Endoscopic Sleeve Gastroplasty: Today’s Advances and Tomorrow’s Potential – Insights from Dr. Prabu Doss

Obesity remains one of the most pressing global health challenges, driving the need for innovative, effective, and less invasive weight loss solutions. Among the latest advancements in this field, Endoscopic Sleeve Gastroplasty (ESG) has emerged as a game-changer, offering a minimally invasive alternative to traditional bariatric surgery. Dr. Prabu Doss, a leading expert in bariatric endoscopy, has been at the forefront of refining this procedure, providing valuable insights into its current advancements and future potential. As of February 25, 2025, ESG continues to evolve, blending cutting-edge technology with patient-centered care to address obesity and its comorbidities.

Today’s Advances in ESG

Endoscopic Sleeve Gastroplasty is a non-surgical procedure that reduces the stomach’s capacity using an endoscope equipped with a suturing device. By placing full-thickness sutures along the greater curvature of the stomach, ESG creates a sleeve-like structure, limiting food intake and promoting early satiety. Unlike laparoscopic sleeve gastrectomy, which involves removing a portion of the stomach, ESG is incisionless, reversible, and associated with fewer complications, making it an attractive option for patients seeking effective weight loss without the risks of traditional surgery.

Dr. Prabu Doss highlights several key advances that have solidified ESG’s place in modern medicine. “The procedure has become more standardized and efficient over the years,” he notes. “Refinements in endoscopic suturing technology, such as the OverStitch system, allow for precise, reproducible results, while procedural times have decreased significantly—often to under an hour.” This efficiency translates to same-day discharge for most patients, reducing hospital stays and recovery periods compared to surgical alternatives.

Recent data underscores ESG’s efficacy. Patients typically achieve 15-20% total body weight loss within one to two years, with sustained results up to five years when paired with lifestyle modifications. Dr. Doss emphasizes the multidisciplinary approach as a cornerstone of success: “Combining ESG with nutritional counseling, behavioral therapy, and exercise regimens enhances outcomes and helps patients maintain their weight loss long-term.” Additionally, ESG has shown promise in improving obesity-related conditions like type 2 diabetes, hypertension, and fatty liver disease, offering a holistic benefit beyond mere weight reduction.

Safety is another area where ESG shines. Complication rates are remarkably low—less than 2% in most studies—covering minor issues like nausea or temporary discomfort rather than severe events like leaks or bleeding. Dr. Doss attributes this to the procedure’s minimally invasive nature and the growing expertise of endoscopists worldwide. “Training programs and simulation technologies have elevated the skill level of practitioners, making ESG accessible beyond academic centers into community settings,” he explains.

Tomorrow’s Potential

Looking ahead, Dr. Prabu Doss envisions a transformative future for ESG, driven by technological innovation and personalized medicine. “We’re just scratching the surface of what this procedure can achieve,” he says. One exciting frontier is the integration of artificial intelligence (AI) and machine learning to optimize outcomes. AI could analyze patient data—such as baseline BMI, metabolic profiles, and early weight loss trends—to predict long-term success and tailor post-procedure plans. “Imagine a system that tells us within a month of ESG whether a patient needs more intensive follow-up or a slight tweak in their suture pattern,” Dr. Doss muses.

Another promising direction is the enhancement of suturing technology. Current devices are effective, but next-generation tools could allow for even greater precision, durability, and customization. Dr. Doss suggests that adjustable or dissolvable sutures might one day enable physicians to modify the sleeve over time, adapting to a patient’s changing needs. “This could make ESG a dynamic intervention, not a one-time fix,” he adds, hinting at its potential to bridge the gap between temporary endoscopic therapies (like intragastric balloons) and permanent surgical options.

The role of ESG in treating a broader range of patients is also expanding. While it’s currently recommended for those with a BMI of 30-40, Dr. Doss sees it as a viable option for higher-BMI individuals or those with contraindications to surgery, such as chronic dialysis patients or those awaiting organ transplants. “We’ve already seen success in these complex cases,” he says. “As evidence grows, ESG could become a first-line therapy for a wider population, especially in regions where surgical resources are limited.”

Furthermore, ongoing research into the physiological effects of ESG—such as its impact on gut hormones, gastric motility, and the microbiome—could unlock new therapeutic avenues. Dr. Doss is particularly excited about how ESG might influence metabolic pathways beyond weight loss. “If we can prove it resets insulin sensitivity or alters bile acid signaling more effectively than we thought, it could redefine how we approach metabolic syndrome,” he predicts.

Challenges and the Road Ahead

Despite its promise, ESG faces hurdles. Dr. Doss acknowledges that long-term data beyond five years is still limited, and more randomized controlled trials are needed to compare it definitively with surgical options and emerging pharmacotherapies like GLP-1 agonists. Cost and accessibility also remain barriers, though he believes that as adoption grows and technology advances, economies of scale will make ESG more affordable.

Patient adherence is another critical factor. “ESG is not a magic bullet,” Dr. Doss cautions. “It requires commitment to lifestyle changes, and we need better tools to identify who will thrive with this approach upfront.” He advocates for psychological screening and early intervention to boost success rates, drawing from his own practice where patient engagement has proven pivotal.

Conclusion

Endoscopic Sleeve Gastroplasty stands at a crossroads of innovation and practicality, offering a compelling solution to the obesity epidemic as of February 25, 2025. Through the lens of Dr. Prabu Doss’s expertise, it’s clear that today’s advances—improved technology, proven efficacy, and enhanced safety—are laying a strong foundation for tomorrow’s potential. As ESG continues to evolve, it promises not only to reshape stomachs but also to transform lives, blending the art of medicine with the science of possibility. With pioneers like Dr. Doss leading the charge, the future of ESG looks bright, poised to redefine weight loss and metabolic health for generations to come.