Endoscopic Procedures

Endoluminal gastroplasty is one such solution that has gained global acceptance in recent years and can be performed using a variety of suturing devices. The best known is endoscopic sleeve gastroplasty (ESG), in which sutures are placed in specific patterns along the great curvature of the stomach to significantly reduce endoluminal gastric volume by creating apposition of the anterior against the posterior wall of the stomach. There are several advantages to endoscopic bariatric procedures. These include particularly anatomical preservation and an improved risk profile. To effectively combat obesity, these benefits also allow for a personalised gradation of procedures offered.

In its current clinically adopted and approved form, ESG utilises a full-thickness endoscopic suturing platform, which allows for full-thickness endoscopic suturing and the creation of running sutures. Suturing begins at the junction of the gastric body and the antrum and progresses upwards towards the fundus, which is usually largely preserved, thus creating a small pouch to allow for fundal accommodation of food. Prolonged gastric accommodation is one significant part of creating satiation. Early satiety is facilitated by the tubular gastric body.

References

Cohen, R., Ponce, J., Abu Dayyeh, B. et al. The International Federation for Surgery and Other Therapies for Obesity (IFSO) Consensus on Clinical Practice in Endoscopic Sleeve Gastroplasty. OBES SURG 36, 1444–1449 (2026). https://doi.org/10.1007/s11695-026-08518-3

Dayyeh, B.K.A., Stier, C., Alqahtani, A. et al. IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management. OBES SURG 34, 4318–4348 (2024). https://doi.org/10.1007/s11695-024-07510-z