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Page 16 of 20 Nwaiwu et al. Mini-invasive Surg. 2025;9:20 https://dx.doi.org/10.20517/2574-1225.2024.112

(fluid-filled balloon), and 10.4% (aspiration therapy), respectively, relative to lifestyle modification (control).
Furthermore, the EWL after POSE (15.3%), DJBL (13.0%), fluid-filled balloon (22.4%), and aspiration
therapy (27.3%) were superior to the control group. However, gas-filled balloons and botulinum toxin
[10]
injection did not show a significant difference in TBWL and EWL relative to the control group .

EBMT IN THE GLOBAL CONTEXT OF PATIENT CARE
Weight loss interventions have been shown to yield better results when integrated into a comprehensive,
multidisciplinary treatment plan. Similarly, EBMTs should be utilized within this framework to maximize
their effectiveness. Key components of these programs include nutritional support, skilled nursing care,
behavioral medicine specialists, and physicians with expertise in managing obesity. Additionally, it is
recommended that physicians and surgeons who can handle potential complications in obese patients be
available and accessible .
[76]

FINANCIAL ASPECTS OF EBMTS
As EBMTs become more widely utilized, understanding the financial aspects of these interventions,
including physician reimbursement, becomes crucial, both for healthcare providers and patients.

Physician reimbursement for endoscopic bariatric therapies
Physician reimbursement for EBMTs varies depending on the healthcare system and the payer. In the
United States, reimbursements from government programs like Medicare or Medicaid are often lower than
[77]
those from private insurance companies . Despite ESG being a minimally invasive procedure with
promising clinical outcomes, reimbursement remains a challenge. The cost of the procedure itself, which
includes equipment and facility fees, can be substantial, but physicians may face pressure from payers who
have yet to establish standardized reimbursement rates for such newer interventions.

Currently, many insurers classify ESG as an experimental or investigational procedure, meaning that
reimbursement is often denied or provided at a lower rate compared to traditional bariatric surgery. This is
due to the lack of long-term data and FDA approval, although ESG is FDA-cleared for diagnostic use. As
more clinical data become available, particularly demonstrating ESG’s effectiveness and safety in the long
term, insurers may update their policies and reimbursement schedules, potentially improving financial
sustainability for physicians performing these procedures. A new level 1 CPT code will become available for
use on January 1, 2026, which may dramatically change the possibility of offering the procedure to
patients .
[78]
Financial costs of endoscopic bariatric procedures
The financial burden of ESG, both for healthcare systems and individual practices, is multifaceted. The
initial procedure cost typically includes the use of specialized endoscopic equipment (such as a balloon or
suturing device), the physician’s time, and operating room expenses. While ESG offers lower direct costs
than traditional surgery by eliminating hospital stays, the overall price can still be significant. Hospitals and
outpatient clinics must factor in staff salaries, facility overhead, and any additional follow-up care that may
be required.

Patients, in turn, may experience out-of-pocket costs depending on their insurance coverage. For those
without adequate insurance, the procedure can be prohibitively expensive, which may limit access to ESG
and other EBMTs. This financial barrier underscores the importance of considering the cost-effectiveness of
ESG compared to traditional operations such as RYGB or SG, which involve higher upfront costs but may
be more likely to be reimbursed.