# Endoscopic Sleeve vs Surgical Sleeve: Less Weight Lost, Fewer Complications By Ruth Calder, Enforcement Editor (https://glpwatchdog.org/authors/ruth-calder) | Published: 2026-08-21 | Updated: 2026-10-27 Canonical page: https://glpwatchdog.org/research/endoscopic-sleeve-versus-surgical-sleeve > 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%. ## Key points - ESG: 13.7-15.2% total body weight loss at 6 months. LSG: 23.5-23.6%, with one study reporting 29.3% at 12 months. - Complication rates excluding the mildest grade (Clavien-Dindo 1): 2.0-2.7% for ESG against 9.2-16.9% for LSG, with no grade IV or V events in either. - ESG weight loss appears to plateau after the one-year mark; two separate papers reported 14.8% at 18 months and 18.6% at 24. - The comparison pools five non-randomized studies with 1,451 ESG patients against only 203 LSG. 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 *From five studies: three ESG cohorts and two case-matched comparisons. 1,451 ESG and 203 LSG patients.[1]* | | 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 comparison is lopsided.** 1,451 ESG patients against 203 LSG patients, across five studies, none of them randomized. The surgical numbers here are the comparator arms of a handful of small studies, not a summary of the very large sleeve-gastrectomy literature. Treat the ESG figures as reasonably supported and the LSG figures as a rough benchmark. ## 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](https://glpwatchdog.org/research/surgery-versus-glp1-drugs) sets out how the two approaches compare on weight, and [the line drawn by surgery](https://glpwatchdog.org/research/the-line-is-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](https://glpwatchdog.org/research/glp1-after-bariatric-surgery-weight-regain). ## Frequently asked questions ### Is endoscopic sleeve gastroplasty as effective as surgery? No. In a systematic review, ESG produced 13.7 to 15.2% total body weight loss at six months against 23.5 to 23.6% for laparoscopic sleeve gastrectomy. Its advantage is a lower complication rate, between 2.0 and 2.7% against 9.2 to 16.9%. ### Does the weight loss last? The review found ESG weight loss appears to plateau after the one-year mark, with medium-term figures of 14.8% at 18 months and 18.6% at 24 months. Weigh that flattening against a six-month headline. ### Is ESG safer? On the complication rates in this review, yes. ESG's rate was roughly a quarter to a fifth of the rate reported for the surgical procedure, excluding the mildest grade. Neither procedure produced any grade IV or V complications in these studies. ### How reliable is this comparison? Moderately. It pools five studies, none randomized, with 1,451 ESG patients against only 203 having the surgical procedure. The surgical figures are the comparator arms of small studies rather than a summary of the much larger sleeve gastrectomy literature. ## 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. https://pubmed.ncbi.nlm.nih.gov/32304011/ --- Cite as: GLP Watchdog, Ruth Calder, "Endoscopic Sleeve vs Surgical Sleeve: Less Weight Lost, Fewer Complications", published 2026-08-21, updated 2026-10-27. https://glpwatchdog.org/research/endoscopic-sleeve-versus-surgical-sleeve Canonical HTML page: https://glpwatchdog.org/research/endoscopic-sleeve-versus-surgical-sleeve Medical disclaimer: Nothing here is medical advice. We report on this subject; we do not treat anyone. Whether to begin a medication, supplement, or treatment, whether to adjust it, and whether to stop are questions for a clinician licensed to answer them, who knows your history.