ESG significantly delayed gastric emptying compared to LS at 3 and 12 months; greater delay in GE at 3 months correlated with greater weight loss. Gastric motility was preserved. Fasting ghrelin, GLP-1, and PYY increased after ESG. ESG promotes weight loss via delayed gastric emptying and hormonal changes while preserving motility, supporting its clinical adoption for obesity management. This evidence concerns the gene PYY and obesity due to melanocortin 4 receptor deficiency.