Endoscopic Sleeve Gastroplasty: A Qualitative Narrative Review of Outcomes, Safety, and Clinical Applications

Endoscopic sleeve gastroplasty (ESG) has emerged as a minimally invasive intervention for obesity, bridging the gap between conservative medical therapy and surgical bariatric procedures. ESG reduces gastric volume through endoscopic suturing, creating a tubular gastric sleeve without gastric resection and with the preservation of native anatomy. This approach offers clinically meaningful weight loss, metabolic improvement, and a favorable safety profile while minimizing procedural risk and recovery time. This qualitative narrative review provides a comprehensive evaluation of ESG, including its historical development, procedural technique, patient selection criteria, mechanisms of action, clinical outcomes, and safety considerations. The comparative efficacy of ESG relative to established bariatric surgeries, including laparoscopic sleeve gastrectomy (LSG) and open sleeve gastrectomy (OSG), is discussed, highlighting ESG's unique balance between effectiveness and minimally invasive design. Evolving applications are also explored, including combination with pharmacologic therapy, use as a bridge to surgery for high-risk patients, and revisional strategies for weight regain after prior non-resective procedures, where preserved gastric anatomy allows safe and effective volume modification. Future directions focus on procedural refinement, optimizing patient selection, combining with adjunct therapies, and integrating into multidisciplinary obesity management. ESG represents a versatile, patient-centered tool that complements existing treatment paradigms, expands therapeutic options, and offers a practical, low-risk alternative for patients seeking minimally invasive treatment for obesity. Its growing adoption underscores its potential to play a central role in contemporary obesity management strategies.