Darlington Memorial Hospital in north-east England has introduced a new endobariatric service that offers a minimally invasive weight-loss procedure called endoscopic sleeve gastroplasty under the NHS. This innovative service could help other NHS centres seeking ways to address the growing obesity epidemic1 given the burden on healthcare systems.
With rising rates of obesity in its region,2 Darlington Memorial Hospital, part of County Durham and Darlington NHS Foundation Trust, could previously only offer weight loss reduction surgery to 10-15% of eligible patients.
‘Over the last five years, our bariatric surgeons realised they were unable to provide weight loss reducing surgery to most patients with moderate-to-severe obesity,’ wrote Professor Anjan Dhar, a gastroenterologist with County Durham and Darlington NHS Foundation Trust, in a recent article for the British Society of Gastroenterology.3 ‘The number of patients who had class 3 obesity was overwhelming the service.’
Class 3 obesity refers to people living with this chronic disease as having a body mass index higher than 40.4
The hospital recognised the growing need for innovative weight loss options such as endoscopic sleeve gastroplasty (ESG) to tackle moderate-to-severe obesity, which can lead to an increased risk of type 2 diabetes, cardiovascular disease, strokes and cancer.5 The NHS spends an estimated £6.5bn annually treating healthcare problems related to obesity.6
Assessing ESG benefits for patients and healthcare systems
As a minimally invasive procedure, ESG can be offered as a day case for many patients. The physician inserts a suturing device through the mouth and into the stomach via an endoscope and then places six to eight running stitches along the greater curve of the inside of the stomach.
When tightened and secured, the sutures draw together the anterior and posterior walls of the stomach, reducing it to a sleeve-like shape that’s about one-third its original size.7 The smaller stomach size limits how much the patient wants to eat, while the narrow shape slows down the passage of food.
Patients can normally return to routine daily activities three days after an ESG procedure and resume normal activity when they feel ready – usually within two weeks, compared with six weeks for bariatric surgeries.
With the correct training and support, ESG can be performed by an endoscopist or by a surgeon.
Mounting evidence in favour of ESG
When Professor Dhar and his team started looking into offering ESG, the procedure was available in a few tertiary university teaching hospitals in the London area, but not in any NHS hospitals in the north of England.
The MERIT study – a prospective, multicentre, randomised trial – has served as important global research on ESG.8 Follow-up studies, completed up to five years after patients’ ESG procedures,9 further support the procedure’s efficacy.
After completing a comprehensive systematic review and meta-analysis of 44 studies involving over 15,700 patients who received ESG with Boston Scientific’s OverStitchTM Endoscopic Suturing System, the International Federation for the Surgery of Obesity and Metabolic Disorders recently endorsed ESG as ‘an effective and valuable treatment for obesity.’10
For Professor Dhar and his team, their business case and the potential health benefits for patients were clear. The team submitted a full costings business case to the County Durham and Darlington NHS Foundation Trust in 2019 to incorporate ESG into its bariatric service with a structured programme for training and implementation.
They developed a multidisciplinary team comprised of an experienced consultant gastroenterologist, a consultant bariatric surgeon, a bariatric specialist nurse, a dietitian, a psychologist and two senior endoscopy nurses.
Collaboration and training key to successful implementation
The team collaborated with Boston Scientific, which distributes the OverStitch Endoscopic Suturing System used in the ESG procedure, to develop a comprehensive training programme.
‘Working with healthcare professionals to develop tailored training programmes for innovative treatments enhances patient care,’ said Astrid Monteau, vice president of Endoscopy in EMEA at Boston Scientific. ‘With the UK having one of the highest obesity rates in Europe, it is important to expand patient choice to address this disease which impacts quality of life.’11
Dry lab training included online sessions on the device, the procedure and patient selection. Wet lab training involved hands-on practice to learn appropriate suturing techniques with the OverStitch system and the recommended ESG suture pattern. The team then watched experienced operators from established centres perform the ESG procedure live.
Live cases: ‘a real lifeline’
The first few live cases at Darlington Memorial Hospital in 2022 were supervised by one of two in-theatre proctors: Professor Bu’ Hussain Hayee, consultant gastroenterologist at King’s College Hospital in London, and Dr Vincenzo Bove, medical director of gastrointestinal endoscopic surgery at Gemelli University Hospital in Rome. They then transitioned to remote proctoring through live video links for the next few cases.
Reporting on the first nine cases, Professor Dhar said each procedure took between 90 and 120 minutes, with no complications. He stressed the value of the training and the proctorship his team received, both live and remote, in helping him to ensure that the hospital could independently carry out ESG procedures and support patients.
‘A team-based approach with industry collaboration is crucial to the success of any modern advanced therapeutic endoscopy service,’ Professor Dhar wrote. ‘Our ESG programme has demonstrated the success of a structured training programme to learn an advanced endoscopic technique and implement this into current NHS service to meet the growing needs of the local population.’
Recognition for leading the way
The team in Darlington was recognised with a ‘highly commended’ award by the British Society of Gastroenterology in June 2024 for the collaboration between the gastroenterology, endoscopy, and bariatric surgery teams for their work on ESG.
County Durham and Darlington NHS Foundation Trust was also a finalist in the Outstanding NHS Industry Collaboration category at the 2024 Bright Ideas in Health Awards, organised by Health Innovation North East and North Cumbria.
In February 2024, the National Institute for Health and Care Excellence recommended that ESG be available on the NHS, based on the mounting evidence confirming its efficacy, safety and cost-effectiveness.7
Currently, there are 20 NHS centres offering ESG. Boston Scientific has trained 22 gastrointestinal and surgical consultants from 11 centres and has opened the Institute for Advancing Science – a dedicated training centre for ESG and other clinical procedures in Hemel Hempstead.12
This article has been funded by Boston Scientific.
References
- European Parliament. Obesity in the EU: an ongoing epidemic. March 2025. [Accessed April 2025].
- Durham County Council. Review of healthy weight approaches in County Durham. October 2023. [Accessed April 2025].
- British Society of Gastroenterology. Developing an Endobariatrics Service – tackling the global obesity pandemic. [Accessed April 2025]
- National Institute for Health and Care Excellence. Obesity: diagnosis – identification and classification. NICE Clinical Knowledge Summaries. Revised February 2025. [Accessed April 2025].
- World Health Organization. Obesity: Health consequences of being overweight. 1 March 2024. [Accessed April 2025].
- Department of Health and Social Care. Government plans to tackle obesity in England. Updated 2 February 2024. [Accessed April 2025].
- National Institute for Health and Care Excellence. Endoscopic sleeve gastroplasty for obesity. NICE Interventional procedures guidance IPG783. 22 February 2024. [Accessed April 2025].
- Abu Dayyeh BK et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet 2022;400(10350):441–51.
- Sharaiha RZ et al. Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity. Clin Gastroenterol Hepatol 2021;19(5):1051–7.
- Abu Dayyeh BK et al. IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management. Obes Surg 2024;34(12):4318–48.
- World Health Organization. WHO European Regional Obesity Report 2022. 2 May 2022. [Accessed April 2025].
- Boston Scientific. Investing in clinician training in the UK to transform patient outcomes. 20 February 2025. [Accessed April 2025].
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