Both laparoscopic and endoscopic sleeves lead to significant weight loss, but the degree differs.
Effectiveness of the laparoscopic gastric sleeve: This operation is currently a gold standard in bariatric surgery for obesity – weight loss results are usually very good. In the first year after the intervention, patients can lose on average between 50% and 70% of their excess body weight, which often corresponds to roughly 20–30% of total body weight. For example, a patient who weighed 120 kg (about 40 kg above their ideal weight) can lose 25–30 kg or even more over the course of the first year. Some medical statistics show that, on average, patients end up losing approximately 25% of their total body weight after the surgical sleeve. Of course, individual results vary depending on the patient’s discipline (diet, exercise) and metabolism. It’s important to note that weight loss continues into the second postoperative year (more slowly), and longer-term studies show that a significant portion of the lost weight is maintained over time, especially if the patient keeps up healthy eating habits. The laparoscopic sleeve also helps reduce the sensation of hunger – by removing the fundus of the stomach, levels of ghrelin (the hunger hormone) are lowered, which gives patients a reduced appetite. Likewise, many health problems related to obesity (type 2 diabetes, hypertension, sleep apnea, etc.) show improvements or even remission after the massive weight loss achieved through this operation.
Effectiveness of the endoscopic gastric sleeve: Being a newer, non-surgical procedure, the endoscopic sleeve also offers significant weight loss, but generally not as much as the laparoscopic operation. Studies and clinical experience to date show that patients can lose, on average, around 15–20% of their total body weight in the first year after endoscopic gastroplasty. For example, a 120 kg patient could lose approximately 18–24 kg in a year with the help of this procedure. Some data from specialized clinics report slightly higher percentages (20–25% of total weight), especially in highly cooperative patients, so the weight loss range can vary. A recent article mentions an average weight loss of 20–30% of body weight in patients who underwent ESG – probably at the upper end of the range for the most determined patients. What is certain is that all patients must adopt a healthy lifestyle after the procedure; otherwise, regardless of the method, they may not lose enough or may regain weight. The effectiveness of ESG approaches that of surgery in patients with mild obesity, but for moderate/morbid obesity (very high BMI), the weight loss with the endoscopic method may not be sufficient. In such cases, ESG can still be considered as a first step, with the patient losing some of the excess, and later – if necessary – surgical intervention may be added. One advantage of ESG is that, if results are suboptimal, the procedure can be repeated, or the patient can later be converted to surgical bariatric intervention (since the stomach remains anatomically untouched, a laparoscopic sleeve or gastric bypass can be performed later if desired).
Comparing effectiveness directly: The laparoscopic sleeve generally produces greater and faster weight loss. This is why it remains recommended for patients with more advanced degrees of obesity. The endoscopic sleeve offers significant but more moderate weight loss, suitable especially for those with smaller excess weight or those who want a lower-risk procedure. Both methods require maintaining a healthy diet and an exercise routine; neither is a permanent “magic solution” without effort from the patient. It’s important to note that, regardless of the procedure, weight loss is only sustainable if the new eating and lifestyle habits are maintained long-term – otherwise, weight regain can occur within a few years.
Risk and pottential complications
Any medical procedure, whether surgical or endoscopic, involves certain risks. The good news is that both gastric sleeve variants have proven to be relatively safe compared to other interventions, but there are differences in the type and frequency of possible complications.
Risks of the laparoscopic gastric sleeve: Being an operation, there are general risks associated with surgery and anesthesia. Major complications are rare, but can include: internal bleeding (hemorrhage from the cut edge of the stomach or from damaged vessels), infections (at the incision sites or intra-abdominal), leakage of gastric contents through the suture line (the so-called fistula or dehiscence, when the stomach stapling gives way over a small portion – one of the most serious possible complications), stenosis (excessive narrowing of the gastric tube), or thromboses (postoperative blood clots, for example in the leg – phlebitis – which can migrate to the lungs). The incidence of severe complications in experienced centers is relatively low (on the order of a few percent). For example, the risk of gastric fistula after laparoscopic sleeve is under 2–3%, and operative mortality is under 0.1%. Nevertheless, because of these small but real risks, patients are closely monitored in the hospital and given prophylaxis (such as anticoagulant medication to prevent clots, antibiotics, etc.). Over the long term, some patients may develop gastroesophageal reflux (heartburn) or worsening of it, because with the stomach being smaller and under pressure, acid can more easily rise into the esophagus – a notable percentage of patients report reflux after the sleeve. Likewise, rapid weight loss can lead to gallstones in the first year, which is why medication is sometimes recommended, or even preventive removal of the gallbladder if risk factors are present. Nutritional deficiencies after the gastric sleeve are less common compared to gastric bypass, but vitamin deficiencies can occur (B12, vitamin D, iron, etc.), which is why the doctor will recommend supplements and periodic check-ups. Finally, there are the risks of any general anesthesia and any abdominal intervention (for example, reactions to the anesthetic, cardiac/anesthetic problems, very rarely complications such as accidental injuries to other organs during the operation). Overall, however, the safety profile of the laparoscopic sleeve is well established, with most complications being preventable or treatable if detected in time. To minimize risks, it is essential that the patient be well prepared (complete preoperative evaluation) and operated on by an experienced surgical team, then strictly follow medical recommendations during the recovery period.
Risks of the endoscopic gastric sleeve: The endoscopic procedure avoids many of the risks associated with surgical intervention, but is not entirely free of possible complications. During or after ESG, bleeding may occur at the gastric mucosa (from the suture sites) – usually minor and either stopping on its own or controllable endoscopically right away. A rare but serious risk is gastric perforation (a hole in the stomach wall caused accidentally by instruments or by suture tension). The incidence of perforation is very low (under 1%) and, if it happens, may require emergency surgery to repair the stomach. Some patients may experience nausea, vomiting, or more severe abdominal pain after the procedure – these are usually temporary and resolve with medication. As with the surgical variant, there is a risk of gastroesophageal reflux or worsening of heartburn after the procedure, although some studies suggest that reflux may actually be less frequent and milder than with the surgical sleeve (because the anatomy of the stomach is not altered as drastically). Serious complications are very rare with the endoscopic sleeve – according to specialists, under 1% of patients experience major problems. One advantage is that, since there are no incisions, there is no risk of incisional hernia or wound infections. Likewise, the short hospital stay reduces the risk of nosocomial infections. Overall, ESG has an excellent safety profile, in part due to its minimally invasive nature. Even so, the patient must strictly follow post-procedure instructions (especially the liquid diet at the beginning) to avoid premature tension on the internal sutures. In rare cases, if the sutures are not well tolerated or late complications appear, there is the possibility of endoscopic removal of the sutures or conversion to classic bariatric surgery.
Comparing the safety of the two methods: The endoscopic sleeve tends to have fewer major complications and a slightly lower overall risk, since it avoids extensive surgical trauma. In practice, the most serious risks associated with surgery (fistulas, severe abdominal infections, anesthetic complications) are greatly reduced with ESG. Comparative studies show that the rate of severe complications is under 1% with the endoscopic sleeve, while with the laparoscopic one it is a few percent (though still small). However, it is important to emphasize that the laparoscopic gastric sleeve, although more invasive, has been performed routinely in many hospitals for years, and complications remain rare when the procedure is carried out by experienced teams. The decision between the two will be based mainly on the patient’s profile and not just on fear of complications – a patient with severe obesity may have much more to gain from the massive weight loss of surgery, even if it involves slightly greater risks, compared to a patient with moderate obesity who may opt for a gentler procedure. Regardless of the method, careful medical supervision and adherence to post-procedure recommendations will reduce risks and ensure a safe recovery.
Final conclusion: both the laparoscopic and the endoscopic sleeve can offer the chance of a new beginning to patients who struggle with excess weight and its complications. Regardless of the method chosen, long-term success depends on the patient’s commitment to changing their lifestyle – healthy eating, portion control, regular physical activity, and medical monitoring. Through close collaboration with doctors (surgeon, gastroenterologist, nutritionist, psychologist), patients can reach their weight goals safely and significantly improve their health and quality of life. A specialist consultation is the first step – an open dialogue with the doctor will clarify any uncertainties and lay the foundation for a personalized treatment plan, whether endoscopic or surgical, for a healthier life.
