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In the United States, obesity has reached epidemic proportions, with nearly 40% of adults classified as obese. This alarming statistic has led to an increased demand for weight loss solutions, including both traditional bariatric surgery and innovative endoscopic weight loss procedures

In this review, we will review the intricacies of these two distinct approaches, providing a clear understanding of their fundamental principles, safety profiles, effectiveness, recovery times, and costs. We will begin by demystifying endoscopic weight loss surgery, a less invasive alternative to traditional surgery, that has been gaining popularity in recent years. 

Following this, we will provide an overview of conventional weight loss surgeries, which have been the go-to solution for severe obesity for decades. We will also discuss the potential risks and safety concerns associated with each procedure, providing you with a balanced view of their respective pros and cons. 

In addition, we will compare the effectiveness of endoscopic procedures and traditional surgeries in achieving long-term weight loss. The recovery time, often a crucial factor in decision-making, will also be discussed. Furthermore, we will provide a cost comparison, an essential aspect to consider when choosing between these two options. 

Finally, we will offer some guidance to help you make an informed decision about which procedure may be the most suitable for your specific circumstances. Together, we can navigate the complex world of weight loss procedures, empowering you to make the best decision for your health and well-being.


Understanding the Basics of Endoscopic Procedures for Weight Loss

Endoscopic procedures for weight loss have emerged as a less invasive alternative to traditional weight loss surgeries. These procedures, which are performed using a flexible tube with a camera and light at the end, known as an endoscope, offer several key advantages. Firstly, they are typically performed on an outpatient basis, meaning patients can return home the same day. Secondly, they tend to involve less pain and a faster recovery time compared to traditional surgeries. Some of the most common endoscopic procedures for weight loss include:

Endoscopic Sleeve Gastroplasty (ESG): 

The ESG procedure is a minimally invasive outpatient procedure performed in less than an hour. The ESG requires anesthesia but it does not involve making any incisions in the skin or any cutting of the abdominal wall muscle or the stomach itself. It is performed through the mouth and it involves suturing the stomach to reduce its size and limit food intake.






Endoscopic intragastric balloon: 

A gastric balloon, such as the Orbera balloon or the Spatz balloon, is inserted into the stomach and filled with saline to help create a feeling of fullness.





Aspiration Therapy: 

A small tube is inserted into the stomach to remove a portion of the food after meals, reducing calorie absorption.


While these procedures can be highly effective, it’s important to note that they are not suitable for everyone. Patients must be committed to a healthy lifestyle and regular follow-up appointments to ensure the best possible outcomes.





Traditional Weight Loss Surgery: An Overview

When it comes to combating obesity, bariatric weight loss surgery has long been considered a reliable solution. These procedures, often referred to as bariatric surgery, typically involve making significant changes to the digestive system to help patients lose weight. The most common types of these surgeries include:


Gastric Bypass surgery (also known as Roux en y):

 This procedure involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing a large part of the stomach and the first section of the small intestine.

gastric bypass illustration


Sleeve Gastrectomy (also known as VSG surgery): 

This involves removing about 80% of the stomach, leaving a long, tube-like pouch. This smaller stomach cannot hold as much food and also produces less of the appetite-regulating hormone ghrelin, which may lessen your desire to eat.

sleeve gastrectomy


Adjustable Gastric Band: 

In this procedure, a band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place. This creates a small stomach pouch above the band with a very narrow opening to the rest of the stomach.

lap band diagram


Duodenal switch: 

This is a weight loss surgical procedure that involves reducing the size of the stomach and rerouting the small intestine. This results in both restrictive and malabsorptive mechanisms, helping patients lose significant weight by limiting food intake and reducing nutrient absorption. It’s a complex procedure reserved for severe obesity cases.

These procedures have proven effective in achieving significant weight loss, improving obesity-related health conditions, and enhancing the quality of life for patients. However, they are not without risks and complications, which can include infection, blood clots, and in rare cases, death. Furthermore, these surgeries require a lifelong commitment to diet and lifestyle changes.

duodenal switch


Key Differences Between Endoscopic Procedures and Traditional Surgery

One of the most significant differences between endoscopic bariatric procedures and traditional bariatric surgery is the level of invasiveness. Endoscopic weight loss procedures are minimally invasive, requiring no incisions at all. This is in stark contrast to traditional bariatric surgery, which often involves large incisions and a more invasive approach. This difference in invasiveness often results in shorter recovery times and less post-operative discomfort for patients who undergo endoscopic weight loss procedures.

Another key difference lies in the risks associated with each procedure. Traditional weight loss surgery carries a higher risk of complications, including infection, bleeding, and adverse reactions to anesthesia. On the other hand, endoscopic procedures for weight loss, due to their minimally invasive nature, generally have a lower risk of these complications. However, it’s important to note that all surgical and endoscopic procedures carry some level of risk, and the patient’s overall health and specific circumstances can significantly influence these risks.

Lastly, the cost and accessibility of these procedures can also vary greatly. Traditional weight loss surgeries can be quite expensive and may not be covered by all insurance plans. In contrast, endoscopic procedures are often more affordable and more widely available. The decision between an endoscopic procedure and traditional surgery should not be based solely on cost but should take into account a variety of factors, including the patient’s health status, the specific nature of their weight problem, and their personal preferences. It’s crucial to have a comprehensive discussion with a healthcare provider to make an informed decision.


Safety and Risks: Endoscopic Procedures vs. Traditional Weight Loss Surgery

Delving into the realm of safety and risks, it’s important to understand that both endoscopic procedures and traditional weight loss surgeries carry their own set of potential complications. However, the former is generally considered less invasive, thereby reducing the risk of certain complications. Endoscopic procedures (like ESG procedure / non-surgical sleeve or intragastric balloon) typically involve no incisions, less pain, and a quicker recovery time. This is largely due to the fact that these procedures are performed using a flexible tube with a light and camera attached to it, which is inserted through the mouth and into the stomach, eliminating the need for large surgical cuts.

On the other hand, traditional weight loss surgeries, such as gastric bypass surgery or laparoscopic gastric sleeve, involve making significant changes to the digestive system. While these procedures have proven effective, they come with a higher risk of complications, including infection, blood clots, leaks, and strictures. Patients undergoing bariatric surgery are also at risk for several vitamin and nutrient deficiencies and are required to take supplements long term to avoid serious complications. 

Additionally, patients undergoing traditional weight loss surgery often face a longer recovery period. Despite these risks, it’s important to note that the long-term weight loss results can be substantial, often leading to significant improvements in obesity-related health conditions. 


Comparing the Effectiveness of Endoscopic Procedures and Traditional Surgery

Both endoscopic weight loss procedures and bariatric surgery have their unique advantages and disadvantages, and their effectiveness can vary based on individual patient conditions.

  • Endoscopic procedures are minimally invasive, often resulting in less post-operative pain, quicker recovery times, and fewer complications. They are generally recommended for patients with a lower BMI who have not had success with traditional weight loss methods. The weight loss with gastric balloons is on average around 13% of body weight. The Endoscopic Sleeve Gastroplasty results in more significant and long-term weight loss. The average ESG weight loss is 18% to 20% of total body weight. Patient lose 50% of their excess body weight a year post-ESG procedure. 
  • On the other hand, traditional weight loss surgeries such as gastric bypass or sleeve gastrectomy, while more invasive, often result in more significant weight loss. These procedures are typically recommended for patients with a higher BMI or those with obesity-related health conditions. A sleeve gastrectomy can result in a 25%-30% total body weight loss in 1 year. This translates to a 50% to 70% excess weight loss. At 3 years, the ESG weight loss was noted to be 14% compared to 19% with the sleeve gastrectomy.

It is always important to note that the success of either procedure ultimately depends on the patient’s commitment to a healthier lifestyle post-surgery. Both procedures require significant lifestyle changes, including diet and exercise, to maintain weight loss and improve overall health.


Recovery Time: Endoscopic Procedures vs. Traditional Weight Loss Surgery

Comparing the recovery time between endoscopic procedures and traditional weight loss surgery, it’s evident that the former offers a significantly shorter recovery period. 

Endoscopic procedures are minimally invasive, and often performed on an outpatient basis, which allows patients to return to their normal activities within a few days. 

On the other hand, traditional weight loss surgery, such as gastric bypass or sleeve gastrectomy, requires a hospital stay and a recovery period that can extend up to several weeks.


Ultimately, the choice between endoscopic procedures and traditional weight loss surgery should be made in consultation with a healthcare professional. Each patient’s individual health status, weight loss goals, and personal preferences should be taken into account. While endoscopic procedures may offer a quicker recovery time, they may not be the best option for everyone. Conversely, while traditional weight loss surgery may require a longer recovery period, the potential for significant long-term weight loss may make it the more suitable option for some patients.


Cost Comparison: Endoscopic Procedures and Traditional Weight Loss Surgery

Assessing the financial implications of weight loss surgery is a critical step in the decision-making process. 

Endoscopic procedures often present a more cost-effective solution compared to traditional weight loss surgeries. The former typically involves shorter hospital stays, less post-operative care, and fewer complications, which all contribute to lower overall costs. 

However, it’s important to note that the cost can vary significantly depending on the specific procedure, the patient’s health insurance coverage, and the geographical location. A comprehensive cost analysis should include not only the upfront surgical costs but also the long-term expenses associated with follow-up care and potential complications. 


Traditional bariatric surgery can be quite expensive when it is not covered by insurance plans. Without insurance coverage, a gastric bypass surgery cost can be extremely high at around $25,000 or more. The gastric sleeve cost can vary from around $12,000 to $20,000 and may be lower depending on the geographic location and whether the surgery is performed in a hospital or an ambulatory surgery center. In contrast, endoscopic procedures are more affordable. Gastric balloon cost is usually around $7,000 to $8,000. Endoscopic Sleeve Gastroplasty self-pay cost varies from $10,000 to $14,000. The cost of endoscopic sleeve gastroplasty covered by insurance will certainly be much lower, however, the ESG procedure is still not covered by insurance. Insurance coverage is expected in the not-so-distant future. 

A thorough cost-benefit analysis is essential on a case-by-case basis to determine the most financially viable option for every patient depending on their goals and the options available to them.  Non-Surgical Alternative to Weight Loss Surgeries with Professional Support

Before you embark on a surgical journey, we always recommend considering all the non-surgical alternatives to bariatric surgery. We usually provide all our patients with lifestyle and dietary consultancy to make sure that the procedure is successful. Are you ready to experience a healthier and happier you without adopting drastic measures? Schedule a consultation today and let our team of highly skilled and experienced professionals guide you on your weight loss journey.







Frequently Asked Questions


What is the main advantage of endoscopic procedures over traditional weight loss surgery?

Endoscopic procedures are generally less invasive than traditional weight loss surgeries. This means they often involve less pain, fewer complications, shorter hospital stays, and faster recovery times.


How does ESG surgery compare to traditional bariatric surgery?

Endoscopic ESG procedure offers a minimally invasive approach for weight loss and metabolic health, contrasting with traditional surgery that involves more invasive procedures and longer recovery times. 


Can endoscopic procedures be repeated if the weight loss is not sufficient?

Yes, one of the benefits of endoscopic procedures is that they can often be repeated if necessary. However, the need for repeat procedures is relatively rare, as most patients achieve significant weight loss with the initial procedure.


What is the cost difference between endoscopic gastric sleeve and traditional sleeve surgery?

The cost of endoscopic procedures can vary widely, but they are generally less expensive than traditional weight loss surgeries. However, the exact cost difference will depend on a variety of factors, including the specific procedure, the patient’s health insurance coverage, and the region in which the procedure is performed. Generally, the ESG procedure is $2,000 to $5,000 less expensive than the laparoscopic gastric sleeve.


How long does it take to recover from an endoscopic procedure compared to traditional weight loss surgery?

Recovery times can vary, but generally, patients recover faster from endoscopic procedures than from traditional weight loss surgeries. Most patients are able to return to normal activities within a few days after an endoscopic procedure, while recovery from traditional surgery can take several weeks.

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