AI Summary Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, incision-free endoscopic procedure that reduces stomach volume to support weight loss and may improve liver health in people with MASLD or MASH.
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Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight-loss procedure that uses an endoscope to reduce stomach volume, without requiring surgical incisions. It may be considered for adults with obesity, MASLD, or MASH who need weight reduction and metabolic improvement, particularly those seeking a less invasive alternative to bariatric surgery. Treatment decisions should always be individualized and guided by a healthcare professional.
This page covers ESG's role in MASLD and MASH management — how it works, who may be eligible, benefits, risks, and monitoring. You can also connect with a liver specialist near you for personalized guidance on whether ESG fits your care plan.
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ABOUT ESG TREATMENT
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight-loss procedure that reduces stomach volume using an endoscope, without requiring surgical incisions, according to the Liver Therapies Patient Guide.
During the procedure, a gastroenterologist passes an endoscope through the mouth and places sutures inside the stomach to reduce its volume. This limits how much food the stomach can hold and promotes earlier fullness after meals.
ESG may be considered for adults with obesity, MASLD, or MASH who need weight reduction and metabolic improvement, particularly those seeking a less invasive alternative to bariatric surgery. It is typically used alongside dietary counseling, physical activity, and regular monitoring by your healthcare provider, such as Liver Function Tests (LFTs).
WHO ESG MAY BE SUITABLE FOR
Eligibility for ESG depends on your weight, liver condition, and treatment goals. Your healthcare provider may recommend ESG if you have obesity or excess body weight affecting your health, have MASLD or MASH associated with obesity, or if lifestyle modifications alone have not achieved sufficient weight loss, according to the Liver Therapies Patient Guide.
ESG may also be considered when you are seeking a less invasive alternative to bariatric surgery and you meet the eligibility criteria for endoscopic weight-loss therapy.
Because every patient's weight, liver condition, and overall health are different, there is no one-size-fits-all answer to who should have ESG. Treatment decisions are individualized and should be made by a qualified healthcare professional after a full assessment of your weight, liver condition, and treatment goals.
ELIGIBILITY OVERVIEW
ESG may be considered for adults with the following conditions, risk factors, or treatment goals:
Before recommending ESG, healthcare providers evaluate several factors to determine whether it is an appropriate option, including:
HOW ESG CAN HELP YOUR LIVER
During ESG, a gastroenterologist inserts an endoscope through the mouth and places sutures inside the stomach to reduce its volume, according to the Liver Therapies Patient Guide. No external surgical incisions are needed.
By decreasing stomach volume, ESG limits how much food you can eat at one time and promotes earlier fullness after meals. This supports gradual and sustained weight loss over time.
As weight decreases, metabolic risk factors often improve, which may help reduce liver fat and support outcomes related to MASLD and MASH. ESG is not used on its own — providers pair it with dietary counseling, exercise, and behavioral modifications, along with regular monitoring, such as Liver Function Tests (LFTs), to track weight loss and treatment response.
LIVER BENEFITS
In MASLD, extra fat builds up in liver cells. ESG does not act on the liver directly. It helps you lose weight, and the Liver Therapies Patient Guide says this may help reduce liver fat. Research summarized for fatty liver disease shows that losing at least 5% of body weight is needed to reduce liver fat.
Insulin resistance and related metabolic problems are closely tied to MASLD and MASH. The guide says ESG may improve metabolic risk factors, including diabetes and insulin resistance. When these improve, the liver may be under less metabolic strain.
MASH involves liver inflammation and, in some people, scarring called fibrosis. The guide says ESG may help improve MASLD/MASH-related outcomes. Research on weight loss in fatty liver disease links a 7% to 10% loss with resolution of steatohepatitis, and a loss of more than 10% with better fibrosis. The guide does not give ESG-specific figures, so ask your care team what to expect.
Liver benefits depend on keeping weight off, so ESG is paired with a reduced-calorie diet, exercise, and behavioral changes. Regular follow-up lets your care team check weight loss, nutritional status, and treatment response, and review liver tests such as [Liver Function Tests (LFTs)](/liver-tests/blood-tests/liver-function-tests).
ESG supports the liver indirectly, through weight loss and better metabolic health. Results vary from person to person, so talk with your healthcare professional about what to expect for your liver.
TREATMENT PROCESS
Patients undergo medical evaluation and receive dietary instructions before the procedure.
An endoscope is inserted through the mouth, and sutures are placed inside the stomach to reduce its volume. No external surgical incision is required.
Most patients return home the same day or after a brief observation period.
ESG is a long-term weight management procedure with effects intended to be sustained over time. Ongoing adherence to dietary and lifestyle recommendations is essential to maintain weight loss and metabolic benefits.
Ongoing dietary counseling, exercise, and behavioral modifications are recommended to support and maintain results.
Regular follow-up is needed to assess weight loss, nutritional status, and treatment response.
BENEFITS AND SAFETY
ESG may support adults with obesity, MASLD, or MASH by reducing stomach volume to promote meaningful weight reduction and appetite control. According to the Liver Therapies Patient Guide, this minimally invasive approach requires no external surgical incisions and may also support metabolic improvement, including benefits for diabetes and insulin resistance, and help reduce liver fat as part of MASLD/MASH-related outcomes. The extent of these benefits varies from person to person, depending on starting weight, liver condition, and how closely lifestyle recommendations are followed.
ESG is not a stand-alone treatment — it works best as part of a broader, personalized care plan that combines the procedure with a structured reduced-calorie diet, portion control, high-protein nutrition, regular physical activity, and ongoing dietary counseling to support sustained weight loss and prevent weight regain.
As with any procedure, ESG may cause side effects, most commonly nausea, abdominal pain or cramping, vomiting, temporary fatigue, or acid reflux and indigestion. Your healthcare provider will discuss these risks and monitor your weight loss, nutritional status, and treatment response over time.
BENEFITS
ESG is done with an endoscope passed through the mouth, so it needs no external surgical incisions. According to the Liver Therapies Patient Guide, most patients return home the same day or after a brief observation period. This may appeal to people who want a less invasive alternative to bariatric surgery.
By decreasing stomach volume, ESG promotes meaningful weight reduction and helps control appetite. Combined with a structured reduced-calorie diet, high-protein nutrition, and regular physical activity, it can help you lose weight and avoid regaining it.
The weight loss that follows ESG may improve diabetes, insulin resistance, and related conditions. For many people with obesity and MASLD or MASH, these conditions occur together, so improving them can benefit overall health beyond the liver.
ESG may help reduce liver fat and improve MASLD/MASH-related outcomes when it is part of a long-term plan. Regular follow-up lets your healthcare provider check your progress and adjust your care as needed.
These effects are often more noticeable soon after the procedure and may improve over time. Your healthcare provider will discuss the potential benefits and risks before treatment and provide ongoing support, including monitoring of weight loss and nutritional status, to ensure safe use.
SUPPORTING YOUR RESULTS
ESG works best alongside a structured reduced-calorie diet, portion control, high-protein nutrition, regular physical activity, and behavioral changes. Ongoing dietary counseling is essential to support sustained weight loss and prevent weight regain.
Long-term lifestyle modification is critical for success after ESG. These habits can help maximize improvements in weight, metabolic health, and liver-related outcomes over time.
Areas that may support treatment:
COMMON QUESTIONS
No, Endoscopic Sleeve Gastroplasty is not a cure. It is a minimally invasive procedure that reduces stomach volume using an endoscope, supporting gradual and sustained weight loss without surgical incisions. This weight loss may improve metabolic risk factors and reduce liver fat in people with MASLD or MASH, but results vary based on starting weight, liver condition, and adherence to lifestyle changes. Long-term success depends on ongoing dietary counseling, physical activity, and behavioral changes. Discuss your individual goals and expected outcomes with a healthcare professional before considering this procedure.
Endoscopic Sleeve Gastroplasty may be considered for adults with obesity or excess body weight affecting their health, or MASLD or MASH associated with obesity. It may also suit those for whom lifestyle modifications alone have not achieved sufficient weight loss, or who are seeking a less invasive alternative to bariatric surgery. Eligibility depends on meeting specific criteria for endoscopic weight-loss therapy. A healthcare provider determines candidacy after a full assessment of your weight, liver condition, and overall health, so speak with a specialist to learn if this procedure fits your treatment goals.
Endoscopic Sleeve Gastroplasty uses an endoscope passed through the mouth to place sutures inside the stomach, reducing its volume without any external surgical incisions. Bariatric surgery, such as sleeve gastrectomy or gastric bypass, is a more invasive, permanent procedure that requires surgical incisions and alters the digestive tract. Endoscopic Sleeve Gastroplasty is often considered by patients seeking a less invasive option. Because each approach carries different risks, benefits, and recovery expectations, talk with a healthcare professional to determine which option best fits your health needs and treatment goals.
During Endoscopic Sleeve Gastroplasty, a gastroenterologist inserts an endoscope through the mouth and places sutures inside the stomach to reduce its volume, with patients typically undergoing medical evaluation and dietary preparation beforehand. Most people return home the same day or after a brief observation period. Afterward, ongoing dietary counseling, physical activity, and behavioral modifications support and maintain results, along with regular follow-up to monitor weight loss, nutritional status, and treatment response. Ask your healthcare provider what to expect for your specific recovery timeline and lifestyle adjustments.
Common risks of Endoscopic Sleeve Gastroplasty include nausea, abdominal pain or cramping, vomiting, temporary fatigue, and acid reflux or indigestion. These effects are often more noticeable soon after the procedure and typically improve over time as the body adjusts. Because individual responses vary, your healthcare provider will review your medical history, discuss potential benefits and risks, and monitor your weight loss, nutritional status, and treatment response afterward. Always raise any new or worsening symptoms with your healthcare professional promptly.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
