an ESG can safely be performed after the surgical sleeve gastrectomy (sometimes referred to as a “revisional ESG”), with total body weight loss of approximately 16-18% at 12 months. While weight loss is not thought to be as robust as the initial weight loss surgery, the revisional ESG has an improved safety profile compared to a surgical revision and is therefore hypothesized to have greater patient acceptance. Comparison to laparoscopic sleeve gastrectomy Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgeries performed worldwide and shares a similar restricted stomach configuration with the ESG. However, it appears to operate with different weight loss mechanisms from the ESG, as it has been shown to reduce the hunger hormone ghrelin, as well as accelerate, rather than delay, stomach emptying. Large, prospective studies directly comparing LSG to ESG are lacking. Comparison of the two therapies has relied on retrospective analysis and findings are conflicting. In a recent propensity score-matched study, the difference in weight loss for LSG vs ESG was 9.7% at 1 year, 6.0% at 2 years, and 4.8% at 3 years in favor of LSG, though the authors described the ESG as non-inferior based on an a priori definition of non-inferiority as being within 10% total body weight loss of the surgical arm. Advantages of the ESG over LSG include lack of incisions, shorter length of stay (same-day-discharge vs 3 days in hospital); less gastroesophageal reflux (0-2% vs 15-31%); and lower morbidity and overall adverse event rate (1.9% vs 14.5%), though some studies have presented similar rates of adverse events between ESG and LSG. Despite less weight loss, one study found that patients who had undergone ESG had the same degree of comorbidity resolution and had higher quality of life scores at 6 months compared to those who had undergone LSG. See also Vertical banded gastroplasty surgery Intragastric balloon Sleeve gastrectomy surgery Roux-en-Y gastric bypass surgery References Further reading Abu Dayyeh, B. K. et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet 400, 441–451 (2022). James, T. W., Reddy, S., Vulpis, T. & McGowan, C. E. Endoscopic Sleeve Gastroplasty Is Feasible, Safe, and Effective in a Non-academic Setting: Short-Term Outcomes from a Community Gastroenterology Practice. Obes Surg 30, 1404–1409 (2020). Endoscopic Sleeve Gastroplasty for Weight Loss by Dr. Christopher McGowan, https://trueyouweightloss.com/blog/endoscopic-sleeve-gastroplasty-for-weight-loss/ https://www.mayoclinic.org/tests-procedures/endoscopic-sleeve-gastroplasty/about/pac-20393958 Endoscopy Digestive system procedures Bariatrics