What is Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic sleeve gastroplasty (ESG) is a newer type of weight-loss procedure. Endoscopic sleeve gastroplasty reduces the size of your stomach using an endoscopic suturing device without the need for surgery.

This procedure may be an option if you're significantly overweight - a body mass index of 30 or more - and diet and exercise haven't worked for you.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. And the procedure is minimally invasive, reducing the risk of operative complications.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires a commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

How does the ESG work?

The ESG works in two ways, firstly by restriction – the capacity of the stomach is restricted so it holds less. It also slows gastric emptying. This means the food you eat stays in the stomach a little longer.

The ESG involves suturing the stomach from the inside to significantly reduce its capacity by up to 80%. After the procedure, the stomach remains intact but has been sutured from top to bottom to leave a smaller banana shaped stomach through which the food you eat passes.

 The operation itself

The ESG procedure is done using a device called an Overstitch; a device that is placed into the stomach through the mouth that enables us to place a number of sutures (stitches) inside the stomach to significantly reduce its capacity by up to 80%.

Watch a video about the procedure here.  

As the procedure requires about an hour to complete we do it under general anaesthetic for your comfort. However, unlike surgery, we do not need to make any incisions to access the abdominal cavity thus reducing the risk to you and enabling a faster recovery.ound two hours under general anaesthetic.

The ESG is an exciting development in obesity treatment that offers people a safe and effective alternative to the established weight loss options. Its main attraction is that it is non-surgical so people benefit from a lower risk profile and faster recovery time.

What are the benefits of an ESG?

The ESG is a technique of oral stomach reduction through an endoscope, which offers a series of advantages over traditional stomach reduction, among which we can highlight:

• Safe and minimally invasive technique

• Less pain and risk of infection

• Absence of external scars

• Recovery in a shorter period

• Short hospital stay

Why is an ESG carried out?

Endoscopic sleeve gastroplasty is performed to help you lose weight and potentially lower your risk of serious weight-related health problems, including:

• Gastroesophageal reflux disease

• Heart disease and stroke

• High blood pressure

• Sleep apnea

• Type 2 diabetes

Endoscopic sleeve gastroplasty and other weight-loss procedures or surgeries are typically done only after you've tried to lose weight by improving your diet and exercise habits. Endoscopic sleeve gastroplasty is less invasive and cheaper than other forms of bariatric surgery.

Who is ESG for?

Endoscopic sleeve gastroplasty is often an option for people who aren't candidates for other bariatric surgeries. The procedure is available to people whose body mass index (BMI) is above 30 who haven't been successful in maintaining weight loss with other methods.

But endoscopic sleeve gastroplasty isn't for everyone who is overweight.

A screening process helps doctors see if the procedure might be beneficial for you. And you must be willing to commit to healthy lifestyle changes, regular medical follow-up and participate in behavioural therapy.

Endoscopic sleeve gastroplasty isn't appropriate for anyone who has:

• gastrointestinal bleeding

• a hiatal hernia larger than three centimetres

• had prior stomach surgery 

Given that endoscopic sleeve gastroplasty is a new procedure, it might not be covered by your health insurance.

What happens after an ESG?

After the procedure, you generally won't be allowed to eat for about eight hours.

Then, you'll be allowed to start a liquid diet, which you need to continue for at least two weeks. Over four weeks, you'll move on to semi-solid foods, and then to a regular healthy diet. You'll also have medical check-ups and meet with a nutritionist and psychologist frequently after your procedure.

What are the results of an ESG?

Endoscopic sleeve gastroplasty can lead to significant weight loss. The amount of weight you lose also depends on how much you can change your lifestyle habits.

But studies have shown promising results. A recent study of people with an average BMI of around 38 found that endoscopic sleeve gastroplasty led to an average weight loss of 39 pounds (17.8 kilograms) after 6 months. After 12 months, weight loss was 42 pounds (19 kilograms).

In a study of people with an average BMI of about 45, the procedure resulted in an average weight loss of about 73 pounds (33 kilograms) during the first six months.

As with other procedures and surgeries that lead to significant weight loss, endoscopic sleeve gastroplasty may improve conditions often related to being overweight, including:

• Gastroesophageal reflux disease

• Heart disease or stroke

• High blood pressure

• Severe sleep apnea

• Type 2 diabetes

When weight loss surgery doesn’t work

It's possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don't follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.