Improvement in Obesity-Related Comorbidities 5 Years After Endoscopic Sleeve Gastroplasty: A Prospective Cohort Study.

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Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure that the gastric cavity to facilitate weight loss. We aimed to evaluate the long-term effects of ESG as a monotherapy on obesity-related comorbidities over five years. This prospective study analyzed data from 404 consecutive patients (45±11.9 years; 76% female) who underwent ESG from August 2013 through June 2024. All patients had BMI ≥30 or ≥27 kg/m2 with comorbidities. Patients receiving adjuvant therapy were excluded to assess ESG as a monotherapy. All procedures were performed with a flexible endoscopic suturing system to facilitate restriction of the stomach. Patients were evaluated after 12 months (n=336), 36 months (n=210), and 60 months (n=196) for anthropometric features, clinical parameters, metabolic panels, and liver function tests. The primary outcomes were the effects of ESG on obesity-related comorbidities and metabolic biomarkers. Secondary outcomes were total body weight loss and safety. At five-years after ESG, patients had significant reductions in levels of hemoglobin A1c (Δ 0.42%, p=0.0007), systolic blood pressure (Δ 4.1 mmHg, p=0.0071), and alanine aminotransferase (Δ 7.4 U/L, p=0.002). BMI before the procedure was 37.5 ± 5.8 and 33.8 ± 6.7 kg/m2 at 60 months (p<0.001). Total body weight loss was 13.4% at 12 months (84.5% follow-up), 9.9% at 36 months (63.3% follow-up), and 11.8% at 60 months (74.8% follow-up) - with three moderate adverse events (0.7%). ESG is an effective, noninvasive monotherapy that improved markers of hypertension, diabetes, MASLD, and led to total body weight loss of 11.8% at five years post-procedure.