ESG Yields Significant Weight Loss Across Obesity Classes


Endoscopic sleeve gastroplasty (ESG) is safe and effective for weight loss in adults with class I, II, or III obesity, according to real-world data from a large US study.


  • Researchers conducted a retrospective analysis of 1506 adults (85% female, 70% White) with severe obesity (501 class I, 546 class II, and 459 class III) who underwent ESG at seven academic and private US centers from 2013-2022.

  • Average percent total body weight loss (%TBWL) was evaluated at 6, 12, 18, and 24 months after the procedure.

  • Weight loss and safety outcomes were evaluated according to obesity class.


  • At 12 months, 83.2% of patients achieved ≥10% TBWL and 60.9% achieved ≥15% TBWL across all obesity classes.

  • There was a significant difference in TBWL by baseline obesity class, with average weight loss significantly greater in class III than classes I and II at all timepoints. At 24 months, class III patients had mean TBWL of 20.4%, compared with 13.3% for class I and 13.6% for class II patients.

  • As early as 6 months post-ESG, patients in all BMI classes were able to drop to the next lower BMI class and remained there through 2 years. However, ongoing improvement in BMI until the end of follow-up was seen only in class III patients. Notably, class III patients were significantly younger and taller than class I and class II patients.

  • There were no differences in adverse events between obesity classes. Only 2.6% of patients had an adverse event requiring hospitalization. Most of these events (86%) were for symptom management and/or fluid replacement.


“Traditionally, ESG has been proposed as a treatment choice for patients with class I and II obesity because of its modest weight loss outcomes. However, our data show a %TBWL crossing 20% in patients with class III disease, which may push the envelope of perceived utility of ESG,” the authors write.


The study, with first author Khushboo Gala, MBBS, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, was published online October 3 in Clinical and Translational Gastroenterology.


Limitations include the retrospective design, with outcomes only out to 2 years, and loss of follow-up, with only 339 of the 1506 patients evaluated at 2 years.


The study had no financial support. Several study authors reported ties to industry. The full list can be found with the original article.

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