Endoscopic Sleeve Gastroplasty (ESG): Top 9 Questions Answered

As a fairly new but already very successful weight loss procedure, endoscopic sleeve gastroplasty (ESG) is becoming more and more popular among patients.

Like any other bariatric procedure, endoscopic sleeve gastroplasty should not be seen as a one-and-done treatment to obesity but rather a tool to aid weight loss. Patients undergoing a bariatric procedure should be committed to following certain lifestyle changes, including regular exercise, a balanced diet, and portion eating.

There are different types of weight loss surgeries and you will discuss with your doctor what surgery best works in your case. This typically depends on a series of factors, including your Body Mass Index (BMI), any conditions you might have, or if you have undergone bariatric surgery before. This decision will be made on a case-to-case basis.

Endoscopic Sleeve Gastroplasty has received much attention recently. In this article, we are going to answer the most-commonly asked questions about the procedure.

1. What is an endoscopic sleeve gastroplasty (ESG)?

Endoscopic sleeve gastroplasty, also known with the acronym ESG, is an incisionless, outpatient procedure that involves reducing the size of your stomach to limit food intake.

The surgery is performed under general anaesthesia. The doctor will insert an endoscope through your mouth until your stomach. With the help of a suturing device attached at the end of the endoscope, the doctor will stitch together parts of the stomach walls to create a sleeve-like shape. This way, the stomach will be reduced to approximately one third of its original size.

How Endoscopic Sleeve Gastroplasty (ESG) works

The procedure lasts around 1-2 hours. You will be able to leave the hospital on the same day or the following day.

2. Is endoscopic sleeve gastroplasty right for me?

Endoscopic sleeve gastroplasty is recommended to individuals with a BMI of 27 (you can calculate your BMI here). Typically, bariatric procedures are recommended to patients with a BMI of 32-35, which means that ESG is suitable as a primary procedure for individuals who are at obesity stage I. It is often performed as an alternative procedure to the gastric balloon.

Endoscopic sleeve gastroplasty can also be performed in individuals who have already undergone a weight loss procedure and need a revision. This happens when the stomach of the patient has stretched out and an additional procedure is required. In this case, ESG is recommended due to its low invasiveness and risks.

Moreover, endoscopic sleeve gastroplasty may be recommended as the first step for obesity treatment in patients with a BMI of 60. Patients who need to undergo a more invasive bariatric procedure such as gastric bypass can first have ESG in order to lose a certain amount of weight and have a safer surgery later on.

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

The main difference is that while during a sleeve gastrectomy part of the stomach is removed, with an endoscopic sleeve gastroplasty the stomach is stitched together without removing it. This means that sleeve gastrectomy is a more invasive surgery, usually performed laparoscopically, which requires a hospital stay of around 3 days. Endoscopic sleeve gastroplasty patients can typically leave the hospital on the same day or the following, as no incisions are made and recovery is faster.

While gastric sleeve is an irreversible procedure, endoscopic sleeve gastroplasty is reversible: within a certain period of time, the stitches can be removed and the stomach can go back to its original size.

4. What happens to the sutures inside the stomach?

The sutures are non-absorbable, so they stay in place and are meant to remain there permanently. With time, the stomach will heal and the stitches will hold the newly-formed sleeve tight and become part of it.

5. Is endoscopic sleeve gastroplasty reversible?

Yes, endoscopic sleeve gastroplasty is a reversible procedure. Within a certain timeframe, i.e. before the stomach walls have completely healed and the sutures have become an integral part of the stomach, stitches can be removed, allowing the stomach to go back to its original size.

6. How much weight can you expect to lose after an endoscopic sleeve gastroplasty?

According to recent data, you can expect to lose approximately 20% of your body weight over 1.5-2 years following surgery. Please always consider that weight loss is successful only if you commit to drastic lifestyle changes after surgery.

7. What are the risks of an endoscopic sleeve gastroplasty?

The most common side effects include nausea and discomfort in the stomach area. Many patients report feeling a ‘gas bubble’ in their stomach, but this typically disappears within 36 hours.

More serious and rare complications include bleeding, perforations or infections, which are prevented with the prescription of antibiotics.

8. Can I undergo an endoscopic sleeve gastroplasty if I already had another weight loss surgery?

While this will depend on each patient’s medical history and underlying conditions, it is generally possible to have an endoscopic sleeve gastroplasty after having undergone another bariatric surgery.

This is typically the case when the patient needs revision surgery, i.e. a previous surgery has not worked as expected or the stomach has stretched out and needs resizing.

9. How do I ensure surgery will be successful?

Endoscopic sleeve gastroplasty, just like any other weight loss procedure, requires the patient’s full commitment to drastically change their lifestyle habits and diet. Having a smaller stomach will make you feel full sooner but it’s always advisable to never reach the sensation of feeling really full. It’s all about understanding what your body actually needs. You can use portion plates or spoons for portion control and get in the habit of eating just what you really need. Eat slowly and avoid drinking and eating at the same time, as it would inevitably stretch your stomach.

Other than a balanced diet, you should consider doing regular exercise and stay active.

Your doctor will support you with this, providing a dietary plan and exercise routine that you are strongly advised to follow after surgery.