Sleeve gastrectomy roughly doubled six-month weight loss compared with endoscopic sleeve gastroplasty

Design

Retrospective registry analysis (MBSAQIP 2023 with 6-month follow-up)

Population

115,476 adults: 114,967 sleeve gastrectomy, 509 endoscopic sleeve gastroplasty

Primary outcome

Six-month weight and comorbidity change

Effect

BMI loss 8.2 vs 3.9 kg/m²; total weight loss 22.6 vs 11.1 kg

Using the 2023 US MBSAQIP accreditation registry with six-month follow-up (Surgical Endoscopy, 15 October 2026), investigators compared 114,967 laparoscopic sleeve gastrectomies with 509 endoscopic sleeve gastroplasties. Patients having the endoscopic procedure were slightly older and lighter at baseline (mean BMI 40.9 vs 45.0).

At six months, the surgical sleeve produced greater BMI reduction (8.2 vs 3.9 kg/m²) and total weight loss (22.6 vs 11.1 kg). Medication- or insulin-treated diabetes fell by about half after the surgical sleeve, with improvements in dyslipidaemia, hypertension and sleep apnoea, whereas no clinically meaningful comorbidity improvement was seen after endoscopic gastroplasty.

Endoscopic gastroplasty still has a place for patients who decline or are unsuitable for surgery, but it should not be presented as a metabolic equivalent of a sleeve.

• Counsel patients that a surgical sleeve produced about twice the six-month weight loss of an endoscopic sleeve in US registry data.
• For patients with diabetes or sleep apnoea, a surgical sleeve showed comorbidity gains not seen after endoscopic gastroplasty.
• Offer endoscopic gastroplasty mainly to patients who decline or cannot have surgery.
• Set expectations at six months; longer-term durability of both remains to be compared in this dataset.

Why it matters

It gives large real-world numbers to a choice patients increasingly raise after reading about 'non-surgical' options.

Don't overread it

The endoscopic group was small, lighter and less comorbid at baseline, so part of the gap may reflect who was selected.

The statistics, in plain English

The standard deviations are larger than the means, which tells you outcomes varied enormously between patients and follow-up data were patchy; the averages are a guide, not a promise.

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