ESG Offers Safe Weight Loss for Patients with Class III Obesity

Dr. Christopher McGowan
May 24, 2022

Patients lost and maintained more than 20 percent of total body weight after three years, with clinical improvement in metabolic comorbidities

Endoscopic sleeve gastroplasty (ESG) is an effective, long-term weight loss tool for patients with class III obesity—leading to significant total body weight loss (TBWL) and excess weight loss (EWL) after three years, according to research that was selected for presentation at Digestive Disease Week® (DDW) 2022. While ESG is traditionally viewed as optimal for patients with a body mass index (BMI) below 40 kg/m2, findings from this study show that the procedure can lead to significant weight loss and improvement in metabolic comorbidities in higher BMI patients who don’t want or aren’t eligible for traditional bariatric surgery.

In the largest longitudinal ESG study to date in patients with class III obesity (defined as a body mass index for 40 or higher), more than 400 patients underwent the ESG procedure at two sites (Cary, North Carolina, and Sao Paulo, Brazil) and were followed for up to three years. Patients lost 16.5 percent of their total body weight at 6 months; 20.9 percent at 12 months; 20.5 percent at 24 months and 20.3 percent at 36 months.

The research also demonstrated significant improvement in metabolic comorbidities, with 66 percent of patients with hypertension seeing improvement just six months after their ESG procedure. Similarly, 61 percent of patients with type II diabetes; 52 percent of patients with obstructive sleep apnea; and, 45 percent of patients with hyperlipidemia saw improvement or resolution of their respective comorbidity.

“We are in desperate need of additional tools and treatments for patients affected by obesity, especially in class III, where the treatment gap remains so large,” explains Dr. Christopher McGowan, founder and medical director of True You Weight Loss and principal investigator of the study. “We know that only one percent of those eligible for bariatric surgery will ultimately choose the surgical path. Non-surgical endobariatric procedures like ESG offer highly effective, extremely safe options for patients who want to get their weight under control but aren’t interested in or eligible for bariatric surgery.”

ESG is performed endoscopically with the Apollo Overstitch suturing system (Apollo Endosurgery; Austin, TX), with an endoscopist placing a series of running sutures within the stomach to create a sleeve-like shape, reducing the capacity of the stomach by as much as 80%, and leading to earlier satiety. Owing to its non-surgical technique, ESG carries a lower risk of complications and long-term side effects such as gastroesophageal reflux disease (GERD). In this study, the overall adverse event rate was a mere 0.5%, markedly lower than the complication rate seen with traditional bariatric surgery.

“Given the long-term effectiveness and safety of the ESG procedure in patients with class III obesity as evidenced in this study, ESG should be considered an acceptable option for patients with a BMI of 40+ who are looking for alternatives to bariatric surgery,” said Dr. McGowan. “This procedure is significantly improving patients’ lives and overall health—without the significant risk of complications that comes with having major surgery. We are so thrilled that we can now offer minimally invasive weight loss procedures that can deliver near surgical level results.”

DDW Presentation Details

Dr. McGowan will present data from the study during his presentation titled, “ESG in Class III Obesity: Weight Loss and Metabolic Outcomes in 404 Consecutive Patients” [abstract 3694076] during the “Endoscopic Sleeve Gastroplasty Gastric Plication: The Maturing of a Procedure” topic forum on Tuesday, May 24, at 10 am PDT.  



Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW is an in-person and virtual meeting from May 21-24, 2022. The meeting showcases more than 3,100 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at

For Additional Information/Media Interviews:

Jill Dykes

True You Weight Loss/Dr. McGowan


Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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