The Endo-Sleeve procedure using the OverStitchTM Technology (also known as the Endoscopic Gastroplasty (ESG) technique) is a procedure to permanently reduce the size of the stomach and is suitable for individuals suffering with excess weight and obesity. 

Performed while under anesthesia, the surgeon uses an endoscopic suturing device, entering the patient’s stomach via the mouth and esophagus to reduce the size of the stomach using gathered suture plications. The procedure closely replicates what would usually occur from a surgical sleeve gastrectomy, without the need for surgery. Unlike a surgical sleeve gastrectomy, the Endo-Sleeve procedure with the OverStitchTM Technology has a significantly lower risk of complications, faster recovery time, and is minimally invasive – therefore leaving no incisions or scars. The Endo-Sleeveprocedure with the OverStitchTM Technology is best suited for individuals with a BMI of 30 kg/m2 or more who have tried other weight loss programs, including conventional diet and exercise alone, but were unsuccessful.1

The Endo-Sleeve procedure is a modern, safe, and effective weight loss procedure. The majority studies examining the weight loss results of individuals suffering with overweight and obesity with the Endo-Sleeve procedure are one to two years in duration. In comparison, Sharaiha, Reem Z., et al (2021) is one of the longest studies to assess the weight loss outcomes of obese individuals following their Endo-Sleeve procedure using the OverStitchTM technology.


The Study design

Sharaiha, Reem Z., et al, assessed the weight loss outcomes of individuals suffering with obesity following their Endo-Sleeve procedure for up to 5 years after the procedure. The study’s inclusion criteria for patients who qualified for the Endo-Sleeve procedure included:

1) BMI >30 kg/m2, or >27 kg/m2 with comorbidities, and had previously tried other non-invasive weight loss methods but did not lose more than 5% of their body weight;

2) a BMI >40 kg/m2 and they either refused to have bariatric surgery or needed to lose weight prior to undergoing bariatric surgery; or,

3) previously received pharmacotherapy weight loss methods and their weight was stable for 3 months, or were gaining weight while receiving pharmacotherapy.

The average age was 46 years old (33-59 years old) with a BMI of 39 kg/m2 (33-45 kg/m2) prior to undergoing the Endo-Sleeve procedure using the ESG technique. Furthermore, 213 of the 216 patients had no history of bariatric weight loss procedures.  



What was the goal of the study?

The main goals of the study were to examine the total body weight loss (TBWL) and excess weight loss (EWL) of each patient following their ENDO-SLEEVE procedure. Patients’ weights were taken before the procedure and taken at the routine follow-up appointments at 1, 3, 6, 12 and 24 months, and annually thereafter. In addition, complementary pharmacotherapy was offered to patients if they either, did not achieve a weight loss of at least 5% in the first 3 months following the procedure, or experienced weight regain at any point after the ENDO-SLEEVE procedure.

What did the results show?

Based on the patients’ initial body weight and excess weight prior to the ENDO-SLEEVE procedure, Sharaiha, Reem Z., et al (2021), assessed the patients’ TBWL and EWL at the 1-, 3-, and 5-year routine follow-up appointments. The key findings showed:


The study by Sharaiha, Reem Z., et al (2021), is one of the few studies to examine the weight loss results of individuals suffering with obesity for five years following their ENDO-SLEEVE procedure using the OverStitchTM Technology.


90% of patients maintained a TBWL of 5% or greater, and 74% of patients maintained an EWL of 25% or greater after 5 years following the procedure, thus demonstrating the ENDO-SLEEVE procedure to be an effective weight loss intervention for the treatment of obesity.

This weight loss is significant because as little as 5% of weight loss can improve overall health and reduce the risk of obesity-related comorbidities, such as high cholesterol, type 2 diabetes, and cardiovascular disease. While the results of this study are promising for the success of long-term weight loss, further long-term studies are required.



  1. “Endoscopic Sleeve Gastroplasty (Accordion) Procedure.” The Johns Hopkins Digestive Weight Loss Center, John Hopkins Medicine, 16 Feb. 2021,
  2. Sharaiha, Reem Z., et al. “Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity.” Clinical Gastroenterology and Hepatology, vol. 19, no. 5, May 2021, pp. 1051–1057. Elsevier,