Long-Term Effects of Sleeve Gastroplasty
Sleeve gastroplasty (both surgical and endoscopic) produces sustained weight loss of 15-20% total body weight loss at 5 years, with significant improvement in obesity-related comorbidities including diabetes, hypertension, and dyslipidemia, though weight regain and new-onset gastroesophageal reflux disease occur in approximately 20% of patients after 3 years. 1, 2
Weight Loss Outcomes
Surgical Sleeve Gastrectomy
- Achieves 25% total body weight loss (TBWL) with 38-79% excess weight loss (EWL) in the first 3 years 3
- At 6+ years post-operatively, mean EWL drops to 53-57%, representing significant weight regain between years 3-6 2
- Despite weight regain, outcomes remain satisfactory by Reinhold criteria at 6 years 2
- Weight loss is most dramatic in the first 2-3 years, followed by gradual regain 2
Endoscopic Sleeve Gastroplasty (ESG)
- Produces 15.9% TBWL at 5 years, with 90% of patients maintaining ≥5% TBWL and 61% maintaining ≥10% TBWL 1
- At 18 months, achieves 14.8-19.8% TBWL across multiple studies 3, 4, 5
- Weight loss at 6 months strongly predicts long-term success—patients achieving <10% TBWL at 6 months have only 18% odds of achieving ≥10% TBWL at 24 months 5
- Results are reproducible across multiple centers 5
Comorbidity Resolution
Metabolic improvements occur rapidly and are substantial: 3, 4
- Diabetes: 76% complete remission by 3 months (13 of 17 cases) 4
- Hypertension: 100% complete remission by 3 months (all 28 cases) 4
- Dyslipidemia: 56% complete remission by 3 months (18 of 32 cases) 4
- Additional improvements documented in NAFLD, GERD, polycystic ovary syndrome, degenerative joint disease, pseudotumor cerebri, and cardiovascular disease 3
Physiological Mechanisms
ESG induces weight loss through multiple mechanisms: 6
- 59% reduction in caloric consumption to reach maximum fullness 6
- Significant slowing of gastric emptying of solids 6
- Trend toward improved insulin sensitivity 6
- Hormonal effects likely mediated by ghrelin reduction (in surgical sleeve gastrectomy) 3
Long-Term Complications and Adverse Effects
Surgical Sleeve Gastrectomy
- Stenosis and staple line dehiscence occur in <1-2.7% of cases 3, 7
- New-onset gastroesophageal reflux disease develops in 21% of patients between years 3-6 2
- Perioperative mortality ranges from 0.1-0.3% 3
- Relative contraindications include established Barrett's esophagus and refractory GERD 3
- Long-term risks include chronic GERD, esophagitis, and potential Barrett's esophagus development 3
Endoscopic Sleeve Gastroplasty
- Overall serious adverse event rate of 1.3-2% with no severe or fatal events 1, 3
- Specific serious complications include: 3, 4
- Perigastric inflammatory fluid collections (2 cases, resolved with percutaneous drainage and antibiotics)
- Self-limited hemorrhage from splenic laceration (1 case)
- Pulmonary embolism (1 case at 72 hours post-procedure)
- Pneumoperitoneum and pneumothorax requiring chest tube (1 case)
- 92.4% of patients experience nausea or abdominal pain in the first week, controlled with medications 4
- Readmission rate of 2.4% for severe pain, bleeding, or perigastric collections 4
- Revision rate: 0.8% required conversion to sleeve gastrectomy, 0.5% underwent redo-ESG, and 0.3% required ESG reversal 4
Critical Predictors of Success
Patient follow-up and participation in comprehensive lifestyle programs are essential for long-term success 3
- Weight regain between years 3-6 may be preventable with continued office visits beyond year 3 2
- Early weight loss at 6 months is the strongest predictor of 24-month outcomes 5
- Patients failing to achieve adequate early weight loss should be offered adjunctive therapies promptly 5
Mortality Benefits
Long-term studies demonstrate improved all-cause survival compared to non-surgical cohorts with severe obesity and weight-related disease 3
Common Pitfalls to Avoid
- Inadequate long-term follow-up leads to weight regain—continued monitoring beyond 3 years is critical 2
- Failure to recognize early treatment failure—patients not achieving 10% TBWL at 6 months require intervention 5
- Performing ESG in patients with established Barrett's esophagus or refractory GERD (relative contraindication for surgical sleeve) 3
- Pregnancy within the first year post-procedure—women should wait at least 12 months to minimize nutritional risks 3
Quality of Life
Patient acceptance remains good at 6+ years despite weight regain and new reflux symptoms 2
The evidence demonstrates that both surgical and endoscopic sleeve gastroplasty provide durable weight loss and significant comorbidity improvement, with ESG offering a less invasive option for patients with BMI 30-40 kg/m² who are not candidates for or decline surgery 3, 8. However, the durability beyond 5 years for ESG remains uncertain and requires ongoing evaluation 8.