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Nwaiwu et al. Mini-invasive Surg. 2025;9:20 https://dx.doi.org/10.20517/2574-1225.2024.112 Page 17 of 20

Cost analysis and future directions
A growing body of research suggests that ESG, despite its relatively lower cost per procedure, can be a cost-
effective option for treating obesity, especially when factoring in the long-term healthcare savings related to
weight loss and improved comorbidities, such as diabetes and hypertension. In this context, ESG offers an
alternative for cost-conscious healthcare systems that are looking to reduce the financial burden of obesity-
related complications.

However, financial analysis must also consider the potential for increased demand as patients become more
aware of minimally invasive alternatives. The scalability of ESG, given its reduced need for postoperative
care and shorter recovery times, may position it as a key player in the evolving landscape of obesity
management.

While physician reimbursement and financial costs associated with EBMTs remain complex, the potential
for improved patient outcomes, reduced long-term healthcare costs, and increased availability of coverage
through insurers offer optimism for broader adoption. Ongoing research into the efficacy and cost-
effectiveness of EBMTs, along with changes in reimbursement policies, will be essential for maximizing the
financial sustainability of these innovative treatments.

FUTURE OF EBMT
With the magnitude of the global obesity problem, significant resources have been deployed to develop
endoscopic therapies to treat obesity and related diseases. While many of these technologies have proven
ineffective, others - despite demonstrating clinical efficacy - have failed in the marketplace and are no longer
available. Despite these limitations, there remains significant interest in EBMTs. ESG and magnetic
anastomoses for intestinal bypass seem to be the most promising of the currently available therapies. We
anticipate seeing increased utilization of these technologies in the coming years. As with other surgical
decisions, selecting the most appropriate EBMT for a given patient requires a more comprehensive,
multifactorial assessment of factors such as the patient’s clinical profile and treatment goals, the available
EBMT options, the surgeon’s skill set, and the relative risks and benefits of the considered EBMT compared
with other alternatives.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study: Pryor AD, Nwaiwu CA, Giorgi M
Performed writing and critical review of the manuscript: Pryor AD, Nwaiwu CA, Giorgi M, Hunte EM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.