Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: What’s the Difference?

Obesity is a disease that can seriously affect your health and well-being. It can be emotionally and mentally frustrating to not be able to lose weight despite diet changes or regular exercise. Thankfully, today’s bariatric procedures can help you in your weight loss journey. There are different techniques available and your doctor can help you decide what procedure best works in your case.

Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy are two bariatric procedures that have already helped many patients lose excess weight and live a healthier life. Although they both aim to reduce the size of your stomach, the procedures themselves differ in many ways. In this article, we’re going to describe both procedures as well as identify their main differences.

Let’s first have a look at what each procedure entails.

Endoscopic Sleeve Gastroplasty (ESG)

What is Endoscopic Sleeve Gastroplasty?

Endoscopic sleeve gastroplasty, also known as ESG, is a procedure carried out endoscopically where parts of your stomach are stitched together to make your stomach smaller.

How does Endoscopic Sleeve Gastroplasty work?

Endoscopic sleeve gastroplasty is performed under general anaesthesia. An endoscope will be inserted through your mouth until it reaches your stomach. At the end of the endoscope, a suturing device and a tiny camera will help the doctor see the inside of your stomach during the operation. At this point, the doctor will create triangular patterns with non-absorbable sutures to stitch parts of your stomach together and make it smaller. The stomach will be reduced to one-third of its size and will have a sleeve-like shape. The endoscope is removed and you will be able to go back home on the same day or the next day. The procedure lasts around 1-2 hours.

Laparoscopic Sleeve Gastrectomy

What is Laparoscopic Sleeve Gastrectomy?

Laparoscopic sleeve gastrectomy, also simply known as gastric sleeve, is a surgical procedure that removes a part of your stomach to reduce its size and limit food intake.

How does Laparoscopic Sleeve Gastrectomy work?

A sleeve gastrectomy is performed laparoscopically. This means that the surgeon will access your stomach through your belly by making a few small incisions.

The procedure starts by administering general anaesthesia. Once you’re asleep, the surgeon will create the incisions in the abdominal wall to access your stomach with specific surgical instruments and a camera. Your abdomen may be filled with carbon dioxide gas to make more space between the organs for easier access. Now, the surgeon will resize the stomach to a sleeve-like shape, removing around 80% of its size. Finally, instruments are removed and incisions closed. The procedure lasts around 1-2 hours.

How do Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy differ?

The differences between endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy can be defined as follows.

Patient eligibility

In order to be eligible for bariatric surgery, patients should have a BMI higher than 40 or higher than 35 if there are other conditions related to obesity. This applies also to laparoscopic sleeve gastrectomy. If you don’t know your BMI, you can calculate it here.

Endoscopic sleeve gastroplasty is suitable for those who have a BMI higher than 27 who are not suitable for more invasive bariatric treatments. This procedure is often recommended as an alternative to the gastric balloon. Alternatively, ESG can also be recommended to obese patients with higher BMI who need to lose some weight before undergoing weight loss surgery.

How the stomach is treated

While both procedures aim to make your stomach smaller to make you feel full sooner and thus reduce the amount of food intake, the way each procedure works is fundamentally different.

During a gastric sleeve, the surgeon will reduce the size of your stomach by removing a part of it. Then, the remaining stomach is stapled back together. As a consequence, gastric sleeve surgery is an irreversible procedure.

On the contrary, an endoscopic sleeve gastroplasty does not involve removing any parts of the stomach, but rather stitching it together from the inside to reduce its size. In this case, the doctor will use non-absorbable stitches that will hold the newly-formed stomach together. This procedure is reversible, as the doctor can remove the stitches and have the stomach go back to its original size.

Laparoscopy vs Endoscopy

Gastric sleeve surgery is performed laparoscopically; endoscopic sleeve gastroplasty is performed endoscopically. These techniques are very different.

Laparoscopic surgery involves creating a few small incisions to access the area to be treated. It is typically performed with a laparoscope, a specific surgical instrument that carries a camera to view the organs in the abdomen and perform surgery. This technique is more invasive than an endoscopic procedure.

Endoscopy is a non-surgical procedure used to inspect a patient’s digestive tract. This procedure is incisionless, making recovery faster. The doctor inserts a specific instrument – the endoscope – into the mouth and lets it slide until the stomach. For ESG, a camera and a suturing device are attached at the end of the instrument to help the doctor make the necessary sutures.

Treatment duration and recovery

While both procedures last around 1-2 hours, gastric sleeve surgery, on average, is a longer operation. This depends on the fact that there are a couple of steps more before actually reshaping the stomach, including the creation of the incisions and gas administration.

As endoscopic sleeve gastroplasty is carried out without making any incisions, recovery from this procedure is typically faster. Patients are able to leave the hospital on the same day or the next day, depending on what time the procedure was performed and on the patient’s individual needs. Gastric sleeve surgery, on the other hand, requires a 3-day hospital stay on average.

A final note

As for all bariatric surgeries, the patient’s commitment and will to stick to dietary and exercise plans is crucial. Both endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy can have incredible benefits and help you in your journey towards a healthier life. This is possible only if you follow all pre-and-post-operative guidelines. Your doctor will support you with this, providing the assistance you need.