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Results
Most weight loss occurs over the first 3 to 6 months and is greatest when you follow the dietitian’s plan and stay active. The balloon is removed at the planned time (generally about 6 months), and weight regain is common unless eating and activity habits are kept. For ESG, benefit is typically assessed at 6 and 12 months. Realistic goals are a body-weight loss of roughly 10% to 15%, not the larger reductions seen with surgery or newer injections. Ask the centre for its own results and for follow-up arrangements.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Endoscopic bariatric therapies are procedures done through the mouth with an endoscope (a flexible tube with a camera), without cutting the skin. They sit between lifestyle and medicines on one side and weight-loss surgery on the other. The main types are: (1) an intragastric balloon, a soft balloon placed in the stomach to take up space and increase fullness, removed after about 6 months or sometimes up to 12; (2) endoscopic sleeve gastroplasty (ESG), in which stitches placed inside the stomach make it narrower, like a tube, without removing any stomach; (3) aspiration therapy, in which a tube lets part of a meal be drained from the stomach after eating; and (4) duodenal mucosal resurfacing (DMR), which heat-treats the lining of the first part of the small bowel, mainly studied in type 2 diabetes rather than for weight. Other devices have been tried, such as a pyloric (stomach-outlet) shuttle and a duodenal-jejunal bypass liner, and have been withdrawn or stopped. Honest answer to “which one?”: the evidence is strongest for ESG and for balloons in selected people, while aspiration therapy and DMR are not widely available and are not routine care.
Why is it done?
The aim is to give people who have not reached their goals with lifestyle change and medicines a less invasive option than surgery, with loss of weight and improvement in weight-related conditions. Evidence: in the MERIT randomised trial, ESG plus lifestyle gave about 13.6% total body weight loss at one year versus 0.8% with lifestyle alone, and many people kept most of it at two years. Balloons typically produce around 10% of body weight loss at 6 months in trials, but much of it is often regained after removal unless the lifestyle plan continues. Weight loss with endoscopic therapies is usually less than with sleeve gastrectomy or gastric bypass, and long-term data (beyond 2 to 5 years) are still limited. Professional societies (ASGE, ASMBS) have set minimum efficacy targets for these devices and, in a 2021 ASGE guideline, conditionally suggested ESG and fluid-filled balloons as options for selected adults with a BMI of about 30 to 40 on low-certainty evidence.
Who needs it?
- Adults with obesity, usually a BMI of about 30 to 40, who have tried lifestyle change (and often medicines) without enough benefit, and who prefer a non-surgical option
- People who are not suitable for or do not want surgery, or want a step before surgery (for example to lose weight before another operation)
- Selected people with weight regain after bariatric surgery; a stretched stomach opening can sometimes be tightened endoscopically (transoral outlet reduction)
- Not suitable for most people with a very high BMI, active ulcers, large hiatus hernia, previous major stomach surgery (depending on the device), severe reflux, bleeding disorders or blood thinners that cannot be paused, pregnancy, or an untreated eating disorder or serious psychological illness
Before the procedure
- A full assessment by a team that includes a gastroenterologist or bariatric physician, a dietitian and often a psychologist. Expect a gastroscopy first, blood tests and a review of your medicines.
- Ask which device is used, whether it is registered for use in Saudi Arabia (SFDA), the total cost, what happens if there is a complication, and who will follow you for at least a year.
- Tell the team about all medicines, especially blood thinners, aspirin, diabetes medicines, and weight-loss injections, and about allergies. Follow the fasting rules exactly; some centres ask for a liquid diet beforehand if you use GLP-1 medicines.
- Procedures are done under general anaesthesia or deep sedation, so arrange an adult to take you home. Plan time off work.
- Agree a plan for food, activity and follow-up before the procedure. These devices work only together with a lasting change in eating.
During the procedure
You are asleep or deeply sedated and monitored throughout. For a balloon, the doctor passes the endoscope through the mouth, places the deflated balloon in the stomach and fills it (usually with saline) before withdrawing the endoscope; it takes about 20 to 30 minutes. For ESG, a special suturing device on the endoscope places a series of stitches that fold the stomach into a narrower tube; it commonly takes one to two hours. For aspiration therapy, a tube is placed through the stomach wall to the skin (as in a feeding tube) so that a part of a meal can be drained. DMR uses a catheter that lifts and heat-treats the lining of the duodenum. You will not feel the procedure itself.
After the procedure
Most people go home the same day or after one night. Nausea, vomiting, belly cramps and discomfort are very common in the first few days after a balloon or ESG, and anti-sickness and pain medicines are prescribed. You will follow a staged diet of liquids, then pureed, then soft food over several weeks, and the dietitian reviews you regularly. Balloons must be removed by endoscopy at the planned time; leaving one in longer than advised is dangerous. Plan regular follow-up for at least a year. Drinking enough fluids and taking the prescribed stomach-protecting medicine matter.
Risks
- Nausea, vomiting, belly pain and cramps, especially in the first days (very common with balloons and ESG)
- Reflux and heartburn, stomach ulcers or erosions, and bleeding
- Balloon problems: deflation and passage into the bowel with blockage, and rare over-inflation or pancreatitis. The US FDA has issued safety communications about balloon-related deaths and complications, so balloons need careful follow-up.
- For ESG: serious but uncommon problems such as bleeding, collections around the stomach, infection, a tear or perforation that may need surgery, or lung and chest complications; the stitches may loosen over time and weight can return.
- Aspiration therapy: infection or leakage around the tube, persistent site problems, and concern that it may encourage unhealthy eating habits; the main device is reported to have been withdrawn from the market by its maker, so it is rarely available.
- Risks of anaesthesia or sedation, and the chance that the procedure does not give enough weight loss or cannot be completed
- Go to the emergency department urgently if after the procedure you have severe or worsening belly or chest pain, repeated vomiting that stops you drinking, vomiting blood or black stools, fever or chills, breathlessness, a swollen hard belly, or you cannot swallow fluids.
When you get results
Alternatives if you decline
Alternatives are structured lifestyle programmes, prescription weight-loss medicines (including GLP-1 based injections, which usually produce larger average weight loss than balloons), and bariatric surgery such as sleeve gastrectomy or gastric bypass, which gives the largest and most durable weight loss in most studies but is a major operation. If you decline an endoscopic procedure, you can still try these options. The right choice depends on your BMI, health conditions, preferences, costs and local availability.
In the Saudi context
Endoscopic weight-loss procedures are offered in a limited number of private and referral centres in Saudi Arabia, and they are often not covered by insurance, so ask about total cost including removal, follow-up and complications. Device availability and regulatory status change quickly (several devices sold earlier have been withdrawn), so ask whether the exact device is registered with the SFDA and how long the centre has used it. If you plan to fast in Ramadan with a balloon or after ESG, speak with your team: the early weeks should be avoided, and later fasting needs a plan for fluids and protein. Avoid centres promoting “quick” or guaranteed results.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Which procedure, if any, is suitable for me compared with medicines or surgery?
- Is this device registered in Saudi Arabia, and how long has the centre used it?
- How much weight loss is realistic, and what happens to it after the balloon is removed?
- What are the complication rates in your centre, and who treats me if something goes wrong?
- What will it cost in total, including removal and follow-up, and will my insurance pay?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide