What is Endoscopic Sleeve Gastroplasty? Purpose, Procedure & Results

Endoscopic sleeve gastroplasty is a minimally invasive weight loss procedure that reduces your stomach size without surgery. During this outpatient procedure, your doctor uses an endoscope (a thin, flexible tube with a camera) to place sutures inside your stomach, creating a smaller sleeve-shaped pouch. This helps you feel full faster and eat less, supporting sustainable weight loss when combined with lifestyle changes.

What is endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty, often called ESG, is a newer weight loss procedure that shrinks your stomach from the inside. Your doctor doesn't make any cuts on your skin. Instead, they guide a specialized endoscope through your mouth and down into your stomach to place permanent sutures.

These sutures gather and fold the stomach walls together, creating a tube-like shape that's about 70% smaller than your original stomach. Think of it like cinching a drawstring bag to make it smaller. The procedure typically takes 60 to 90 minutes, and you can usually go home the same day.

ESG offers a middle ground between traditional diet and exercise approaches and more invasive surgical options like gastric bypass. It's designed for people who need more support than lifestyle changes alone can provide, but who may not be candidates for or prefer to avoid major surgery.

Why is endoscopic sleeve gastroplasty done?

ESG is primarily done to help people achieve significant weight loss when other methods haven't been successful. Your doctor might recommend this procedure if you have a body mass index (BMI) of 30 or higher and have struggled with obesity-related health conditions.

The procedure works by restricting how much food your stomach can hold. When your stomach is smaller, you feel satisfied with much less food, which naturally reduces your calorie intake. This physical change, combined with proper nutrition guidance and lifestyle modifications, can lead to meaningful weight loss.

Common reasons doctors recommend ESG include uncontrolled diabetes, high blood pressure, sleep apnea, or joint problems that worsen with excess weight. It's also considered for people who want to avoid the risks and recovery time associated with traditional weight loss surgery.

Some people choose ESG as a stepping stone procedure. If you're significantly overweight, losing some weight through ESG might make you a better candidate for other treatments or surgeries later if needed.

What is the procedure for endoscopic sleeve gastroplasty?

The ESG procedure begins with you receiving general anesthesia, so you'll be completely asleep and comfortable throughout. Your doctor will then gently insert the endoscope through your mouth and guide it down your throat into your stomach.

Using the endoscope's camera for guidance, your doctor will place a series of sutures along the greater curve of your stomach. These sutures are placed in a specific pattern to create the sleeve shape. The entire process is done from inside your stomach, so there are no external incisions.

Here's what happens during the procedure:

1. You receive general anesthesia for comfort and safety
2. The endoscope is inserted through your mouth into your stomach
3. Your doctor places 8-12 sutures along the stomach wall using specialized tools
4. The sutures are tightened to create the sleeve shape
5. The endoscope is removed, and you're taken to recovery

The entire procedure typically takes between 60 to 90 minutes. Because it's minimally invasive, most people can go home the same day once they've recovered from anesthesia.

How to prepare for your endoscopic sleeve gastroplasty?

Preparing for ESG involves several important steps to ensure your safety and the best possible outcome. Your doctor will likely recommend starting a pre-procedure diet about two weeks before your scheduled date.

This pre-procedure diet typically includes eating smaller portions and avoiding certain foods that might interfere with the procedure. You'll usually need to follow a liquid diet for 24-48 hours before ESG to ensure your stomach is empty and clean.

Your preparation timeline will include these key steps:

• Complete pre-procedure medical clearance and blood work
Stop certain medications as directed by your doctor
• Follow the prescribed pre-procedure diet for 1-2 weeks
• Arrange for someone to drive you home after the procedure
• Fast from food and liquids for 8-12 hours before your procedure

Your healthcare team will also discuss any medications you're taking, especially blood thinners or diabetes medications, as these may need to be adjusted. It's important to follow all pre-procedure instructions exactly as given to minimize risks and ensure the best results.

How to read your endoscopic sleeve gastroplasty results?

Success with ESG is typically measured by the percentage of excess weight you lose over time. Most people lose about 15-20% of their total body weight within the first year, though individual results can vary significantly.

Your doctor will track your progress through regular follow-up appointments. They'll monitor not just your weight loss, but also improvements in obesity-related health conditions like diabetes, high blood pressure, or sleep apnea.

Typical ESG results include:

• 15-20% total body weight loss in the first year
• Improvement in blood sugar control for people with diabetes
• Reduced blood pressure and cholesterol levels
• Better sleep quality and reduced sleep apnea symptoms
• Improved mobility and reduced joint pain

Keep in mind that ESG is a tool to help you lose weight, not a magic solution. Your long-term success depends heavily on making permanent changes to your eating habits and staying physically active. People who commit to these lifestyle changes typically see the best and most lasting results.

How to maintain your results after endoscopic sleeve gastroplasty?

Maintaining your weight loss after ESG requires a lifelong commitment to healthy eating and regular physical activity. The procedure gives you a powerful tool, but your daily choices determine your long-term success.

Your smaller stomach will help you feel full faster, but you'll need to make smart food choices to maximize this benefit. Focus on eating protein-rich foods first, then vegetables, and limit processed foods and sugary drinks that can stretch your stomach over time.

Essential maintenance strategies include:

• Eat small, frequent meals throughout the day
• Chew food thoroughly and eat slowly
• Stay hydrated, but avoid drinking with meals
• Take recommended vitamins and supplements
• Exercise regularly as approved by your doctor
• Attend all follow-up appointments

Regular follow-up with your healthcare team is crucial for long-term success. They'll monitor your progress, adjust your nutrition plan as needed, and address any concerns that arise. Many people find that ongoing support groups or counseling help them stay motivated and accountable.

What is the best candidate for endoscopic sleeve gastroplasty?

The ideal candidate for ESG is someone with a BMI of 30 or higher who has tried other weight loss methods without lasting success. You should be committed to making permanent lifestyle changes and able to follow post-procedure dietary guidelines.

Good candidates typically have realistic expectations about the procedure and understand that ESG is a tool that requires ongoing effort. You should be physically healthy enough for the procedure and mentally prepared for the lifestyle changes it requires.

You might be a good candidate if you:

• Have a BMI of 30 or higher
• Have tried diet and exercise without lasting success
• Want to avoid traditional weight loss surgery
• Are committed to long-term lifestyle changes
• Don't have certain stomach conditions that would interfere
• Are between 18-65 years old

However, ESG isn't right for everyone. People with certain stomach conditions, severe acid reflux, or previous stomach surgery may not be good candidates. Your doctor will evaluate your individual situation to determine if ESG is the best option for you.

What are the risk factors for complications with endoscopic sleeve gastroplasty?

While ESG is generally safer than traditional weight loss surgery, it still carries some risks that you should understand before proceeding. Most complications are mild and temporary, but serious issues can occasionally occur.

Factors that might increase your risk include having certain medical conditions, taking specific medications, or having previous stomach surgery. Your doctor will carefully evaluate these factors during your pre-procedure assessment.

Risk factors for complications include:

• Previous stomach surgery or significant scarring
• Severe acid reflux or stomach ulcers
• Blood clotting disorders
• Severe heart or lung disease
• Active substance abuse
• Unrealistic expectations about results

Your age and overall health also play a role in determining your risk level. People over 65 or those with multiple health conditions may face higher risks, though many can still safely undergo the procedure with proper medical management.

Is endoscopic sleeve gastroplasty better than other weight loss procedures?

ESG offers unique advantages compared to other weight loss procedures, but whether it's "better" depends on your individual circumstances and goals. It's less invasive than traditional surgery but may not lead to as much weight loss as procedures like gastric bypass.

Compared to surgical options, ESG has a shorter recovery time, lower risk of complications, and can be reversed if necessary. However, surgical procedures typically result in more significant and longer-lasting weight loss.

ESG advantages include:

• No external incisions or scars
• Same-day discharge in most cases
• Lower risk of serious complications
• Potentially reversible
• Shorter recovery time

The best procedure for you depends on factors like your BMI, health conditions, previous weight loss attempts, and personal preferences. Your doctor can help you weigh the pros and cons of each option based on your specific situation.

What are the possible complications of endoscopic sleeve gastroplasty?

While ESG is generally safe, like any medical procedure, it can have complications. Most side effects are mild and temporary, but it's important to understand what could happen so you can make an informed decision.

The most common issues people experience are nausea, vomiting, and stomach discomfort for the first few days after the procedure. These symptoms usually improve quickly as your body adjusts to the changes.

Common temporary complications include:

• Nausea and vomiting for 1-3 days
• Stomach pain or cramping
• Difficulty swallowing initially
• Fatigue from the anesthesia
• Throat soreness from the endoscope

More serious complications are rare but can occur. These might include bleeding, infection, or problems with the sutures. In very rare cases, the sutures might come loose, requiring additional treatment.

Rare but serious complications include:

• Bleeding requiring additional treatment
• Infection at the suture sites
• Suture complications requiring revision
• Severe stomach obstruction
• Adverse reactions to anesthesia

Your doctor will monitor you closely for any signs of complications and provide clear instructions about when to seek immediate medical attention. Most people recover without any serious issues.

When should I see a doctor after endoscopic sleeve gastroplasty?

You should contact your doctor immediately if you experience severe symptoms after ESG, especially persistent vomiting, severe stomach pain, or signs of infection. While some discomfort is normal, certain symptoms require prompt medical attention.

Most people have some nausea and discomfort for the first few days, but these symptoms should gradually improve. If they worsen or don't improve after a few days, it's important to reach out to your healthcare team.

Contact your doctor immediately if you experience:

• Severe or worsening stomach pain
• Persistent vomiting that prevents you from keeping fluids down
• Signs of infection like fever or chills
• Difficulty swallowing that doesn't improve
• Chest pain or difficulty breathing
• Vomiting blood or dark material

You should also stay in touch with your healthcare team for regular follow-up appointments, even if you're feeling well. These visits help ensure you're healing properly and making good progress with your weight loss goals.