Revisional bariatric surgery may be an option for people who have experienced weight regain...
For many people, weight loss is not a straight line. Diet and exercise may not be enough.
Medication can help with weight loss, but it may not be the right long-term fit for everyone. And while bariatric surgery can be life-changing for patients who qualify, some people are not ready for surgery or do not meet the body mass index (BMI) requirements.
A newer option, called Endoscopic Sleeve Gastroplasty (ESG), may help bridge that gap. ESG is an incision-free, same-day weight loss procedure designed for people who need more support than lifestyle changes alone, but who may not qualify for or feel ready to pursue bariatric surgery.
“Instead of making surgical incisions, the procedure is performed through the mouth using an endoscope, a thin flexible tube equipped with a camera and specialized tools,” said Christopher Bashian, DO, general and bariatric surgeon at Inspira Health. “Sutures are placed inside the stomach to reduce its size, helping patients feel full with smaller portions.”
Because there are no external incisions, ESG typically offers a faster recovery than traditional bariatric surgery. Most patients return home the same day and continue their weight-loss care with structured nutrition, activity and a follow-up plan.
A middle ground between medication and surgery
The rise of GLP-1 medications has changed the conversation around medical weight management. For many patients, these therapies can be an effective tool, but they aren’t the only option. They may not be appropriate, affordable or sustainable for everyone.
Bariatric surgery is a potential treatment for patients with more advanced obesity or weight-related health issues. However, surgical procedures generally have higher BMI requirements and can feel like a major step for patients who are still exploring their choices. ESG may help fill the space between these options.
“Patients with a BMI of 30 or higher may be candidates for ESG, compared with a threshold of 35 for some surgical weight-loss procedures,” said Dr. Bashian. “That lower BMI requirement means more people may be able to consider procedural weight loss care before their condition progresses or before surgery becomes the only option.”
How ESG works
During ESG, the stomach is reduced from the inside using a specialized endoscopic suturing device. The goal is to create a smaller stomach shape, similar in concept to a sleeve, without removing any part of the stomach and without making incisions.
With a smaller stomach capacity, patients may feel satisfied sooner during meals. Over time, this can support meaningful weight loss when combined with long-term lifestyle changes.
ESG is not a quick fix. Like any weight-loss treatment, it works best as part of a comprehensive medical weight management plan. Patients still need to follow nutrition guidance, build healthy activity habits and attend regular follow-up visits to support lasting results.
Who may benefit from ESG?
ESG may be an option for adults who:
- Have a BMI of 30 or higher
- Have struggled to lose weight with diet and exercise alone
- Do not qualify for bariatric surgery based on BMI
- Are not ready for surgery or want an incision-free approach
- Are looking for a structured, medically supervised weight loss option
A medical weight management team can help determine whether ESG, medication, bariatric surgery or another treatment path is the safest and most effective choice for each patient based on their health history, goals and needs.
Expanding access to weight loss care
Obesity is a complex medical condition, not a lack of willpower. Many patients benefit from having several treatment options available, especially as their needs change over time.
“The addition of ESG gives patients another way to pursue clinically supported weight loss without taking the step into surgery,” said Dr. Bashian. “For people who have felt caught between medication and bariatric surgery, ESG may offer a new path forward.”
Patients interested in ESG should speak with a medical weight management provider to learn more about eligibility, insurance coverage, expected recovery and what to expect before and after the procedure.
