessed costs, quality-adjusted life-years (QALYs), and weight loss in simulated 45-year-old patients with BMI 37
ESG yielded greater sustained weight reduction (final BMI 31.7 vs 33.0) and was cost-saving, with an incremental cost-effectiveness ratio of -$595,532/QALY. It added 0.06 QALYs while reducing costs by $33,583 compared to semaglutide. Safety considerations included low perioperative risks for ESG and dropout rates for semaglutide. Conclusions emphasize ESG's economic viability for long-term obesity management, particularly when pharmacological costs are prohibitive.
Additional Key Findings from ESG Research
Other studies reinforce these results. For instance, systematic reviews and meta-analyses confirm ESG's pooled %TBWL of 15-17% at 12 months, with low complication rates (1-5%). Comparisons with laparoscopic sleeve gastrectomy show equivalent weight loss for BMI <40 kg/m², but with fewer risks for ESG. These collective insights position ESG as a cornerstone in modern bariatric care, offering a balance of efficacy, safety, and accessibility.
The summarized studies collectively demonstrate that endoscopic sleeve gastroplasty is a safe, effective, and durable weight loss procedure for various obesity severities, improving comorbidities and quality of life. As research evolves, ESG continues to emerge as a preferred minimally invasive alternative to traditional weight loss surgeries.