Scientific deep-dive
Endoscopic Sleeve vs Surgical Sleeve: Less Weight Lost, Fewer Complications
A systematic review found endoscopic sleeve gastroplasty produced 13.7-15.2% total body weight loss at six months against 23.5-23.6% for surgery, with complication rates, excluding the mildest grade, of 2.0-2.7% against 9.2-16.9%.
Endoscopic sleeve gastroplasty stitches the stomach smaller through the mouth, with no incisions. Laparoscopic sleeve gastrectomy cuts part of it away. A systematic review comparing them found the endoscopic procedure produced 13.7–15.2% total body weight loss at six months against 23.5–23.6% for surgery, with complication rates (excluding the mildest grade) of 2.0–2.7% against 9.2–16.9%.[1] A fair comparison needs both numbers, because the choice is a trade between them.
The two columns
| Endoscopic (ESG) | Surgical (LSG) | |
|---|---|---|
| Total body weight loss, 6 months | 13.7–15.2% | 23.5–23.6% |
| At 12 months | — | 29.3% (one study) |
| At 18 and 24 months | 14.8% and 18.6% | — |
| Complication rate, excluding the mildest grade | 2.0–2.7% | 9.2–16.9% |
| Grade IV or V complications | none | none |
Read the rows against each other rather than in isolation. Surgery produced at least half again as much weight loss at six months. The endoscopic procedure produced roughly a quarter to a fifth as many complications. A person deciding between them is trading one for the other, and which trade is right depends on things a meta-analysis does not know about them.
The plateau
The review’s own conclusion contains a line that matters more than either headline figure: weight loss results for the endoscopic procedure appear to plateau after the one-year mark.[1] The 18- and 24-month figures (14.8% and 18.6%) come from two different papers and sit within about five points of the six-month range.
If you are choosing a procedure on the strength of a six-month number, that is the sentence to weigh. A shallower curve that flattens early is a different long-term proposition from a steeper one, whatever the complication rates say.
Where the drugs sit in this
This comparison predates the current generation of weight-loss drugs being widely available, and neither procedure was compared against them here. That comparison is its own question, and we cover it separately: surgery versus GLP-1 drugs sets out how the two approaches compare on weight, and the line drawn by surgery covers the eligibility thresholds.
If you are considering either procedure, know that weight regain after bariatric surgery is common enough that GLP‑1 drugs are now used for it, which we cover in GLP-1s after bariatric surgery.
Frequently Asked Questions
References
- 1.Jalal MA, Cheng Q, Edye MB. Systematic Review and Meta-Analysis of Endoscopic Sleeve Gastroplasty with Comparison to Laparoscopic Sleeve Gastrectomy Obesity Surgery. 2020. PMID: 32304011.
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Where to get GLP-1 online, safely: sellers our editors have checked
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