According to consultant gastroenterologist, hepatologist and bariatric endoscopist Dr Yong Karl King, obesity – long treated as a cosmetic issue – is now globally recognised as a disease that requires medical treatment. Yet many patients continue to face judgement and a lack of accessible options.
“Obesity is not just in Malaysia, it is a global pandemic. But many people don’t seek medical help because of stigma,” he told Bernama.
He explained that traditional approaches to obesity treatment often oscillate between lifestyle modification and full bariatric surgery, leaving patients with few middle-ground choices.
“ESG is emerging as one of several procedures being explored to support patients with obesity, under medical guidance,” Yong said.
He explained that ESG is “not a surgery”; rather, it is classified as a minimally invasive endoscopic procedure to remodel the stomach.
“The procedure is performed under general anaesthesia, through the mouth using an endoscope, and involves suturing or plicating the stomach to reduce stomach capacity without removing any parts of the intestine or stomach. There is no cutting, no scars whatsoever.
“Studies have shown patients may experience average weight loss of 14-17% of total body weight over one year, provided they commit to lifestyle changes after the procedure. Results may vary between individuals,” he said.
Yong, who is one of the early adopters who pioneered the setup of ESG at St Mary’s Hospital in London, said the procedure has several advantages over traditional bariatric surgery, including safety, reversibility and repeatability.
“If patients regain weight after a few years, they can repeat it. If they don’t like the effect, another endoscopic procedure can be performed to remove the stitches. Such flexibility does not exist with surgery,” he added.
He said another benefit is that ESG can “bridge” high-risk patients for future bariatric surgery, time-critical major surgeries, or fertility treatments.
While patient experiences vary, Yong said a vast majority tolerate the procedure well, with reports of initial discomfort such as nausea, vomiting and mild abdominal pain that typically subsides within days to months.
Crucially, most patients undergoing ESG recover without the need for intensive care.
Despite its safety profile, Yong cautioned that ESG, like any procedure, carries risks such as bleeding, infection and excessive weight loss, but all are relatively rare and manageable.
He stressed that patient safety is paramount, and a thorough evaluation is essential to determine if a patient is a suitable candidate for ESG. Eligibility criteria include being overweight or obese, and having tried lifestyle modifications unsuccessfully.
Yong stressed that ESG is not a “panacea” or to eliminate hunger, but an adjunct to achieve food-portion control by providing an earlier sense of fullness, which allows patients to take charge of their eating habits.
“I would like to emphasise that this is not a cosmetic procedure; the ultimate goal is to prevent obesity-related comorbidities,” Yong said.
“The end goal is lasting patient health improvement and satisfaction. They deserve to have choices beyond the extremes of lifestyle changes or surgery.”