Endoscopic Sleeve Gastroplasty: 10 answers from Dr. Artur Raiter, MD

Endoscopic Sleeve Gastroplasty (ESG) is one of the most advanced bariatric procedures. KCM Clinic prides itself in offering this cutting-edge technique thanks to the invaluable expertise of Dr. Artur Raiter, MD, one of the few surgeons in Europe who performs this procedure.

Dr. Artur Raiter, MD graduated at the Medical Academy of Gdańsk and is a specialist in General Surgery and Gastroenterology at the Center for Bariatric and Metabolic Surgery at KCM Clinic.

We sat down with Dr. Raiter for some time out of his busy schedule and asked him a few questions about endoscopic sleeve gastroplasty to help you get a better understanding of what the procedure entails.

1. How does endoscopic sleeve gastroplasty (ESG) work?

“First of all, I think it’s important to mention that endoscopic sleeve gastroplasty is a non-surgical procedure. This means that the procedure is carried out without any incisions and that the patient will be able to leave the hospital on the same day or the following. It’s carried out with general anaesthesia. Once the patient is asleep, we insert an endoscope through their mouth until we reach the stomach. Here, with the help of a suturing device, we staple parts of the stomach walls together to reduce the size. So we basically make the stomach smaller from the inside. After that, we remove the endoscope and wait for the patient to wake up. The aim of the procedure is to make the patient feel full sooner to reduce food intake.”

2. What is the difference between endoscopic sleeve gastroplasty and sleeve gastrectomy?

“The main difference between these two procedures is that while sleeve gastrectomy is a surgical procedure, endoscopic sleeve gastroplasty is performed without any incisions. Sleeve gastrectomy is carried out laparoscopically: we make a few small incisions in the abdominal area of the patient to access the stomach and remove a part of it. This means that the procedure is irreversible. On the other hand, we do not remove any parts of the stomach in an endoscopic sleeve gastroplasty, but rather we stitch parts of it together. In this case, the procedure can be reversed.”

You can find a detailed explanation of all the differences between these two procedures in this article.

3. How much weight can patients expect to lose after an endoscopic sleeve gastroplasty?

“According to the data we have (this is a fairly new procedure), patients can expect to lose around 20% of their body weight over the course of 2 years. This of course will also depend on the patient’s ability to follow all post-op guidelines and maintain a healthy lifestyle, which includes a balanced diet and regular exercise.”

4. Is endoscopic sleeve gastroplasty a safe procedure?

“Overall, endoscopic sleeve gastroplasty can be considered a safe procedure. However, it is not recommended for individuals with inflammation in the stomach or oesophagus, structural changes to the upper gastrointestinal tract, or gastrointestinal hernia.”

5. Who is endoscopic sleeve gastroplasty for?

​​”Contrarily to surgical bariatric procedures, where patients should have a BMI higher than 40 or higher than 35 if there are other conditions, endoscopic sleeve gastroplasty is suitable for those who have a BMI higher than 27. We will of course check if a patient is eligible on a case-to-case basis but this is a procedure that is typically recommended if patients are not suitable for more invasive treatments. This is why this procedure is often recommended as an alternative to the gastric balloon.”

6. What is the incidence of gastroesophageal reflux?

“Typically, if a patient has severe reflux disease, endoscopic sleeve gastroplasty might not be the best option, because by making the stomach smaller and more tubularized it can potentially worsen. However, weight loss does improve reflux in many patients. This means that in order to decide whether a patient can have the procedure we’d need to check how severe the reflux is and if there are other underlying conditions.”

7. What do you recommend to your patients before and after the procedure?

“First of all, it’s important to discuss with a bariatrician and a dietician their medical history and what they want to achieve with the procedure. After we’ve established that endoscopic sleeve gastroplasty is the right treatment for them, we’ll schedule the procedure and ask them to be on a liquid diet for a few days before. We will also perform a gastroscopy to assess the conditions of the stomach. After the procedure, we will provide patients with post-op guidelines, which include diet and exercise recommendations.”

8. Is endoscopic sleeve gastroplasty a reversible procedure?

“As mentioned earlier, yes, it is. We can remove the sutures so that the stomach can go back to its original size. However, this should happen before the stomach walls have healed completely and the sutures have become part of the newly-shaped stomach.”

9. Do many patients come back to you, needing a revision?

“It may happen that after an endoscopic sleeve gastroplasty the stitches get loose and the stomach increases in size. This typically happens when patients eat large amounts of food, making the stomach stretch out. In this case, we can reinforce the sutures or apply new ones. But I wouldn’t say this happens often and if patients follow guidelines strictly, such as portion eating, it is very unlikely to happen.”

10. What should patients consider before planning the procedure?

“Well, I think it’s important that patients have realistic expectations of what endoscopic sleeve gastroplasty involves. Even though it’s a nonsurgical procedure, it’s still a medical treatment and they should be mindful about all pre- and post-op guidelines we provide them with. In order for the procedure to be successful, it’s crucial that patients follow them carefully. The team at KCM Clinic will support them throughout the journey, of course.”

We’d like to thank Dr. Artur Raiter, MD, for taking the time to join our interview. To book a consultation, feel free to contact us anytime using the form below.