Redo Endoscopic Sleeve Gastroplasty (ESG) and Endoscopic Revision for Weight Regain in Bangkok, Thailand

Key takeaways

• Redo ESG and endoscopic revision narrow the stomach, or the outlet of a gastric bypass, from the inside through the mouth, with no cuts on the abdomen.
• They are for weight regain after a previous ESG (including ESG done elsewhere), a sleeve gastrectomy or a gastric bypass, and an endoscopy assessment always comes first.
• Weight loss after a revision is usually smaller than after a first ESG, and the evidence is mostly observational.
• Redo ESG starts from THB 490,000; revision after a sleeve or bypass is quoted in writing after assessment.

What it cannot do

• It does not remove the reasons weight returned. Eating patterns, sleep, stress, medicines and hormones all play a part.
• It usually produces less weight loss than a first ESG. The figures below show this honestly.

Realistic results

The evidence for revision is weaker than for a first-time ESG. Most studies are observational, groups are small, and fewer patients are followed up over time. The figures below are published averages, not a prediction for you, shown as the percentage of total body weight lost from your weight at the time of the procedure.

• For context, first-time ESG. The IFSO Bariatric Endoscopy Committee position statement (Obesity Surgery, 2024) pooled 44 articles and 15,714 patients: total body weight loss was 17.56% at 12 months, and serious adverse events were 1.25%.
• Revision after a sleeve gastrectomy. An international multicentre study by Maselli and colleagues (Gastrointestinal Endoscopy, 2021) treated 82 patients with weight regain after a sleeve gastrectomy with revisional ESG. Total body weight loss was 13.2% at 6 months and 15.7% at 12 months, although only about half of patients had 12-month follow-up. One moderate adverse event was reported.
• Revision after a sleeve, with medication. A single-centre study (Obesity Surgery, 2025) of 55 patients, 65% of whom were also taking GLP-1 medication, reported total body weight loss of 8.6% at 12 months and 12.6% at 24 months, with fewer patients followed to 24 months.
• TORe after a gastric bypass. A systematic review and meta-analysis (Obesity Surgery, 2025) of 25 studies and 2,667 patients found pooled total weight loss of about 8.0% at 12 months, 7.7% at 24 months and about 4% at 36 months. The effect fades for many people, so follow-up matters.
• Redo ESG after a previous ESG. A multicentre study by Espinet-Coll and colleagues (Obesity Surgery, 2026) followed 25 patients across six centres who had a repeat ESG. They lost a further 10.8% of total body weight on average (standard deviation 8.7%) at a mean of 17 months, and about half (52%) reached a clinically meaningful result. Two patients (8%) had bleeding that settled without surgery. This is a small series, so your doctor explains what is realistic for you after the assessment.

In the United States, the endoscopic suturing technique used for ESG was authorised in 2022 for ESG and for endoscopic revision after bariatric surgery.

Procedure, stay and follow-up

• Where: at a JCI- or AACI-accredited partner private hospital in Bangkok, with anaesthesia care and continuous monitoring.

Frequently asked questions