Endoscopic sleeve gastroplasty for Japanese obese patients

Gastrointestinal weight loss surgery (GIWLS), including laparoscopic sleeve gastroplasty and gastric bypass, is performed for reducing body weight and eventually treats metabolic syndrome such as high blood pressure, diabetes merits, and so on. The surgery is effective but causes serious adverse events. Endoscopic sleeve gastroplasty (ESG) is developed at Mayo Clinic in 2013. This per oral flexible endoscopic procedure can complete the procedure without a skin incision, and fewer serious adverse events and preferred long-term outcomes were reported. ESG is considered a bridge therapy between lifestyle interventions or pharmacotherapy and surgery. Most ESG cases were performed in the western country, and there were few reports from Asia. This may be due to the low incidence of obesity, as reflected by the number of GIWLS in Asia. Asian patients can develop metabolic syndrome when only overweight with BMI less than 25kg/m2. Thus, there are many potential patients suitable for ESG in Asian countries. Accordingly, we introduced ESG in Japan in 2020. I would like to present this new therapy with the endoscopic maneuver, clinical course, and advantage in this session. I will also show the importance of ESG in Asia. I hope ESG spreads in Japan and we can save more obese patients in the future.