Endoscopic Sleeve Gastroplasty Is Not Equal to Vertical Gastric Sleeve

Endoscopic gastroplasty is not equal to a sleeve gastrectomy.

The endoscopic gastroplasty is a procedure that has received some press.  The endoscopic gastroplasty is a procedure where the stomach is cinched down and narrowed using sutures.  The sutures are placed within the inside of the stomach using an endoscope.

The supposed benefits of the endoscopic gastroplasty is that it is an “incisionless” surgery, in that the entire procedure is performed using an endoscopic delivered through the mouth.  

Most importantly, this procedure if often, but INCORRECTLY, referred to, as endoscopic sleeve. The endoscopic gastroplasty IS NOT the same as sleeve gastrectomy.

No portion of the stomach is removed in an endoscopic gastroplasty.  The stomach is only cinched down.  By NOT removing a portion of the stomach, there is subsequently none of the metabolic changes that occur with the removal of the portion of the stomach that you get with a sleeve gastrectomy.  Therefore, the weight loss that you get with a sleeve gastrectomy is superior.

In addition, in an endoscopic gastroplasty, as only sutures are placed (versus staples in a sleeve gastrectomy), there is a very high chance that the stomach opens up again and the entire gastroplasty is reversed.  Literature has shown that long term weight loss after an endoscopic gastroplasty is less than that of a sleeve gastrectomy.  Conversely, rates of weight regain after a gastroplasty are therefore also higher.

And finally, the endoscopic gastroplasty is not covered by insurance, likely as a result of poor data.  The sleeve gastrectomy has much stronger data behind it, and is an extremely safe procedure.  The incisions from a sleeve gastrectomy as tiny and the recovery is fast.  The small incisions are worth the price of a more effective and long lasting surgery that is oftentimes covered by insurance.  

The endoscopic gastroplasty is NOT a sleeve gastrectomy.