Multicentre ESG Randomised Interventional Trial - MERIT

Contribution To Literature:

The MERIT trial showed that endoscopic sleeve gastroplasty (ESG) results in sustained weight loss.


The goal of the trial was to evaluate ESG compared with control among obese individuals.

Study Design

  • Randomization
  • Parallel
  • Stratification

Obese subjects were randomized to ESG plus lifestyle modification (n = 85) versus lifestyle modification alone (n = 124). Lifestyle modification included a low-calorie diet and physical activity.

After 12 months, subjects in the ESG group could receive re-tightening based on initial suboptimal response. Subjects in the control group could cross over to ESG if they did not reach the primary target weight loss.

  • Total number of enrollees: 209
  • Duration of follow-up: 12 months
  • Mean patient age: 46 years
  • Percentage female: 84%
  • Percentage with diabetics: 33%

Inclusion criteria:

  • Obesity (body mass index 30 to <40 kg/m2)
  • Patients 21–65 years of age
  • History of failure of nonsurgical weight loss methods

Exclusion criteria:

  • Gastrointestinal surgery
  • Gastrointestinal tract inflammatory disease

Principal Findings:

The primary outcome, mean percentage of excess weight loss at 52 weeks, was 49.2% in the ESG group versus 3.2% in the control group (p < 0.0001).

Secondary outcomes:

  • Mean percentage of total bodyweight loss at 52 weeks: 13.6% in the ESG group versus 0.8% in the control group (p < 0.0001)
  • Achieving ≥25% of excess weight loss at 52 weeks: 77% in the ESG group versus 12% in the control group
  • Improvement in 1 or more metabolic comorbidities at 52 weeks: 80% in the ESG versus 45% in the control group


Among obese individuals, ESG resulted in significant and sustained weight loss at 52 weeks compared with control. Weight loss was sustained at 104 weeks. ESG is a minimally invasive procedure, which uses endoscopic suturing to imbricate most of the stomach. ESG also resulted in improvement in metabolic comorbidities. ESG can be considered a synergistic weight loss intervention among obese individuals.


Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet 2022;400:441-51.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise

Keywords: Body Mass Index, Caloric Restriction, Comorbidity, Exercise, Gastroplasty, Life Style, Metabolic Syndrome, Obesity, Primary Prevention, Minimally Invasive Surgical Procedures, Weight Loss

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