Endoscopic Sleeve Gastroplasty: 6-Year Outcomes in 1,377 Patients

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoluminal bariatric procedure, but long-term outcomes beyond 5 years remain limited. This study reports 6-year weight loss, comorbidity outcomes, and safety data from a large single-center cohort. This retrospective cohort study included adults undergoing ESG between June 2019 and June 2025 with mean follow up of 3.8 ± 1.4 years. Primary outcomes were percent total weight loss (%TWL) and percent excess weight loss (%EWL) assessed up to 6 years. Secondary outcomes included resolution or improvement of type 2 diabetes mellitus (T2DM), hypertension, obstructive sleep apnea (OSA), and dyslipidemia. Adverse events and revision procedures were recorded. Missing data were handled using multiple imputation by chained equations within an intention-to-treat framework, with sensitivity analyses using non-responder imputation and last-observation-carried-forward methods. A total of 1,377 patients underwent ESG (mean age 41.5 ± 12.2 years; 53.5% female; baseline BMI 35.2 ± 4.8 kg/m²). Mean %TWL was 21.2% (95% CI 20.8–21.6) at 1 year and 14.4% (95% CI 14.0–14.8) at 6 years. Mean %EWL was 56.9% at 1 year and 43.4% at 6 years. At 6 years, resolution or improvement was observed in T2DM (51.2%), hypertension (65.8%), OSA (89.9%), and dyslipidemia (73.6%). There was no mortality. One patient (0.07%) required operative intervention for bleeding. Revision procedures occurred in 5.7% of patients. This study shows that ESG produces measurable weight loss and achieves comorbidity improvement through 6 years, with a favourable safety profile and low revision rate. however, prospective comparative studies are needed to define its role relative to surgical and pharmacologic therapies.