Endoscopic Sleeve Gastroplasty (ESG) and GLP-1 Therapy in 2025: A Comprehensive Guide to the Future of Bariatric Endoscopy
A new era in obesity and metabolic care
The rising prevalence of overweight, obesity, and metabolic syndrome has become one of the most urgent public health challenges globally. These conditions significantly contribute to type 2 diabetes, cardiovascular disease, and non-alcoholic fatty liver disease. Affecting more than one-third of the adult population worldwide, they not only reduce quality of life but also impose trillions of dollars in healthcare costs annually.
As the need for scalable, effective, and minimally invasive treatment options grows, the combination of endoscopic sleeve gastroplasty (ESG) and GLP-1 receptor agonists has emerged as a promising therapeutic strategy. Bumrungrad International Hospital is proud to be among the first centers globally to offer this advanced approach, achieving impressive results with total weight loss as high as 44%
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This integrated method offers meaningful and sustained weight loss, metabolic improvements, and reduced disease progression—filling a critical gap between lifestyle changes and bariatric surgery.
In 2025, bariatric endoscopy continues to evolve, providing patients with less invasive, highly effective, and personalized options for weight loss and metabolic health improvement. Among the most promising innovations is the combination of Endoscopic Sleeve Gastroplasty (ESG) with injectable GLP-1 receptor agonists, such as semaglutide and tirzepatide. This article provides a comprehensive, 25-minute read on everything patients need to know about ESG, GLP-1 medications, and the latest advancements in bariatric endoscopy.
Understanding Endoscopic Sleeve Gastroplasty (ESG): A Minimally Invasive Weight Loss Solution
Benefits, Procedure, and Risks of Endoscopic Sleeve Gastroplasty (ESG)
Procedure overview
- Preparation: Fasting and pre-operative assessment.
- Anesthesia: Typically performed under general anesthesia.
- Suturing: Using an endoscopic suturing device, U- or Z-shaped sutures are placed in the stomach wall.
- Recovery: Most patients return home the same day or after an overnight stay.
- Post-procedure care: A liquid diet followed by gradual food reintroduction, along with lifestyle and nutritional support.
Benefits of ESG
- Non-surgical, incision-free
- Reversible and repeatable
- Short recovery time (3–7 days)
- 15–20% average total body weight loss
- Improvement in blood sugar, cholesterol, and blood pressure
Who is ESG for?
- Individuals with BMI ≥30 kg/m² or BMI 27–30 kg/m² with obesity-related conditions
- Patients not suitable for or unwilling to undergo surgery
- Individuals who haven’t achieved success with lifestyle or medical therapy
Risks and complications
- Nausea, vomiting, and abdominal pain, mainly during the first week
- Less gastroesophageal reflux compared to bariatric surgery
- Rare complications such as bleeding, infection, or gastric leak
GLP-1 Receptor Agonists Explained: Semaglutide, Tirzepatide, and More
Benefits, Side Effects, and Weight Loss Outcomes of GLP-1 Therapy in 2025
GLP-1 medications in 2025
- Semaglutide (Wegovy®, Ozempic®)
- Tirzepatide (Zepbound™, Mounjaro™) — also acts on GIP (glucose-dependent insulinotropic polypeptide)
Mechanism of action
- Reduces appetite and caloric intake
- Improves glycemic control and insulin sensitivity
- Affects both central and peripheral metabolic pathways
Weight loss outcomes
- Semaglutide: 12–17% total body weight loss
- Tirzepatide: 15–22% or more
Other benefits
- Lower HbA1c levels
- Improved lipid profiles
- Reduction in cardiovascular risk
- Reversal or remission of type 2 diabetes in many cases
Common side effects
- Nausea, diarrhea, constipation
- Rare gallbladder or pancreas-related issues
- Risk of muscle loss if weight loss occurs too rapidly without exercise
Combining ESG and GLP-1 Therapy: A Breakthrough in Obesity Treatment for 2025
Why combine ESG and GLP-1 therapy?
- More sustainable and enhanced weight loss
- Greater metabolic improvement
- Lower hunger and increased feelings of fullness
- Better patient adherence and satisfaction
Outcomes of combination therapy
- 25–30% total body weight loss
- Up to 2.0% HbA1c reduction
- Significant reductions in LDL and triglycerides
- Improved liver health and reversal of fatty liver disease
- Lower 10-year cardiovascular event risk
Why ESG Plus GLP-1 Therapy May Be Better Than Bariatric Surgery
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Feature
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ESG + GLP-1
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Bariatric Surgery
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|
Procedure Type
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Minimally invasive
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Invasive surgery
|
|
Hospital Stay
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0–1 days
|
2–5 days
|
|
Recovery Time
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3–7 days
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2–6 weeks
|
|
Weight Loss
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25–30%
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25–40%
|
|
Reversibility
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Yes
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No
|
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Complication Risk
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Low
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Moderate to High
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Who should consider this approach?
- Patients seeking a safer, reversible alternative to surgery
- Those with multiple metabolic conditions
- Individuals preferring outpatient options with faster recovery
What’s New in Bariatric Endoscopy in 2025: Technology, Research, and Global Trends
New technologies and techniques
- Enhanced suturing devices for quicker, more reliable ESG procedures
- Robotic-assisted endoscopy for greater precision and reduced operator fatigue
- AI in endoscopy for real-time feedback and outcome prediction
Expanded indications
- Use in lower BMI patients with metabolic syndrome
- Preventive therapy in pre-diabetic individuals
- Broader global adoption through simplified training modules
Improved multidisciplinary care
- Integration with digital coaching and remote patient monitoring
- Customized GLP-1 dosage and timing protocols
- Comprehensive psychological and nutritional support
Clinical research and evidence
- Long-term trials demonstrating durability of combination therapy
- Real-world registries confirming low complication rates and sustained benefits
ESG and GLP-1 Therapy at Bumrungrad — A Safer, More Effective Future for Weight Loss
As 2025 progresses, the combination of Endoscopic Sleeve Gastroplasty and GLP-1 therapy stands as a transformative solution for obesity and metabolic syndrome. For many patients, it offers a safe, reversible, and highly effective path to better health.
If you are struggling with weight-related health issues and wish to avoid surgery, consult your healthcare provider to explore whether ESG and GLP-1 therapy at Bumrungrad International Hospital are right for you.
With the right support and a personalized plan, long-term success is not just possible — it’s within reach.
Talk to your doctor today. The future of bariatric care is here.
Tossapol Kerdsirichairat, MD, FACG, FASGE
Clinical Associate Professor of Medicine
Advanced/Bariatric Endoscopy, Digestive Disease Center
Bumrungrad International Hospital
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Last modify: May 05, 2025