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What is Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight loss procedure that reduces the size of your stomach (around 70%) using a special suturing device that is attached to the end of an endoscope. This procedure restricts your food intake so you feel full quicker and helps you to cut down on calories and achieve an ideal weight. You will also see a marked improvement in metabolic diseases such as diabetes and hypertension due to the associated weight loss.

Endoscopic sleeve gastroplasty is similar to a surgical sleeve gastrectomy, but it is performed endoscopically through the mouth, so it doesn’t leave behind a scar and offers a quicker recovery with no overnight stay.

However, you must follow a healthier lifestyle to ensure permanent weight loss and long-lasting success.

What are the Indications for Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic sleeve gastroplasty (ESG) is recommended for adults who are 18 years and older. In addition, you must fulfill any of the following conditions:

  • Body mass index of 30 or more
  • Diet and exercise have been ineffective in controlling your body weight
  • You are not suitable for a traditional bariatric surgery
  • You want an alternative or a minimally invasive approach for your weight loss

Endoscopic sleeve gastroplasty can also be performed on those patients who had previously had a laparoscopic sleeve gastrectomy and regained weight.

Pre-Surgical Preparation for Endoscopic Sleeve Gastroplasty (ESG)

Presurgical preparation for endoscopic sleeve gastroplasty (ESG) involves the following steps:

  • A thorough examination by your gastroenterologist to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your age and medical history, you may be required to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • Avoid tobacco, smoking, and drinking at least a week before and two weeks after the procedure.
  • Do not consume solid food or liquids except water for at least 8 hours prior to the procedure.

Endoscopic Sleeve Gastroplasty (ESG) Procedure

Endoscopic sleeve gastroplasty is performed in a hospital. The common steps include:

  • You are required to change into a surgical gown or drape and lie on the operating table in supine position (on your back).
  • General anesthesia is administered to put you to sleep.
  • The endoscope is inserted through your mouth and advanced into the stomach.
  • The camera generates images of your stomach that are displayed on the screen attached to the endoscope.
  • The front and back walls of the stomach are marked to help guide the placement of the sutures.
  • Then, the endoscopic suturing device that is attached to the end of an endoscope is used.
  • Your surgeon stitches (sutures) the marked walls of the stomach with the suturing device taking guidance from the images generated from the endoscope.
  • Then, the sutures are tightened to bring the front and back walls of the stomach together.
  • This reduces the volume and the length of your stomach.
  • Upon completion, the endoscope is removed.

ESG may take around 1-2 hours.

Post-surgical Care for Endoscopic Sleeve Gastroplasty (ESG)

You may be required to stay in the hospital for a few hours. Once you are feeling comfortable walking around, you will be discharged.

  • You can expect a complete recovery and return to regular activities within 1-3 days.
  • Your doctor will give you specific instructions about your diet and lifestyle modifications. These include:
    • Avoid eating for the first eight hours after the procedure.
    • You may begin a liquid diet after the initial eight hours, which may be continued for a week or two.
    • You can then advance to semisolid foods around two weeks after the procedure, and then eventually to a regular healthy diet per your surgeon’s instructions.

What are the Risks and Complications of Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic sleeve gastroplasty (ESG) is a safe and minimally invasive procedure with a quick recovery time. However, it may have certain risks such as:

  • Reaction to anesthesia
  • Infection
  • Perforation
  • Injury to an adjacent organ
  • Bleeding or formation of a blood clot

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