You may have heard of a newer procedure called endoscopic sleeve gastroplasty. This is a non-surgical procedure that is intended to lead to weight loss. This is NOT bariatric surgery and does not lead to sustainable weight loss.

Your body releases ghrelin, our “hunger” hormone, as a signal to your brain that it is time to eat. Ghrelin is predominately released from the fundus of your stomach, but also can be released in the small intestine and pancreas. Ghrelin is sent out when the stomach is empty or close to empty and is at its highest prior to meal times.

In gastric sleeve patients, the fundus is removed (where ghrelin, the hunger hormone, is released from), limiting hunger sensations.

In gastric bypass patients, the portion of the stomach that has the fundus is “bypassed”, leaving the fundus with no direct contact with food, limiting hunger sensations.

In the endoscopic sleeve gastroplasty procedure, the fundus is never removed or disconnected. A portion of the stomach is stapled together, but the fundus is still intact, allowing for the hunger hormone, ghrelin, to act normally in promoting hunger.

Studies show that gastric bypass patients lose on average 70% of their extra body weight after 12 months. For gastric sleeve patients, an average of 60% of excess body weight is lost. In endoscopic sleeve gastroplasty patients, they lost around 16% after 12 months- significantly less than both gastric bypass and gastric sleeve patients.

Remember that with the endoscopic sleeve gastroplasty, the fundus remains intact after the procedure, with no change in hunger before vs. after the procedure.


Frühbeck, G., Diez Caballero, A., & Gil, M. (2004, January 15). Fundus Functionality and Ghrelin Concentrations after Bariatric Surgery. The New England Journal of Medicine. Retrieved March 21, 2023, from https://www.nejm.org/doi/full/10.1056/NEJM200401153500323

Bariatric surgery faqs: Patients: ASMBS. American Society for Metabolic and Bariatric Surgery. (n.d.). Retrieved March 21, 2023, from https://asmbs.org/patients/faqs-of-bariatric-surgery O'Brien PE;Hindle A;Brennan L;Skinner S;Burton P;Smith A;Crosthwaite G;Brown W; (n.d.). Long-term outcomes after bariatric surgery: A systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obesity surgery. Retrieved March 21, 2023, from https://pubmed.ncbi.nlm.nih.gov/30293134/