Bypass, sleeve, Endosleeve: three effective but very different approaches. Here is a transparent comparison to understand where the endoscopic route stands — and for which patient profile.
Bariatric surgery — mainly gastric bypass and sleeve gastrectomy — remains today the reference for treating severe obesity. It alters the anatomy of the digestive tract and allows the greatest weight loss. The Endosleeve (Endoscopic Sleeve Gastroplasty) belongs to another generation of techniques: performed entirely through natural routes, without incision or removal, it reduces the volume of the stomach with internal sutures. Less invasive, it often suits different patients — without replacing surgery when surgery is indicated.
The purpose of this page is not to rank these techniques, but to clarify their differences. Only a thorough medical consultation can determine the option best suited to your situation.
The gastric bypass (Roux-en-Y) creates a small gastric pouch connected directly to the small intestine, combining a restrictive effect with partial malabsorption. It is one of the most effective procedures, with weight loss in the order of 30 to 35% of total body weight and a strong impact on type 2 diabetes. In return, it is major surgery: a permanent change in anatomy, a lifelong risk of nutritional deficiencies, possible surgical complications and a longer recovery. The Endosleeve, by contrast, neither cuts nor bypasses the stomach: it reduces its volume in a minimally invasive way, with more moderate weight loss (in the order of 15 to 20%), but a markedly lower operative risk, no induced deficiency, on an outpatient basis or with one night's stay, and potentially reversible.
Surgical sleeve gastrectomy involves permanently removing about 75 to 80% of the stomach by laparoscopy, keeping only a narrow gastric tube. It leads to significant weight loss (in the order of 25 to 30% of total body weight) and remains irreversible, since part of the stomach is removed. The Endosleeve achieves a comparable reduction in gastric volume — but without any removal: the stomach is fully preserved and reshaped from the inside with sutures. Weight loss is generally more moderate, but the procedure avoids abdominal incisions, greatly reduces risks, shortens recovery and preserves the integrity of the organ.
The main differences between the endoscopic approach and conventional bariatric surgery. Surgery remains more powerful for weight loss; the Endosleeve stands out for being minimally invasive.
The choice depends on many factors: body mass index (BMI), the presence and severity of comorbidities, medical and surgical history, but also the patient's expectations and preferences. Broadly speaking, bariatric surgery remains the reference for the most severe or complicated forms of obesity, while the Endosleeve is a preferred option for patients with overweight or moderate obesity, or for those who wish to avoid surgery. This decision is always built during an individualised medical discussion with Dr. Sitte.
“The best treatment is not the most spectacular one, but the one that best fits your situation and your goals.”
Eligibility for each technique is assessed during a thorough consultation with Dr. Sitte.
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