Obesity is a chronic illness recognized by the Centers for Disease Control. The Endoscopic Sleeve Gastroplasty (ESG) is the newest FDA approved treatment for obesity. This condition is a major and growing epidemic in the United States and large portions of the world for decades. The health challenges brought on by obesity, including metabolic syndrome and type-2 diabetes, shorten lives and reduce the quality of life. For individuals battling obesity, defined as possessing a Body Mass Index (BMI) of 30 or above, and who have not succeeded in other weight loss attempts such as diet and exercise, the Happy Stitch Weight Loss Program offers a promising solution: Endoscopic Sleeve Gastroplasty (ESG).
What is Endoscopic Sleeve Gastroplasty (ESG)?
Endoscopic sleeve gastroplasty (ESG) is a term used to describe a relatively new weight loss process developed at the Mayo Clinic in 2012, and now utilized in numerous medical centers around the world. ESG is a minimally invasive, incisionless procedure performed in an outpatient setting. Unlike the somewhat similar laparoscopic Gastric Sleeve surgery, the ESG procedure is incisionless and also performed by a weight loss surgeon using a specialized endoscopic suture device in order to decrease the size of the stomach with permanent sutures. During an ESG procedure, surgeons use a specialized endoscopic device to stitch the stomach, shrinking the portion of a patient’s stomach that accepts and digests food, ultimately leading to a significant reduction in caloric intake.
How ESG Works
After receiving sedation anesthesia, a bariatric surgeon will insert a thin, flexible endoscope into the patient’s stomach (via the mouth and throat). That is why there is no incision required. Via this camera-guided endoscopy, the surgeon will insert sutures into the lining of the stomach. The sutures - which are made of a durable, permanent material - essentially separate a section of the stomach. This makes the portion of the stomach that accepts and digests food 70-80% smaller than it was before, which dramatically reduces the amount of food you will need to eat in order to feel full. In turn, this limits the amount of calories that you will ingest and also allows you to feel full longer.
The sutures alter the abdominal structure, leaving it in the form of a tube. The physical procedure lasts about 90 minutes, and most patients return home the same day. Some patients may require a short stay in the hospital for a day or less for observation after the procedure.
Over time, your stomach will naturally bridge over the sutures. This new tissue seals off the reduced stomach - which is now more of a tube shape. The endoscopic sleeve gastroplasty procedure forms a tubular-shaped stomach that is substantially narrower, while shortening the length of the stomach by about 50 percent. It is believed that the reduction in stomach volume achieved after ESG is approximately 75 percent.
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Benefits of ESG
ESG offers several advantages over other bariatric procedures:
- Less downtime: Patients often return to a normal routine after a few days of at-home recovery. Most individuals take one to three days off from work to recover before returning to their normal routine. Strenuous activity is prohibited for at least one week after surgery.
- No incisions: The procedure is performed endoscopically, meaning no cuts or incisions are made.
- All organs remain intact: Only the stomach is affected (other bariatric surgeries may require incisions in your small intestine).
- Lower cost: Because it is a non-surgical, outpatient procedure, it does cost less than surgical options.
- Proven results: ESG can be a kickstarter for substantial weight loss. Combined with a lasting commitment to a healthy lifestyle, the Endoscopic Sleeve Gastroplasty offers a kickstart to significant weight loss. Perhaps most impressive, the ESG offers similar results to established bariatric surgeries - but in a quicker, less invasive fashion, with patients often returning to a normal routine after a few days of at-home recovery.
Weight Loss and Health Improvements
A large, randomized clinical study conducted by the medical journal The Lancet in 2022 showed that patients lost an average of 14% of their body weight within one year of undergoing ESG*. A recent study of patients who had an average BMI of 38 and underwent ESG showed that the procedure resulted in an average weight loss of 39 pounds (17.8 kg) after 6 months. Studies show that when combined with a comprehensive dietary and lifestyle program, ESG can lead to an average of 20 to 25% total body weight loss (TBWL) over 18 months (i.e. a 100 kg person would lose 20 to 25kg).
Weight loss of this amount can make a massive difference in the life of a patient, including reducing the other health concerns that often accompany obesity. Patients who undergo ESG often see more improvements than just weight loss. Those who struggle with co-morbidities from obesity - such as high blood pressure, diabetes, high cholesterol, sleep apnea, asthma, and even heart problems - may see those concerns reduced or resolved. ESG is proven effective at reducing comorbidities including:
- High blood pressure
- Diabetes
- High cholesterol
- Sleep apnea
- Asthma
- Heart problems
Recovery and Post-Procedure Care
In the hours following surgery, the patient begins a liquid diet, which will last for two weeks, before proceeding to a semi-solid food diet and regular foods within a short time. Endoscopic Sleeve Gastroplasty also does not require you to maintain a strict vitamin regimen post-surgery such as with laparoscopic bariatric procedures.
After an endoscopic sleeve gastroplasty, patients are usually transferred to the recovery room. A brief observation period often takes place to help ensure there are no immediate complications from surgery.
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Who is a Good Candidate for ESG?
ESG may be appropriate for obese patients who need help losing weight, for patients who are unwilling to have invasive surgery, and for patients who cannot safely undergo surgery.
ESG is only an option for someone battling obesity, which is defined as possessing a Body Mass Index (BMI) of 30 or above, and who has not succeeded in other weight loss attempts such as diet and exercise. ESG also is intended for patients age 21 and above, as authorized by the FDA. It is also ideal for any patient who is battling co-morbidities due to weight gain, including but not limited to:
- Type 2 diabetes
- High Blood Pressure (Hypertension)
- High Cholesterol
- Asthma
- Sleep Apnea
- Joint Problems
- Heart Disease
That is why the staff at the Center for Weight Management considers each patient’s entire medical history before recommending or performing ESG.
ESG vs. Other Weight Loss Procedures
While Dr. Bagshahi does not recommend ESG or offer the treatment at his practice, he is committed to identifying the most ideal weight loss system or procedure for your unique needs. He would be happy to speak with you in a consultation about more effective bariatric procedures to achieve your goals.
ESG vs. Gastric Sleeve Surgery
Simply put, an endoscopic sleeve gastroplasty is a minimally invasive treatment option designed to mirror the gastric sleeve procedure. Minimally invasive, the ESG procedure is still a more recent technique and results are not as definitive when compared to more predictable and robustly researched bariatric options, such as gastric sleeve surgery.
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In fact, many patients are now utilizing Endoscopic Sleeve Gastroplasty as an alternative to laparoscopic surgeries and experiencing the same weight loss success. A well-tolerated, incisionless, minimally invasive outpatient procedure, ESG also offers a route to better health for those who otherwise do not qualify for bariatric surgery.
| Feature | Endoscopic Sleeve Gastroplasty (ESG) | Laparoscopic Sleeve Gastrectomy (LSG) |
|---|---|---|
| Invasiveness | Minimally invasive, incisionless | Surgical, requires incisions |
| Stomach Alteration | Sutures to reduce stomach size | Removal of a portion of the stomach |
| Reversibility | Potentially reversible | Irreversible |
| Recovery Time | Few days | Several weeks |
| Weight Loss (Excess Weight) | Up to 60% | Up to 80% |
ESG vs. Gastric Balloon
Intragastric balloon treatments, such as the Orbera system, are non-invasive and non-surgical and promote rapid weight-loss through reducing the available stomach volume.
The main difference between ESG and intragastric balloon therapy is that ESG is a permanent treatment (but reversible in many cases). The stitches are designed to be permanent, and the stomach size can be reduced indefinitely for ESG patients. The balloon, however, must be removed from intragastric balloon therapy patients. This risks a return to normal eating and subsequent weight gain before new habits of eating and exercise can take hold permanently.
Risks and Considerations
The risk of complications after ESG is surprisingly low. This procedure has no documented deaths with more than 2,000 cases carried out worldwide. However, there are risks of bleeding and infection that amount to less than one percent. Other side effects after the endoscopic sleeve gastroplasty procedure include abdominal pain, nausea, cramping, and vomiting. That said, our practice maintains a unique program to reduce the risk of these complications-especially nausea and vomiting. To date, complications have been managed by endoscopes, drugs, or minor treatments.
As with any weight loss procedure, your new stomach (sleeve) can stretch over time. However, doctors may still perform a retightening procedure to restore the sleeve. Although the stitches placed cannot be dissolved, sutures can be loosened or disappear after several years. This can occur due to vomiting or overeating. Weight gain is expected when the stitches used to narrow the stomach become loose or broken-this can often be avoided by not overeating or vomiting.
Because ESG is relatively new, it is not yet covered by most insurance plans. However because it is a non-surgical, outpatient procedure, it does cost less than surgical options.
Potential Side Effects
ESG is proven both effective and well-tolerated. Some common side effects include nausea, abdominal pain, vomiting, constipation, burping or diarrhea. However, these symptoms typically resolve within 30 to 60 days.
The Importance of Lifestyle Changes
However, understand that while the Endoscopic Sleeve Gastroplasty can kickstart your weight loss journey, it must be combined with a commitment to healthy living to achieve lasting and ultimate success. The advent of bariatric surgeries and treatments has provided a new avenue of hope for patients who have repeatedly been frustrated by attempts to lose excess weight.
Like most weight loss procedures, an endoscopic sleeve gastroplasty is most successful when paired with regular exercise and healthy habits. Helpful exercise tips after an ESG include measuring achievements (calculating steps/distance/time) and setting goals.
If I don’t change the behaviors that led me to seek this procedure, eventually my stomach can stretch back out,” she said. “I look at this procedure as a tool, because that’s what it is. I’ve had a total life transformation, and I’m proud of myself.
Support and Guidance
That is why our clinic maintains a commitment to our patients throughout their weight loss journeys, staying in touch to ensure that you have everything you need to reach and maintain your goals and enjoy your best health. We offer diverse assistance, such as support groups to encourage you along the way guidance in the kitchen (including recipes), and even access to a clothes closet to help when you’re moving through different clothing sizes due to weight loss.
Cost and Financing
An endoscopic sleeve gastroplasty usually costs between $7,000 and $9,000. The actual price of the treatment will vary according to patient requirements, but the range is between $9,000 and $11,000. Paying for ESGThough FDA approved, most insurances are not covering the procedure at this time. To help our patients pay for surgery, we are offering a special introductory rate of $9,999* (regularly $11,999).
Health insurance can very often cover part or all of your weight loss procedure, and our knowledgeable office team will help you verify insurance coverage. We encourage you to reach out to your insurance representative to learn the full scope of your benefits and determine out-of-pocket costs. For expenses that medical insurance cannot cover, Bagshahi Bariatric and General Surgery accepts third-party bariatric surgery financing from trusted lenders like CareCredit®, United Medical Credit®, and Prosper® Healthcare Lending. These companies can offer qualified patients flexible payment plans with little or no interest rates within a given promotional period. At this time, most insurance companies do not cover this relatively new treatment. Our clinic’s relationship with CareCredit provides financing options for patients requiring means to pay for the treatment. We are happy to assist. We know health is priceless, and we are committed to helping our patients find the means to secure the healthcare they need.
Finding a Provider
Longstreet Clinic’s Center for Weight Management is excited to announce that it now offers the latest FDA-approved non-surgical treatment for obesity: the Endoscopic Sleeve Gastroplasty (ESG). The Center for Weight Management is the only practice in the region to offer this new, leading edge route to lasting weight loss.
At the Center for Weight Management, we make our patients’ lifelong health our priority; that’s why we’re here, to help people attain their health goals,” Dr. Richard said. Longstreet Clinic Center for Weight Management is now scheduling consultations with patients interested in ESG.
What to Expect During a Consultation
The team at Batash Endoscopic Weight Loss Center will ensure each patient is fully prepared for their treatment. Patients can expect to accomplish lab tests in the days or weeks leading up to the treatment. They can also expect to follow appropriate dietary restrictions and possible changes to their medication regime immediately before their treatment appointment.