Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure that utilizes full-thickness endoscopic suturing to achieve tubular reconfiguration and substantial volume reduction of the gastric body. ESG has been established as a safe, durable, and effective management option for obesity. This study aims to present our single-center experience from Türkiye, focusing on changes in anthropometric measurements and clinical outcomes following ESG in a real-world clinical setting.

We performed a retrospective analysis of prospectively collected medical records of consecutive patients who underwent ESG between October 2022 and August 2025. Detailed procedure-related data, including suture counts and technique, were recorded. Patient data—comprising demographics, anthropometrics, and comorbidity status—were systematically collected at baseline and during every follow-up visit. The follow-up protocol involved intensive, structured monitoring via online or face-to-face appointments: weekly for the first two months, followed by bi-weekly visits for a total one-year program. Crucially, interviews were complemented by personalized nutritional trainingdesigned to ensure sustained behavioral modification. Instead of a restrictive standard diet plan, completely individualized nutritional programs were implemented.

A total of 29 patients were included in the analysis [Females: 82.8%; Age: 39.1±8 years; Baseline Weight: 101±16.8 kg; Baseline Body Mass Index (BMI): 36.6±5.4 kg/m2]. All patients reported at least one transient post-procedural symptom, such as minimal abdominal pain, abdominal discomfort, nausea, or vomiting. Only one patient required an overnight hospital stay due to persistent vomiting and pain; the remaining twenty-eight patients were discharged six hours post-ESG. No hospital readmissions or re-hospitalizations occurred after initial discharge. Furthermore, no instances of fluid, electrolyte, or nutritional insufficiency were observed throughout the follow-up period, underscoring the procedure's high safety profile. Follow-up data completeness was 100% at 1 month, 89.7% (n=26) at 3 months, 75.9% (n=22) at 6 months, and 31.0% (n=9) at 12 months. Procedure-related details showed that the median number of sutures utilized was 5 (range: 3–6), with 22 patients specifically receiving 5 sutures. Regarding the suture pattern, U-pattern was employed in 17 cases, while the interlocking ESG technique was used in 12 cases.Body Mass Index (BMI) demonstrated a significant and continuous decrease post-procedure, starting from a baseline of 36.6±5.4 kg/m2 and dropping to 32.9±4.9 kg/m2 at 1 month, 30.6±4.4 kg/m2 at 3 months, 29.4±3.9 kg/m2 at 6 months, and finally reaching 28.6±5.3 kg/m2 at 12 months. Correspondingly, the percentage of Total Body Weight Loss (%TBWL) progressed steadily, averaging 9.8±2.5% at 1 month, 16.0±3.8% at 3 months, 16.6±6.4% at 6 months, and stabilizing at 16.8±6.6% by the 12-month mark. Furthermore, the percentage of Excess Weight Loss (%EWL) showed excellent outcomes, advancing from 29.9±9.0% at 1 month to 48.9±14.9% at 3 months, 53.3±23.7% at 6 months, and culminating in 60.3±31.7% at 12 months. The percentage of patients achieving key weight loss thresholds remained high across follow-up: At the end of the first month, 100% of patients achieved the ≥5% TBWL target, with 45% reaching ≥10% TBWL and 6.9% reaching ≥15%TBWL. By the third month, 100% maintained the ≥5% TBWL achievement, while the rates for ≥10% and ≥15% TBWL increased significantly to 96% and 62%, respectively. At six months, 96% of patients maintained ≥5% TBWL, with 82%and 68% achieving ≥10% and ≥15% weight loss, respectively. Finally, at the twelve-month follow-up, 100% of the available patients had sustained ≥5% TBWL, with 78% reaching ≥10% and 67% achieving ≥15% weight loss.

Our early experience from Türkiye demonstrates that ESG is a procedure with a high safety profile and results in significant and clinically meaningful improvements in body composition and weight loss up to 12 months post-procedure. The integration of a highly individualized nutritional support program may contribute to these favorable outcomes.