This is weight loss treatment without an operation. No incisions on the abdomen, nothing removed, and no rerouting of the intestine.
The whole procedure is performed through the mouth using an endoscope. A suturing device passed through the scope places a series of stitches inside the stomach, folding it inwards along its length so that it becomes a narrow tube. The stomach holds much less, and it empties more slowly, so you feel full sooner and stay full longer.
You go home the same day or the next morning, usually with three or four days off work.
Who it suits
People who want help but do not want surgery. This is the largest group. Many people who would benefit from bariatric treatment will not consider an operation, and for years the only alternative offered was another diet.
Lower BMI patients, generally from around a BMI of 27 to 30 upwards, who fall below the usual thresholds for surgery but for whom diet and medication have not worked.
People who are not fit for surgery, or who cannot take the recovery time an operation requires.
People who want something reversible in principle. Nothing is cut away and nothing is permanently rerouted. The sutures can be released, and it does not prevent surgery later if you need it.
Who it does not suit
Being honest about this matters more than listing the advantages.
It is generally not appropriate if you have a large hiatus hernia, significant acid reflux, a large stomach ulcer, or have had previous surgery on the stomach. An endoscopy before the procedure is what establishes this.
It is also not the right choice if you have a very high BMI and need substantial weight loss, or if you have poorly controlled type 2 diabetes where a bypass would have a far stronger effect. In those situations, choosing the endoscopic route because it feels less frightening usually means falling short of what you actually needed.
What to expect from it
Endoscopic sleeve gastroplasty produces less weight loss than surgery. Reported results are generally in the region of 15 to 20 percent of total body weight over the first one to two years, compared with more after a surgical sleeve or bypass. That is the trade-off, and it is a real one. It is not a lesser version of surgery, it is a different balance of result against risk and recovery.
Individual results vary considerably, and no specific figure can be promised. What is consistent across every study and every clinic is that the people who do well are the ones who change how they eat and stay engaged with follow-up. The procedure creates the opportunity. It does not do the work.
The procedure
It is performed under general anaesthesia and usually takes around an hour to an hour and a half.
An endoscope is passed through the mouth into the stomach. A suturing device mounted on the scope places full-thickness stitches through the stomach wall, drawing the sides inwards in a pattern that shortens and narrows the stomach cavity. The stomach is not cut, stapled or removed.
There are no wounds on the abdomen afterwards. Nothing to dress, nothing to keep dry, and no scars.
Before the procedure
You will need an endoscopy to inspect the stomach and rule out a hiatus hernia, ulcer or other condition that would make this unsuitable. Blood tests, including sugar, thyroid and vitamin levels, are standard, along with an ultrasound of the abdomen.
You will also see a dietitian beforehand. This is not a formality. The eating pattern afterwards is what determines the result, and it is easier to learn before the procedure than during recovery.
A short pre-procedure diet may be advised.
The first weeks
Expect nausea, cramping and a feeling of tightness for the first few days. This is normal and settles, and medication is given for it.
The diet is staged. Clear liquids first, then full liquids, then pureed food, then soft textures, and finally normal food, progressing over roughly six weeks. Protein is prioritised throughout, and you will be given specific targets.
Small sips rather than large drinks, and no drinking during meals, since the stomach cannot hold both. Most patients return to desk work within three to five days.
Follow-up and supplements
Vitamin and mineral supplements are usually advised, though the requirement is lighter than after a bypass because nothing has been rerouted and absorption is not altered in the same way. Blood levels are monitored.
Follow-up continues for years, not months. Review appointments, dietitian input and blood monitoring at set intervals. The patients who keep their result are the ones who keep attending.
Risks
The risk profile is lower than surgery, which is much of the point, but it is not zero.
Nausea, vomiting and abdominal pain in the first few days, common and short-lived.
Bleeding at a suture site, uncommon.
Perforation or a leak, rare, but the reason this is done in a hospital setting with surgical backup rather than as a clinic procedure.
A collection of fluid outside the stomach, rare, occasionally requiring drainage.
Sutures loosening over time, which can reduce the effect and allow weight to return.
An important practical point: this should be performed by someone who can manage a complication surgically if one occurs. That is a fair question to ask before booking anywhere.
If it does not work, or stops working
The stitches can loosen over months to years, and some patients regain weight.
Where that happens, the options are to repeat the procedure, or to proceed to surgical treatment. Having had this procedure does not close the door on a sleeve gastrectomy or bypass later, which is one of its genuine advantages over a permanent operation done too early.
How it compares
Against a surgical sleeve gastrectomy: less weight loss, considerably lower risk, no incisions, faster recovery, and it does not remove any part of the stomach. The surgical sleeve has longer-term evidence behind it and a stronger effect on weight and on diabetes.
Against a gastric balloon: a balloon sits inside the stomach and is removed after six to twelve months, after which the effect ends. This procedure alters the shape of the stomach itself and lasts longer.
Against medication alone: weight loss medications work while you take them and weight commonly returns when they stop. Some patients use both together, and that combination is worth discussing.
Questions worth asking
- Am I a candidate, and has an endoscopy confirmed it?
- What weight loss is realistic in my particular case?
- Would a surgical procedure serve me better, given my BMI and my medical conditions?
- Who manages a complication if one occurs?
- What does the follow-up programme involve, and for how long?
- If it stops working, what are my options?
Frequently asked questions
Is this actually surgery?
No. There are no incisions and nothing is cut or removed. It is an endoscopic procedure performed through the mouth, under general anaesthesia.
How much weight will I lose?
Reported results are generally around 15 to 20 percent of total body weight in the first one to two years, less than surgery. Individual results vary considerably and no figure can be guaranteed.
Is it reversible?
In principle yes. Nothing is removed and the sutures can be released. It also does not prevent surgical treatment later.
How long is the recovery?
Most people return to desk work within three to five days. The staged diet continues for around six weeks.
Will I need vitamins for life?
Supplements are usually advised, but the requirement is lighter than after a bypass because absorption is not altered in the same way.
Can I have it if my BMI is under 30?
Possibly, from around 27 upwards depending on your medical conditions and what you have already tried. Assessment is individual.
Can the weight come back?
Yes. Sutures can loosen over time, and old eating patterns will defeat this procedure as they will any other. Repeat treatment or surgery are both options if that happens.
Consultation
Dr. Ripudaman Singh Lubana holds a Certificate Course in Endoluminal Bariatric and Metabolic Surgery from IRCAD India, alongside a University Diploma in Minimal Access Surgery from IRCAD, France. Both the endoscopic and the surgical routes are available under one surgeon, which means the recommendation is based on what suits you rather than on what is on offer.
He consults at Doctor Square Hospital on VIP Road Zirakpur, Trinity Hospital in Zirakpur, Curasia Hospital in Dhakoli, and Adesh Medical College Hospital in Mohri, Ambala Cantt.
Call 8054173528 to arrange an assessment. Being assessed does not commit you to a procedure.
This page is for patient education. It is not a diagnosis or a treatment plan. Suitability and results differ for every patient depending on weight, medical conditions and individual circumstances, and no specific weight loss outcome is promised. Every patient is examined and assessed individually.
