SAGES 2026 Annual Meeting Emerging Technology Session

Endoscopic Sleeve Gastroplasty (ESG) Results in Persistent Weight Loss Up to 5 Years, Regardless of Payer

Julia R. Amundson MD MPH, Kristine Kuchta MS, Natalie Liu MD, H. Mason Hedberg MD MS, Michael B. Ujiki MD FACS

Endeavor Health, Evanston, IL

Background ESG is an endoscopic procedure to treat obesity and associated metabolic comorbidities. Outcomes after bariatric surgery have previously been shown to vary by Payer.1-5 Minimal literature exists on outcomes of ESG by payer.6

Aim Review institutional outcomes of ESG stratified by payer (trial, private insurance, self-pay)

Hypothesis Self-pay patients experience greater weight loss and comorbidity resolution than insured patients

Methods Retrospective review of a single institutions prospective bariatric quality database; all ESG 6/2016–9/2025, stratified by payer (trial, private insurance, self-pay) excluding non-U-stitch suture patterns and postop GLP-1 users

Outcomes of interest % excess and total body weight loss (%EWL, %TBWL), comorbidity resolution, and complications

Results

N=78 ESG eligible for inclusion during the study period (15 trial, 25 private insurance, 38 self-pay); excluded 25

No significant demographic differences by payer

No differences in rates of hypertension, hyperlipidemia, obstructive sleep apnea, GERD, smoking or HbA1c

More diabetes mellitus in trial vs self-pay patients at baseline (31.3% vs 6.4%, p=0.037), 6 months postop (26.7% vs 0.0%, p<0.01), 1 year postop (23.3% vs 4.8%, p=0.011), and 3 years postop (80% vs 0%, p<0.01)

No significant intraoperative differences in EBL, OR time

Significant difference in number of endo-sutures used (Trial 6.6±1.6, Insured 5.0±1.2, Self-pay 5.9±1.4)

Significantly longer LOS for insured vs self-pay patients, though all averaged <1 day [0(0-0) vs 0(0-1), p<0.01]

Weight Loss no significant difference in %EWL or %TBWL at 6-month, 1-year, 2-year, 3-year, 4-year or 5-year postoperative timepoints by payer

Conclusion Rapid weight loss occurs in the first 6 months after ESGS and is sustained up to 5-years after ESG, regardless of payer

SAGES 2026 Annual Meeting Emerging Technology Session

ENDOSCOPIC SLEEVE GASTROPLASTY RESULTS IN EXCELLENT WEIGHT LOSS UP TO THREE YEARS, REGARDLESS OF PAYER

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