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.

Endoscopic Sleeve Gastroplasty (ESG) is a revolutionary weight loss procedure that is rapidly gaining traction in the medical community due to its effectiveness and minimally invasive nature. As a fairly new yet already highly successful technique, ESG is becoming increasingly popular among patients seeking a solution for obesity and its associated health challenges.

However, it’s important to emphasize that ESG is not a standalone solution for obesity but rather a powerful tool to aid weight loss and improve overall health. Patients considering ESG, or any other bariatric procedure, should recognize that these procedures are not magical fixes; they require dedication and commitment to long-term lifestyle changes for sustained success.

The world of bariatric surgery offers a range of procedures tailored to individual needs. The decision on which procedure is best suited for a patient depends on several factors, including their Body Mass Index (BMI), medical history, and previous experiences with weight loss surgeries. This personalized approach ensures that patients receive the most appropriate treatment plan.

In recent times, Endoscopic Sleeve Gastroplasty has garnered significant attention for its innovative approach. This article aims to address common questions and concerns surrounding the procedure to provide a comprehensive understanding.

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

ESG is a non-invasive outpatient procedure designed to reduce stomach size, thus limiting food intake. Administered under general anesthesia, the procedure involves the insertion of an endoscope through the mouth, reaching the stomach. Using a suturing device attached to the endoscope, the physician stitches portions of the stomach walls together, forming a sleeve-like configuration. This adjustment reduces the stomach’s capacity to approximately one-third of its original size. The procedure typically lasts 1 to 2 hours, allowing for same-day or next-day hospital discharge.

How Endoscopic Sleeve Gastroplasty (ESG) works

An ESG procedure is done when you’re asleep with a special tube down your throat. During this, they use a special tool to sew the stomach to make it smaller. This helps with losing weight and is safe. ESG is a good way to treat obesity and has been successful in many places. A big study showed that it’s a good option for weight loss.

ESG has shown impressive results in case series and has been adopted in many countries. A large, international multicenter study found that ESG is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption.

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?

Unlike sleeve gastrectomy, where a portion of the stomach is removed, ESG involves suturing the stomach walls without excising any tissue. Consequently, ESG is less invasive, allowing for quicker recovery and often same-day discharge. Unlike sleeve gastrectomy, ESG is reversible within a specified timeframe, as the sutures can be removed, allowing the stomach to return to its original size.

Long-term Impact of Sutures

The non-absorbable sutures utilized in ESG remain in place permanently, integrating into the stomach’s structure as the stomach heals.

Reversibility of ESG

ESG is indeed reversible. The stomach can be restored to its original size by removing the sutures within a defined healing window.

Anticipated Weight Loss

Statistics indicate an approximate 20% body weight reduction over 1.5-2 years post-ESG surgery. Committing to substantial lifestyle changes post-surgery is critical for successful weight loss.

Potential Risks of ESG

Common side effects include temporary nausea and stomach discomfort, with the “gas bubble” sensation usually dissipating within 36 hours. Infrequent but more serious complications, such as bleeding, perforations, or infections, are managed with prescribed antibiotics.

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?

The key to ESG’s success, like any weight loss procedure, hinges on embracing profound lifestyle changes. A smaller stomach capacity necessitates mindful eating, practicing portion control, and adopting balanced dietary choices. Combining these dietary adjustments with regular physical activity is paramount. Medical professionals will provide guidance, including dietary plans and exercise routines, which should be diligently followed post-surgery.

In essence, Endoscopic Sleeve Gastroplasty offers a promising avenue for weight loss but requires a comprehensive approach encompassing medical guidance, lifestyle modifications, and patient commitment to achieving optimal outcomes.

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.

ESG After Prior Weight Loss Surgery

Under specific medical considerations, ESG can be performed following another bariatric surgery, especially when revision surgery is required due to previous surgical outcomes or stomach stretching.