Endoscopic sleeve gastroplasty (ESG) is a newer type of minimally invasive weight-loss procedure. A suturing device is inserted through the throat into the stomach, and the endoscopist places sutures to make the stomach smaller.
It may be an option if you are significantly overweight - typically a body mass index (BMI) of 30 or more - and diet and exercise have not worked for you. ESG helps you lose weight by limiting how much you can eat, with a lower risk of operative complications than traditional surgery and a quicker return to daily activities.
Like other weight-loss procedures, ESG requires a lasting commitment to a healthier lifestyle: permanent changes to your diet and regular exercise are essential for long-term success.
Why it's done
Endoscopic sleeve gastroplasty is performed to help you lose weight and potentially lower your risk of serious weight-related health problems. It is typically considered only after you have already tried to lose weight by improving your diet and exercise habits.
- Heart disease and stroke
- High blood pressure
- Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
- Sleep apnea
- Type 2 diabetes
- Osteoarthritis (joint pain)
Are you suitable?
ESG is available to people whose BMI is above 30, who have not maintained weight loss with lifestyle modification alone, and who do not qualify for - or do not wish to pursue - traditional bariatric surgery.
It is not for everyone who is overweight. A screening process helps clinicians decide whether the procedure may benefit you. You must also be willing to commit to healthy lifestyle changes, regular medical follow-up and behavioural therapy.
ESG is not appropriate for anyone with a large hiatal hernia, or a condition associated with gastrointestinal bleeding, such as gastritis or peptic ulcer disease.
Risks and expected weight loss
So far, endoscopic sleeve gastroplasty has shown a favourable safety profile. Pain and nausea may occur for several days afterwards; these symptoms are usually managed with medication, and most people feel better after a few days.
Although ESG is not designed as a temporary procedure, it can be converted to other bariatric surgery if needed later.
When combined with lifestyle modification, ESG typically results in about 15% to 20% total body weight loss at 12 to 24 months.
Preparing for the procedure
If you qualify, your care team will give you specific instructions. You may need lab tests and exams beforehand, and restrictions on eating, drinking and medications. You may also be asked to start a physical activity programme.
Plan ahead for recovery: arrange for someone to help at home. Recovery from ESG generally takes only a few days.
During the procedure
ESG is done in an endoscopy unit as an outpatient procedure under general anaesthesia, so you will be unconscious.
A flexible tube with a camera and an endoscopic suturing device (endoscope) is passed down your throat into the stomach. The camera lets the endoscopist operate inside the stomach without abdominal incisions.
Sutures reshape the stomach into a tube-like structure, so you feel fuller sooner and eat less. The procedure usually takes about 60 to 90 minutes.
After the procedure
You wake in a recovery room while staff monitor you for complications. Most people go home the same day; some may need a short hospital stay of one day or less for observation.
You generally will not eat for a few hours, then start a liquid diet for at least two weeks, before moving to semisolid foods and eventually a regular healthy diet.
Results
As with any weight-loss programme, commitment to nutrition, physical activity and emotional health plays a large role in how much weight you lose. People who complete the programme and follow the guidelines typically lose about 12% to 20% of their body weight in one year.
ESG may also improve conditions linked to excess weight, including heart disease or stroke risk, high blood pressure, severe sleep apnea, type 2 diabetes, gastroesophageal reflux disease (GERD) and osteoarthritis.
When weight-loss surgery doesn't work
It is possible not to lose enough weight, or to regain weight after any weight-loss procedure - even when the procedure itself works correctly. That often happens when recommended lifestyle changes are not followed.
To help avoid regain, you need permanent healthy changes to your diet together with regular physical activity and exercise.
Talk to our team
If you are considering endoscopic sleeve gastroplasty in the UK or at a trusted clinic abroad, our coordinators can explain suitability, pathways and aftercare in plain language. Enquire for a free, confidential consultation.