For individuals struggling with obesity and seeking an alternative to traditional weight loss surgery, endoscopic sleeve gastroplasty (ESG) presents a minimally invasive, non-surgical solution. This article aims to provide a comprehensive overview of ESG, covering its procedure, benefits, risks, and suitability for different individuals.
What is Endoscopic Sleeve Gastroplasty (ESG)?
Endoscopic sleeve gastroplasty (ESG) is a weight-loss procedure performed without any surgical incisions. During ESG, the size and volume of the stomach are reduced using an endoscope, a long, thin, flexible tube inserted through the mouth into the stomach. Attached to the endoscope are a camera and tiny instruments that suture or sew shut about 70 percent of the organ. After the ESG, the stomach is usually reduced by about 60% to 70%, around the size of a banana. By reducing stomach size, ESG also reduces appetite and makes it easier for persons with weight-related medical conditions to manage their food consumption.
ESG is also known as the accordion procedure, involves using an endoscope with an attached suturing device to place sutures in the stomach. This creates what's called a gastric sleeve or weight loss surgery sleeve. ESG creates folds with full-thickness bites along the outer wall of the stomach that fuse together.
The procedure typically takes an hour to an hour and a half.
How Does ESG Work?
The endoscopic sleeve gastroplasty procedure leads to significant weight loss by limiting how much you can eat.
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During the procedure, the endoscopist places sutures in the stomach using the endoscope. The sutures change the structure of the stomach, leaving it shaped like a tube. The endoscopist operates using special tools attached to the endoscope while watching the monitor.
The endoscopic stitches in place, your stomach cannot expand as much. Your capacity for food intake will be smaller, resulting in fewer calories and weight loss. Research also suggests ESG slows down digestion, allowing you to feel full longer.
Who is a Good Candidate for ESG?
Individuals with a medical diagnosis of obesity are the primary candidates for ESG. ESG may be an option if you're significantly overweight - a body mass index of 30 or more - and diet and exercise haven't worked for you.
ESG is suited for anyone with a BMI of 30 to 40, if lifestyle changes, including improved diet and increased exercise, fail to register weight loss. To qualify for ESG, you need a body mass index (BMI) of at least 32.
Rush endobariatric services works with adults who have a BMI between 30 and 50 who do not qualify for or may not be interested in bariatric surgery.
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However, endoscopic sleeve gastroplasty isn't for everyone who is overweight. A screening process helps your health care team see if the procedure might be beneficial for you. You and your healthcare provider will decide together whether you’re a good candidate for ESG. You’ll go through a health screening process, which may include some standard medical tests to make sure you can safely undergo general anesthesia.
Preparing for ESG
If you qualify for endoscopic sleeve gastroplasty, your health care team will give you instructions on how to prepare for your procedure.
A healthcare provider will ask about your health history, diet, lifestyle and weight loss goals. They’ll counsel you about the risks and benefits of the procedure and the long-term changes you’ll have to adopt to make it successful.
You may need to have lab tests and exams before surgery. You may have restrictions on eating, drinking and taking medicines. It's helpful to plan for your recovery after the procedure. For instance, arrange for a companion or someone else to help at home.
The day before the procedure, you’ll start a liquid diet and not eat or drink anything after midnight. Dietary restrictions. In general, you should stop eating at midnight the day before the procedure.
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What to Expect During the ESG Procedure
Endoscopic sleeve gastroplasty is done in the endoscopy unit as an outpatient procedure. You're given general anesthesia for ESG. So, a family member or friend will need to drive you to and from the procedure. ESG is an outpatient procedure. Most people go home the same day. From the time you check in to the time you go home may be several hours. Your surgeon may ask you to arrive up to an hour beforehand to get you ready for the IV drip.
You'll first receive general anesthesia through an IV drip, so you won't feel any pain during endoscopic sleeve gastroplasty. Your care team will monitor your vital signs throughout the procedure.
The endoscope enters your stomach through the mouth and esophagus. Your stomach will be inflated with a harmless gas that enables the endoscopic specialist to watch the procedure on a television screen. He or she will use the suturing device to first mark and then staple the stomach in eight to ten locations.
They'll first insert a thin flexible tube, called an endoscope, down your throat and into your stomach. Using the endoscopic suturing device, they'll place six stitches that create U-shaped folds along the outer wall of your stomach. This creates what's called a gastric sleeve or weight loss surgery sleeve.
The procedure itself takes 60 to 90 minutes. Most patients are able to return home the same day.
Recovery After ESG
After recovering from sedation, most people go home the same day. About 90% of patients go home the same day. Most patients can return to work after three to five days.
Full recovery from ESG can take up to 30 days, though for many the period is much shorter. Any post-operative pain or discomfort should diminish quickly.
After the procedure, you generally won't be allowed to eat for a few hours. Recovery includes a stepwise progression for what you can eat. Take care with your diet while recovering. You’ll begin with liquids, gradually shifting to semisolid and then solid foods.
You'll first follow a full liquid meal plan, which includes protein shakes and similar products. You then transition to a soft food plan (including easy-to-eat foods, like oatmeal, bananas and soft-cooked rice). Finally, you can return to regular eating.
Shouldn't drive on the day of the procedure. Should avoid strenuous physical activity, like heavy exercising or lifting weights, for four weeks. People usually take 1 to 2 days off work. You should avoid lifting heavy objects after the procedure.
Diet and Lifestyle Changes After ESG
To adjust to a smaller stomach, you'll also need to change how and what you eat. Take smaller bites, eat more slowly, chew thoroughly, and stop eating after you feel satisfied.
Medical procedures are only one part of the weight-loss journey. Permanent weight reduction requires lifestyle changes as well. Exercise and a healthy diet are critical aspects of this process.
Your nutritionist can help you with a healthy eating plan that focuses on eating less carbohydrates, like bread and pasta, and more protein, like lean fish and poultry.
Results and Expected Weight Loss
Most patients lose, on average, around 15% to 20% of their total body weight in the first year. On average, patients can expect to lose 15% to 20% of their total body weight by one year. Most people begin noticing weight loss within three to four weeks.
A successful endoscopic sleeve gastroplasty leads to at least 10% total body weight loss. Over 90% of patients who get the procedure achieve these results.
People who've had ESG report feeling healthier.
Advantages of ESG
ESG offers several advantages over surgical weight-loss procedures, including gastric bypass surgery, sleeve gastrectomy, and laparoscopic sleeve gastrectomy.
- Minimally Invasive: ESG is a minimally invasive procedure that doesn’t require any incisions on the outside of your body and you won’t have any external scars. There are no cuts with endoscopic sleeve gastroplasty.
- Reduced Risks: ESG has reduced risks with about a 2 to 3% risk of serious complication. Any surgical procedure, whether open or laparoscopic, requires incisions - cuts in the body - that increase the possibility of infection, bleeding, and other complications. Endoscopic procedures are free of incisions.
- Outpatient Procedure: ESG is advantageous as a weight loss solution since it is a non-surgical procedure and typically does not require hospitalization. No overnight stay.
- Rapid Recovery: No incisions into the abdomen or stomach, so less postsurgical pain. Rapid recovery.
- Potentially Reversible and Repeatable: For most people, ESG is also a potentially reversible and repeatable procedure.
Risks and Complications
Every weight loss procedure has risks and complications. So far, endoscopic sleeve gastroplasty has been shown to be a safe procedure.
- Pain and Nausea: Pain and nausea may happen for several days after the procedure. These symptoms are usually managed with medicine. Most people have mild pain as their stomach heals. Some have more pronounced pain and nausea for a few days afterward. These side effects are often manageable with over-the-counter (OTC) medications. Your doctor can give you a prescription if needed.
- Burping: About 5% of people experience frequent burping, typically for one to two months following the procedure.
- Nausea: About 10% of people experience nausea or an upset stomach.
- Stomach Stretching: A common concern is that the stomach will stretch over time, or stitches will fall apart.
Long-Term Weight Management
As with any weight-loss program, commitment to nutrition, physical activity, emotional health and resiliency play a large role in how much weight you lose.
Patients who adhere to their diet and exercise recommendations after the procedure often see durable weight loss for many years.
To help boost weight loss, your doctor may prescribe appetite suppressants several months after the procedure. These older drugs are often less expensive and more widely available than the newer weight loss injectable medications.
Like other bariatric procedures, 10% of people either won’t lose much weight or may put some weight back on over time. This weight gain can happen if you don't follow the recommended lifestyle changes.
It's possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly.
If you notice you aren’t losing weight or if it takes longer to feel full, talk to your doctor. While rare, your stitches may have come loose.
Benefits Beyond Weight Loss
Overall, weight loss procedures typically improve conditions such as diabetes, hypertension, cholesterol, liver disease, sleep apnea and joint pain, as well as reduce cancer risk.
You may experience better health, like improvements in weight-related health conditions. These can include sleep apnea, high blood pressure, type 2 diabetes, fatty liver, and dyslipidemia. Dyslipidemia is when you have abnormal amounts of lipids (fats) in your blood.
Cost and Insurance Coverage
ESG currently is not covered by insurance. If you are interested in learning about the cost of ESG, please contact us.
The Importance of a Comprehensive Approach
Our ESG team works with dietitians and psychologists to give each patient the best chance of success.
We provide weight management support after the procedure. We take a collaborative approach to treatment that combines the expertise of many different specialists, including the expertise of dieticians.
From nurses to pharmacists, our team is well-equipped to work with patients who need an endoscopic procedure. If you need other care as part of your weight loss experience, we have a broad range of trained specialists at your fingertips. Our collaborative approach means you can get quick access to any other medical care you need - before, during and after your procedure.