Outcomes of Endoscopic Sleeve Gastroplasty ( <scp>ESG</scp> ) at a Single Institution: The First Report on Weight Loss and Complication Rates in Japan

Endoscopic sleeve gastroplasty (ESG) has gained recognition as a minimally invasive endoscopic treatment for obesity; however, clinical data in Japan is lacking. A retrospective review was conducted of 91 individuals with obesity who underwent ESG between January 2023 and November 2024. Eligibility included BMI ≥ 27.5 with at least one obesity-related comorbidity and preference for non-surgical therapy. Primary outcomes were the percentage of total weight loss (%TWL) at 1 month, 6 months and 1 year, and the rate of complications. The mean %TWL was 10.1% at 1 month, 15.2% at 6 months and 19.8% at 1 year. The follow-up completion rates were 100% at 1 month, 96.7% at 6 months and 87.9% at 12 months. Improvement in obesity-related comorbidities was observed in 57.1% of individuals with hypertension, 94.7% with dyslipidemia, 91.7% with diabetes, 96.9% with fatty liver disease and 75.0% with obstructive sleep apnea. One adverse event (1.1%) occurred, a pyriform sinus injury that resolved with conservative management; no severe complications were observed. ESG demonstrated favourable short-term weight loss and safety outcomes in Japan. These findings suggest ESG as a viable treatment option for Japanese individuals with obesity.