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IFSO Bariatric Endoscopy Committee Evidence‑Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management, 2024
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<aside> 📘
The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy, 2021
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| Procedure | Main Mechanisms |
|---|---|
| ESG | Delayed gastric emptying (gastric stasis). Increased early satiation. Minimal gut hormone alteration. |
| LSG | Rapid gastric emptying into small bowel. Hormonal modulation: ↑ GLP-1, PYY, adiponectin; ↓ ghrelin, leptin. |
| Hormone | After ESG | After LSG |
|---|---|---|
| Leptin | ↓ (reduction) | ↓ (reduction) |
| Insulin | ↓ with improved secretion pattern | Not specified |
| Ghrelin | No change | ↓ (reduction) |
| GLP-1 | No change | ↑ (increase) |
| PYY | No change | ↑ (increase) |
| Adiponectin | Not measured | ↑ (increase) |
| Procedure | Change in T½ | Effect on Solid Food Emptying |
|---|---|---|
| ESG | ↑ by 90 minutes | Delayed emptying |
| LSG | ↓ by 29.2 minutes | Accelerated emptying |
ESG is effective in patients with mild-to-moderate obesity (BMI 30–40 kg/m²).
LSG is superior for patients with BMI >40 kg/m² in terms of weight loss.
| Procedure Type | %TBWL at 12 mo |
|---|---|
| IGB (Balloon) | 13.9% |
| High-Intensity Diet and Lifestyle Therapy | 14.3% |
| ESG | 16.1–20.6% |
| LSG | 23.6% |