A New, Nonsurgical Path for Lasting Weight Loss

For millions of Americans, GLP-1 medications such as Wegovy and Ozempic have become a go-to strategy for weight loss. These drugs can be a game-changer for people who struggle with maintaining a healthy weight, but they come with significant costs—financial and otherwise.

Monthly out-of-pocket expenses for GLP-1 drugs can exceed $1,000 for many patients, and the drugs’ side effects—such as nausea, vomiting and loss of lean muscle mass—can make long-term use challenging. Even more concerning: Once people stop taking the medication, the weight usually comes back and patients are left searching for alternative weight loss support.

But now there’s another option—one that works with the body, doesn’t require surgery and can deliver durable weight loss without lifelong injections or troubling side effects. At Cedars-Sinai, endobariatric pioneer Barham Abu Dayyeh, MD, MPH, director of Interventional Gastroenterology, offers a suite of noninvasive procedures called Endura to address the root cause of obesity.

How Do Endobariatric Procedures Control Hunger?

Hunger is not about willpower. It’s a physiological process controlled by how quickly the stomach fills and how long it stays full. Endura reshapes the stomach, without surgery, so it fills faster and empties more slowly—helping patients feel satisfied with smaller meals for longer periods of time.

During the procedure, doctors pass a flexible tube called an endoscope through the mouth to remodel the stomach internally to regulate hunger and fullness—no cutting, stapling or tissue removal required. Just a natural nudge that quiets the internal tug-of-war around hunger.

This isn’t about forcing weight loss. It’s about giving patients an option that aligns with how the body naturally regulates appetite and energy, so they can regain control of their lives and adopt a healthier lifestyle.

Supported by more than a decade of clinical data and with more than 50,000 procedures performed globally, Endura is emerging as a safe and viable long-term solution for obesity and associated metabolic diseases, such as Type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (formerly known as fatty liver disease).

“By reshaping the stomach from the inside, Endura helps people feel full sooner and stay full longer,” said Abu Dayyeh. “Patients are satisfied with smaller meals and often stay full for hours, without the nausea and digestive side effects that many people experience with weight loss medications.”

Endura’s FDA-approved class of treatments typically produces a 15% to 20% loss of total body weight, with studies in leading medical journals showing that results last for at least three years. And since endobariatric procedures don’t require incisions, patients go home the same day and typically return to their usual activities a few days later.

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Who Is a Good Candidate for Endobariatric Approaches?

More than 40% of U.S. adults meet the clinical criteria for obesity, and many have cycled through diets, medications and even previous bariatric procedures.

The Endura suite includes three types of endobariatric procedures, each helping patients lose weight by effectively reducing their stomach size:

• ‍Endoscopic sleeve gastroplasty (ESG): With ESG weight loss, physicians gently remodel the stomach from the inside, placing stitches in strategic locations, pulling it together into a tube-like shape to make it smaller, almost like an accordion. After the procedure, the stomach stretches more quickly, telling the brain “I’m full,” and it empties more slowly, so you remain satisfied for longer periods of time.‍
• Endura Orbera: In an Endura Orbera procedure, physicians place a soft balloon in the stomach and fill it with saline until it’s about the size of a grapefruit. The balloon takes up space in the stomach, so you feel full more quickly and eat less food overall. The caveat: Unlike ESG, Endura Orbera is temporary. The balloon must be removed or replaced after six months. ‍
• Endura Revision: Endura Revision is designed for patients who have had a previous bariatric surgery, such as gastric bypass or sleeve gastrectomy and noticed their stomach stretching over time. It allows patients to “retighten” the stomach and get back on track, without undergoing another invasive surgery.

Since Endura is grounded in how the body naturally regulates hunger, it’s an especially attractive option for people who:

• Have a body mass index between 30 and 50
• Are unable to sustain weight loss with lifestyle interventions
• Want to avoid traditional surgery
• Do not want to take daily medications
• Have regained weight after a previous bariatric surgery or injectable medications
• Want to maintain the weight they lost on injectable medications and transition off them

How GLP-1 Medications Compare to Endobariatric Procedures

For many patients, cost is a major factor in choosing between GLP-1 medications and an endobariatric procedure. GLP-1 drugs can cost upward of $12,000 per year for as long as a patient takes them. And research shows that more than 60% of patients discontinue these medications within two years due to cost or side effects.

“Compared with medications, Endura offers a unique value proposition as a one-time outpatient procedure with durable results. This combination of effectiveness and long-term value is attracting increasing coverage by insurers,”said Abu Dayyeh.

Beginning in 2026, Endura will have a category 1 Current Procedural Terminology code, opening the door to broader coverage from Medicare and commercial insurers. Abu Dayyeh expects coverage to expand quickly, improving access and equity for patients.

“This isn’t about forcing weight loss,” Abu Dayyeh said. “It’s about giving patients an option that aligns with how the body naturally regulates appetite and energy, so they can regain control of their lives and adopt a healthier lifestyle.”

Wondering whether Endura is right for you? Ask your doctor for a referral to a gastroenterologist who has experience in performing noninvasive weight loss procedures.

Barham Abu Dayyeh, MD, MPH, serves as a consultant for Boston Scientific and Olympus. He has received research support for the conduct of the MERIT trial from Apollo Endosurgery, now Boston Scientific; this support was provided to his previous institution (Mayo Clinic), and he did not receive personal compensation related to the trial. Abu Dayyeh is also a co-inventor of the Endogenex technology, which has been licensed by the Mayo Clinic to Endogenex.