Endoscopic Sleeve Gastroplasty: a Proposal for a Minimal Invasive Endoscopic Approach to Adolescent Obesity

Area of Science:

• Pediatric Gastroenterology
• Bariatric Endoscopy
• Adolescent Health

Background:

• Adolescent obesity is a critical global health issue with limited effective treatments.
• Bariatric surgery is effective but invasive for pediatric patients.
• Endoscopic sleeve gastroplasty (ESG) presents a less invasive alternative.

Purpose of the Study:

• To provide a comprehensive review of endoscopic sleeve gastroplasty (ESG) in adolescents.
• To evaluate ESG's efficacy, safety, mechanisms, and compare it with other obesity interventions.
• To examine current guideline recommendations for ESG in pediatric populations.

Main Methods:

• A narrative review of English-language studies on ESG in individuals under 21 years old.
• Searches conducted across PubMed, Scopus, EMBASE, and Web of Science up to April 2025.
• Inclusion criteria focused on ESG outcomes, safety, mechanisms, indications, and expert consensus.

Main Results:

• Pediatric data show total body weight loss (TBWL) of 14.4% at 6 months, 16.2% at 12 months, and 13.7% at 24 months.
• ESG demonstrated a favorable safety profile with minor adverse events (2-3%) and no severe complications or growth impairment.
• ESG outperformed lifestyle and pharmacotherapy in TBWL and had fewer complications than laparoscopic sleeve gastrectomy.

Conclusions:

• Endoscopic sleeve gastroplasty (ESG) is a safe, anatomy-preserving, and moderately effective option for adolescent obesity.
• ESG may serve as a bridge between conservative therapies and surgical interventions.
• Long-term data and randomized controlled trials are essential to define ESG's role in pediatric obesity care pathways.