Endoscopic Weight Loss Therapy Market - Global Forecast 2026-2032

The Endoscopic Weight Loss Therapy Market size was estimated at USD 317.58 million in 2025 and expected to reach USD 358.03 million in 2026, at a CAGR of 10.79% to reach USD 650.74 million by 2032.

Introduction

The global obesity epidemic has accelerated demand for minimally invasive interventions that can deliver meaningful weight loss outcomes while reducing procedural risk and recovery time. According to a World Health Organization fact sheet, in 2022 over two and a half billion adults were overweight and nearly 890 million were living with obesity, with prevalence more than doubling since 1990 and now affecting 16% of adults worldwide. These rising rates have propelled endoscopic weight loss therapies to the forefront of obesity management, offering patients durable, device-based solutions that avoid the cost and invasiveness of traditional bariatric surgery.

Endoscopic approaches leverage advanced devices and techniques to restrict gastric volume, regulate caloric intake, or extract ingested nutrients postprandially. Aspiration therapy using the AspireAssist System entails endoscopic placement of a percutaneous gastrostomy tube that allows patients to drain approximately 30% of ingested calories, resulting in a mean total body weight loss of 12.1% after 52 weeks and clinically meaningful reductions in excess weight of 31.5% compared to lifestyle counseling alone. Endoscopic sleeve gastroplasty (ESG), facilitated by flexible endoscopic suturing systems, creates a restrictive sleeve without surgical incisions. The MERIT randomized trial demonstrated a 13.6% total body weight loss at one year with ESG versus 0.8% for lifestyle modification alone, establishing its efficacy and safety profile. Intragastric balloons-encompassing both long-term systems such as the twelve-month Orbera 365™ device and novel short-term swallowable balloons-induce satiety and metabolic benefits, with recent meta-analysis reporting a 12.47% mean total weight loss and serious adverse event rate below 1% within four months.

Regulatory advances have kept pace with innovation, with the U.S. Food and Drug Administration granting de novo clearance for ESG devices in July 2022, approving suturing platforms and bariatric revision systems from leading manufacturers. Together, these therapies are reshaping the continuum of obesity care by providing less invasive options that bridge the gap between pharmacotherapy and surgical intervention, meeting the needs of patients who seek effective weight management without the morbidity of surgery.

Transformative shifts in endoscopic weight loss therapy have been driven by a convergence of technological innovation, strategic collaborations, and evolving reimbursement pathways. The acquisition of Apollo Endosurgery by Boston Scientific in late 2022 for $615 million expanded Boston Scientific’s endoluminal surgery portfolio, incorporating the OverStitch™ endoscopic suturing systems and the Orbera® intragastric balloon franchise to accelerate adoption of endoscopic sleeve gastroplasty and balloon therapy worldwide. This consolidation reflects a broader industry trend toward integrated platforms that combine device innovation with robust procedural training and physician education.

At the same time, the contemporary medtech landscape is adapting to tariff-induced supply chain pressures, prompting manufacturers to diversify sourcing strategies and regionalize production. A GlobalData analysis indicates that reinstated Section 301 tariffs on Class I and II medical devices imported from China are catalyzing supply chain diversification, as industry leaders seek to mitigate cost pressures and service disruptions. Companies are optimizing their manufacturing footprints in North America and Southeast Asia, while forging partnerships to localize component supply and reduce exposure to volatile trade policies.

Meanwhile, coding and reimbursement reforms are lowering barriers to clinical uptake. New unlisted CPT codes for ESG (CPT 43999) and upcoming HCPCS Level II codes such as C9784 for gastric restrictive endoscopic procedures are set to formalize coverage pathways and establish clear fee schedules for endoscopic sleeve gastroplasty by 2025. These changes, coupled with growing payer recognition of cost-effectiveness and patient preference data, are driving a paradigm shift in obesity care delivery toward minimally invasive endoscopic interventions.

The reinstatement and escalation of U.S. tariffs on medical device imports in 2025 are exerting cumulative headwinds on the endoscopic weight loss therapy ecosystem. Tariffs under Section 301 target a broad range of equipment components and device assemblies, increasing cost pressures for manufacturers and healthcare providers. GlobalData warns that renewing Trump-era tariffs on Class I and II medical devices will accelerate supply chain diversification efforts, as companies hedge against potential 10% to China-specific duties by relocating production and securing alternative suppliers.

These levies extend beyond direct device tariffs to steel and aluminum derivative duties that took effect in March 2025. Providers are reporting delayed shipments of endoscopic suturing accessories and balloon deployment systems, while hospitals face budgetary constraints that could postpone capital investments. A MedTech Dive analysis found that top medtech companies anticipate a combined tariff impact exceeding $2 billion in 2025, leading to expanded domestic manufacturing projects and nearshoring initiatives to soften tariff exposure.

Johnson & Johnson’s 2025 outlook projects $400 million in additional costs attributable to tariffs on Chinese imports for its medical technology division, underscoring the significant financial strain within the device sector; these costs notably exclude potential pharmaceutical levies and emphasize the tangible impact on surgical device portfolios used in bariatric endoscopy. Baker McKenzie highlights that 25% tariffs on steel- and aluminum-containing goods amplify the effect on device manufacturing, as structural components increasingly rely on imported alloys for precision engineering and biocompatibility standards.

In response, industry leaders are forging strategic alliances to secure raw materials, piloting joint-manufacturing ventures in tariff-friendly locales, and recalibrating pricing strategies to sustain innovation funding. Although these measures may mitigate short-term disruptions, the renewed tariff landscape is reshaping the global supply chain, underscoring the critical importance of agile manufacturing footprints and alliances across the endoscopic weight loss therapy value chain.

Decoding the market through a segmentation lens illuminates distinct pockets of opportunity and targeted growth drivers. When examined by therapy type, aspiration therapy with the AspireAssist System addresses higher-BMI patients seeking reversible caloric drainage, while endoscopic sleeve gastroplasty leverages full-thickness suturing and stapling systems to create a restrictive sleeve without incisions. Intragastric balloons further diversify the portfolio with long-term saline-filled and short-term swallowable options, each suited to different patient preferences and risk profiles.

Segmenting the balloon category by product type reveals an emerging dichotomy between reusable platforms favored by high-volume centers and single-use disposable balloons that simplify logistics and minimize cross-contamination risks. This split underscores evolving hospital procurement strategies and the growing emphasis on infection control and workflow efficiency.

Distinct end user environments-freestanding and hospital-affiliated ambulatory surgical centers, specialized bariatric and gastroenterology clinics, academic and community hospitals, and multidisciplinary or single-practice weight loss centers-demand customized device configurations and support services. Ambulatory surgical centers often prioritize streamlined, high-throughput single-use models, whereas academic hospitals may invest in reusable suturing platforms that support broad procedural training and research initiatives.

Procedure setting further nuances market dynamics, with both inpatient and outpatient pathways gaining traction as payers and providers embrace same-day protocols supported by telemetry, telehealth follow-up, and mobile health monitoring. Understanding these layered segments enables stakeholders to align product development, training, and commercialization strategies with site-specific requirements and patient care models.

Regional dynamics shape the competitive landscape and inform strategic priorities as endoscopic weight loss therapies proliferate globally. In the Americas, the United States remains the epicenter of innovation and adoption, buoyed by favorable reimbursement codes, robust procedural volume, and high obesity prevalence. CMS has issued new HCPCS codes for ESG and actively evaluates additional coverage for intragastric balloon procedures, reinforcing payer confidence and accelerating hospital investment in endoscopic platforms.

Europe, the Middle East, and Africa exhibit a heterogeneous regulatory tapestry where leading markets in Western Europe have embraced intragastric balloons since 2015, while recent approval pathways for ESG devices by the CE mark and de novo FDA approvals have catalyzed rapid uptake. France’s suspension and subsequent relaunch of the Allurion swallowable balloon following ANSM clearance demonstrate the region’s rigorous post-market surveillance and commitment to patient safety; France accounted for roughly 15% of Allurion’s revenue before the temporary pullback.

Asia-Pacific is emerging as a dynamic growth frontier, propelled by rising obesity rates, expanding healthcare infrastructure, and government initiatives to curb non-communicable diseases. According to The Lancet’s Global Burden of Disease forecast, over 400 million adults in China and 180 million in India were living with overweight or obesity in 2021, with projections suggesting further increases by 2050 if no interventions are scaled. Markets such as Japan and Australia are fast-tracking approvals for both balloon and ESG platforms, while telehealth integration and digital health solutions are extending procedural reach to under-served geographies.

A cadre of leading innovators is driving rapid evolution in the endoscopic weight loss therapy space. Boston Scientific, buoyed by its acquisition of Apollo Endosurgery, is integrating OverStitch™ and Orbera® technologies into its endoscopy business to establish a comprehensive endobariatric portfolio and accelerate procedural adoption. Post-acquisition, Boston Scientific reported a 29% increase in metabolic interventions revenue during Q1 2023, highlighting early synergies in combined sales and training initiatives.

Allurion Technologies has distinguished itself with the world’s first swallowable, procedure-less gastric balloon paired with an AI-enabled virtual care suite. The Allurion Program’s early real-world data from France demonstrate a 12.2% total body weight loss at four months alongside improvements in muscle mass and metabolic markers, underscoring the viability of digital health-powered care pathways.

Aspire Bariatrics’ AspireAssist System has proven durable through four years of post-market registry data, with sustained total weight loss exceeding 18% and expedited metabolic improvements in triglycerides and HbA1c. Registry findings from over 200 patients confirm low serious adverse event rates, solidifying AspireAssist’s position as a reversible, outpatient‐based therapy option for Class II and III obesity.

Established medtech players such as Johnson & Johnson, Abbott, and Medtronic are deepening their endoscopic portfolios through targeted investments in suturing systems, laparoscopic-to-endoscopic surgical conversions, and supply chain resilience programs. This blend of specialty device innovators, digital health pioneers, and global giants is forging a competitive, collaborative ecosystem that will continue to shape the market’s trajectory.

To thrive amid dynamic regulation, pricing pressures, and shifting patient preferences, stakeholders should prioritize a multifaceted strategy that aligns innovation with access and value:

Align supply chain investments with tariff-resilient sourcing and near-shoring initiatives to safeguard device availability and control manufacturing costs. Cultivating partnerships with domestic and regional manufacturers will reduce exposure to import duties and improve supply chain agility.

Champion coverage policies by collaborating with payers and professional societies to validate procedural efficacy and cost effectiveness. Securing reimbursement clarity for new CPT and HCPCS codes, while demonstrating favorable real-world outcomes, will drive health system adoption and procedural volume.

Integrate digital health and telemonitoring into care pathways. Leveraging AI-enabled platforms for remote monitoring, patient engagement, and outcome tracking will differentiate offerings and support value-based care models, particularly in under-served markets.

Foster strategic M&A or alliance opportunities that expand device portfolios or digital capabilities. Consolidating complementary technologies-such as suturing systems, balloons, and aspiration platforms-into unified clinical programs will deliver comprehensive solutions that cater to diverse patient segments and procedural settings.

This analysis is grounded in a rigorous, multi-tiered methodology encompassing extensive secondary research, primary stakeholder interviews, and meticulous data triangulation. Peer-reviewed journals, regulatory filings, and reputable health organization fact sheets provided foundational epidemiologic data and clinical efficacy evidence. Industry financial disclosures, tariff impact studies, and global supply chain analyses offered insight into market dynamics and cost pressures.

Primary research included in-depth interviews with bariatric endoscopists, device manufacturers, and payers to validate emerging trends, reimbursement landscapes, and adoption barriers. Quantitative data were synthesized from publicly available health databases, conference proceedings, and corporate presentations. Triangulation of sources ensured consistency and accuracy, while thematic analysis of qualitative inputs refined strategic imperatives.

Competitive intelligence was supplemented by examining strategic transactions, patent portfolios, and product pipelines. Regional market insights drew upon localized regulatory updates, such as ANSM bulletins in France and CMS coding advisories in the United States. Throughout the research process, findings were subjected to iterative expert review to uphold analytical integrity and align conclusions with market realities.

The endoscopic weight loss therapy market stands at a pivotal juncture, driven by an imperative to address the burgeoning obesity epidemic with cost-effective, minimally invasive treatments. Breakthroughs in aspiration therapy, endoscopic sleeve gastroplasty, and intragastric balloon technologies have converged with shifting reimbursement paradigms and digital health integration to create a fertile environment for innovation.

However, escalating tariffs and evolving trade policies underscore the urgency of supply chain resilience and strategic partnerships. Market participants must balance the pursuit of cutting-edge device development with pragmatic considerations around manufacturing localization and diversified sourcing. Payer engagement and evidence generation will remain critical to securing coverage and overcoming procedural inertia.

Looking ahead, the adoption of AI-powered patient support platforms, remote monitoring tools, and telehealth services will further enhance clinical outcomes and practice efficiency. By aligning clinical innovation with value-based care models, stakeholders can ensure that endoscopic weight loss therapies fulfill their promise of delivering safe, durable, and scalable solutions in the fight against obesity.

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