Obesity Surgery

, Volume 28, Issue 7, pp 1812–1821 | Cite as

Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study

  • Adrian Sartoretto
  • Zhixian Sui
  • Christine Hill
  • Margo Dunlap
  • Angielyn R. Rivera
  • Mouen A. Khashab
  • Anthony N. Kalloo
  • Lea Fayad
  • Lawrence J. Cheskin
  • George Marinos
  • Erik Wilson
  • Vivek KumbhariEmail author
Original Contributions



Endoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success.


Patients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events.


In total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed.


ESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.


Endoscopic sleeve gastroplasty Weight loss Obesity Endoscopic bariatric therapy Endoscopic suturing 



argon plasma coagulation


endoscopic bariatric therapy


endoscopic sleeve gastroplasty


excess weight


excess weight loss


obesity-related chronic disease/condition


total body weight loss


Authors’ Contributions

AS and VK had the concept of the work. AS, VK, and ZS completed data analysis and interpretation. All the authors had equal contributions in data collection, drafting the article, and critical revision of the article. All authors approved the final version of the article for publication.


No funding declaration is needed by the authors.

Compliance with Ethical Standards

Conflicts of Interest

AS, EW, and VK are consultants with Apollo Endosurgery. AS and GM are consultants for BAROnova. VK is also a consultant for Boston Scientific, Reshape Medical, and Medtronic. MAK is a consultant for Boston Scientific and Olympus America. ANK is a founding member, equity holder, and consultant for Apollo Endosurgery. EW is a consultant for Gore, Intuitive, Ethicon, Olympus, and EndoGastric Solutions. The remaining authors disclose no conflict of interest.

Ethics Statement

All procedures performed in the study were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required.

Consent Statement

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11695_2018_3135_MOESM1_ESM.docx (648 kb)
ESM 1 (DOCX 647 kb).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Adrian Sartoretto
    • 1
  • Zhixian Sui
    • 1
  • Christine Hill
    • 2
  • Margo Dunlap
    • 3
  • Angielyn R. Rivera
    • 4
  • Mouen A. Khashab
    • 3
  • Anthony N. Kalloo
    • 3
  • Lea Fayad
    • 3
  • Lawrence J. Cheskin
    • 2
    • 3
  • George Marinos
    • 1
  • Erik Wilson
    • 4
  • Vivek Kumbhari
    • 3
    Email author return OK on get
  1. 1.Bariatric and Metabolic InstituteDouble BayAustralia
  2. 2.Johns Hopkins Weight Management Center, Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Division of Gastroenterology and Hepatology, Department of MedicineThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Department of SurgeryThe University of Texas Health Science Center at HoustonHoustonUSA

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