ESG Long-Term Results: The 1-Year and 5-Year Data, and Whether the Weight Comes Back

The results timeline in the published evidence

TBWL is the share of your whole body weight lost (100 kg starting weight, 15 kg lost = 15%). EWL is the share of *excess* weight lost, so it always looks larger for the same result.

These rows come from different studies with different starting populations, so read them as a picture of the available evidence, not one continuous curve. The wording YOUNIFY uses with patients is typically around 15–18% of body weight over one year; individual results may vary.

What "61% maintained" actually means

Among those followed to five years, 61% were still at least 10% below their starting weight, a threshold widely treated as clinically meaningful [1]. The other 39% were not: some held a smaller loss, some returned close to where they started.

A second limitation belongs here. The cohort began with 216 patients and 68 completed the full five-year follow-up [1]. Long-term obesity research routinely loses patients to follow-up, and those who keep returning may differ from those who do not. Read both figures as a picture of the followed group, not a guarantee for everyone.

Why results hold to the degree they do

ESG changes the stomach's structure from the inside, rather than occupying space temporarily the way a balloon does before it is removed on schedule. An endoscopic suturing device folds the stomach wall into a narrow, tube-like shape, reducing gastric volume by roughly 70%, with no tissue removed and no external incisions [3].

Durability also depends on technique. The 2025 global standards of practice were developed by six endoscopists who had each performed more than 300 ESG cases, producing 27 consensus statements [3]. The points bearing directly on durability:

• The first suture starts at the incisura, setting the alignment for the whole pattern.
• Six to ten suture lines in total. Too few or too many affects shape and safety.
• Full-thickness suturing, passing through the wall rather than catching only the surface layer.
• The fundus is avoided, as the wall there is thin and richly vascularised.
• A repeat endoscopic inspection before the scope is withdrawn, every time.

Who regains weight, and why

The difference is usually decided over the twelve months after the procedure, not on the day itself.

Follow-up that quietly stops. The 2024 ASGE–ESGE guideline is explicit that endoscopic bariatric therapies are used *alongside* lifestyle intervention, not instead of it [5]. In MERIT both groups received the same lifestyle programme; the difference was the procedure added on top [2].

Grazing that was never addressed. A smaller stomach constrains *volume per meal*, not how many times a day you eat.

High-calorie liquids. The most common gap. Sweetened drinks, milk-and-syrup coffees, juice, alcohol and blended soups pass through a reduced stomach quickly and do not trigger fullness the way chewed food does.

Coexisting conditions and certain medications. Some conditions and drug groups influence appetite or metabolism. The medical team reviews your medication list before the procedure and again if weight starts moving back up.

Starting weight. The meta-regression found ESG performed comparatively better in patients with a higher baseline BMI (p=0.0001) [4]. Someone starting from a lower weight may see a smaller percentage even when the procedure is working as expected.

What makes results last

1. The first-year follow-up programme. Year one is when portion size, meal sequence, adjustment symptoms and metabolic blood values get tuned, and when the medical team catches a drift before it becomes a regain.

2. Working with the nutrition team. The goal is not eating as little as possible; it is adequate protein and nutrients from a smaller volume of food, with supplementation as assessed by the medical team. Full schedule: ESG recovery and diet timeline.

3. Long-term eating principles

• Protein first, then vegetables, then carbohydrate. Space is limited, so what you eat first is what you actually get.
• Chew slowly and thoroughly so fullness signals arrive before you have overshot.
• Separate fluids from meals. Liquid pushes food through faster and shortens fullness.
• Cut calorie-containing drinks. For many people this single change does more over five years than anything else.
• Eat on a schedule. Planned meals reduce unplanned grazing on their own.

4. Movement you can sustain. A routine you repeat every week beats an intense one that lasts a month. Walking, stairs and light resistance work help preserve muscle mass while weight comes down.

5. Weighing and tracking metabolic numbers. Weigh at the same time and conditions and read the weekly trend, not daily figures, alongside glucose and HbA1c, lipids, blood pressure and liver values as directed.

6. Managing plateaus. Weeks with no movement happen in every form of weight loss and are where many people quit. Review the basics first: daily protein, calorie drinks that crept back, meal and snack frequency, sleep, activity, then book a review instead of a drastic self-directed cut, which mostly costs muscle mass.

Health changes that do not show on the scale

In MERIT at 52 weeks, 80% of the ESG group had improvement in at least one metabolic comorbidity, versus 45% of controls [2]: blood pressure, glucose and diabetes, blood lipids, and fatty liver. A patient whose weight has drifted up slightly by year three may still have better glucose and blood pressure than at baseline, so judging success by weight alone misleads.

Long-term follow-up when you fly home

For international patients the real question is how follow-up works from another country. What we plan with patients travelling to Bangkok:

• Front-load the in-person work: assessment, procedure and the earliest review within one trip wherever possible.
• Scheduled remote reviews for the rest of the first year, working from your weight log, symptom notes and dietary record.
• Blood work done locally: metabolic panels taken at a laboratory at home and shared before each review.
• A written plan your local doctor can act on, plus a direct channel to the team by WhatsApp or LINE.

Ask any clinic how the first year works once you have left the country; if the answer stops at procedure day, that is a material gap.

If the weight does come back

Do not wait until you are back at your starting weight. The order the medical team works through:

• Reassess first. Actual eating patterns, calorie-containing liquids, current medication, changes in health status, and in some cases an endoscopic look at the stomach and existing suture line.
• Adjust nutrition and behaviour. Back to meal structure and protein targets, with temporarily more frequent reviews. Many people resolve it here.
• Consider revision or repeat suturing. Possible in some cases, since no stomach tissue was removed, depending on endoscopic findings, the existing suture line, and overall health.
• Consider weight-management medication under medical supervision. Weighing benefit, side effects and adherence. A 2026 evidence review reported that up to 65% of GLP-1 receptor agonist users discontinue within one year, with roughly two-thirds of lost weight typically regained within a year of stopping and cardiometabolic gains reversing [6]. Sequencing: ESG or GLP-1 medication: which comes first?
• Consider other options. For patients above the range ESG addresses, alternatives may include referral for surgical assessment.

The ATTAIN study (n=59), presented at Digestive Disease Week in May 2026, reported 17% TBWL at 12 months with ESG plus lifestyle intervention versus 0.1% with lifestyle alone [7]. Preliminary conference data that have not completed full peer review.

Safety over the long run

A systematic review and meta-analysis reported a pooled severe adverse event rate of 2.2% (95% CI 1.6–3.1): pain or nausea requiring hospitalisation 1.08%, upper gastrointestinal bleeding 0.56%, leak or perigastric collection 0.48% [8]. The 2024 IFSO position statement, covering 15,398 procedures, reported 1.25% (194 events) [9], the largest dataset currently available.

These events cluster in the early period rather than accumulating over the years. Full detail: Is ESG safe? Side effects and risks explained.

In summary

Five-year follow-up reports a mean 15.9% total body weight loss with 61% still at ≥10% [1]; one-year randomised data show 13.6% versus 0.8% in controls [2]. Results hold for some patients and not others, and the variables separating them are first-year follow-up, eating patterns that genuinely changed, and calorie-containing liquids. The procedure constrains volume per meal; the rest is a plan you build with the medical team.