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Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that can help a patient lose weight. The procedure involves suturing the stomach to make it smaller using an endoscope without any surgical cuts.

• This procedure is considered in patients who have obesity that was not helped by diet or exercise
• ESG can help patients lose up to 20% of body weight
• The long-term success of the procedure depends on the patients willingness to follow a healthy diet and lifestyle
• A recent randomized trial showed ESG to be safe and effective in weight reduction

The Procedure

Endoscopic sleeve gastroplasty is done in the endoscopy suite. General anesthesia is used for the procedure.

The procedure is done using a flexible tube with a camera and an endoscopic suturing device attached (endoscope). The endoscope is inserted down the throat into the stomach. The tiny camera allows the doctor operating the endoscope to see and operate inside the stomach without making incisions in the abdomen.

Using the endoscope, the doctor places sutures in the stomach. The sutures change the structure of the stomach, leaving it shaped like a tube. This restricts the amount of food the patient is allowed, making the patient feel fuller sooner.

Why consider ESG

ESG offers many benefits

• No surgical cuts
• Improve health by lowering the risk of heart disease, high blood pressure, sleep apnea, Type 2 diabetes, fatty liver disease and osteoarthritis
• Can improve self-esteem
• Can be reversible

Eligibility

Patients with a body mass index that is above 30 and who are unable to lose weight by diet and exercise are eligible.

Patients are not eligible for ESG if they have any of the following:

• Previous surgery on your stomach
• Large hiatal hernia
• Gastric ulcers or severe gastritis
• Recent stroke or heart surgery
• Pregnant
• Have medical contraindications for general anesthesia

Alternatives

There are several alternatives to ESG:

• Continued medical management: medications, diet and exercise
• Surgical management: sleeve gastrectomy, gastric bypass, laparoscopic band and other options

Before the Procedure

• Can only have clear liquids for the day
• Do not drink anything after midnight

Day of the Procedure

• Arrive one hour before procedure
• A driver must be present with patient the entirety of stay
• The procedure will last between 1-2 hours
• Will be under general anesthesia
• Expect to stay for about eight hours from the time of check-in
• Patient needs to have someone stay overnight with them

After the Procedure

• Expect to have nausea and mild abdominal pain. These will be treated by medications. These can last 2-3 days
• Not allowed to drink anything for four hours
• Then may have clear liquids for a day, then full liquid for one week. Then, soft foods for two weeks
• Expect to go back to work in one week
• Avoid lifting or strenuous work for four weeks
• Continue to wear CPAP and do not use tobacco products
• Follow all other instructions provided by gastroenterologist

Procedure Cost

As a relatively new procedure, insurance companies may not cover this procedure.