Endoscopic Sleeve Gastroplasty (ESG) is a non-surgical, minimally invasive weight loss procedure. This procedure offers individuals a path to significant weight loss without incisions or the removal of stomach tissue. A key question about ESG is its reversibility, which this article explores by examining its mechanics, circumstances for reversal, and implications for a patient’s weight management journey.
How Endoscopic Sleeve Gastroplasty Works
Endoscopic Sleeve Gastroplasty is performed using an endoscope, a flexible tube equipped with a camera and a suturing device, which is inserted through the mouth into the stomach. The procedure involves placing a series of sutures along the stomach’s inner lining. These sutures fold the stomach in on itself, effectively reducing its overall volume by approximately 70-75%.
The result is a smaller, tube-shaped stomach that limits the amount of food a person can consume at one time. This reduction in stomach capacity helps individuals feel full more quickly and for longer periods. Additionally, ESG can delay gastric emptying, further contributing to prolonged feelings of satiety.
The Nature of ESG Reversibility
Endoscopic Sleeve Gastroplasty is generally considered potentially reversible, unlike surgical sleeve gastrectomy where a portion of the stomach is permanently removed. The sutures placed during the ESG procedure can, in principle, be endoscopically removed.
However, the concept of “reversibility” in ESG carries nuances. While the sutures can be removed, the stomach tissue undergoes a healing process where it remodels around the stitched areas, forming new tissue and scarring. This scarring and bridging tissue help maintain the reduced stomach size over time, even if some sutures were to loosen. Therefore, the stomach may not return to its exact original size or shape after suture removal, especially if a significant amount of time has passed since the initial procedure. Reversal is not a standard or routinely performed practice but rather an option considered under specific circumstances.
Reasons and Challenges for Reversal
Patients might consider ESG reversal for various reasons, including severe or persistent complications like persistent nausea, vomiting, or other digestive issues. Another reason could be inadequate weight loss, or the desire to pursue a different type of bariatric procedure.
Reversing ESG presents several practical challenges. The primary difficulty lies in the removal of sutures, particularly if they have become embedded in the stomach tissue or if significant scar tissue has formed around them. The longer the period since the initial ESG procedure, the more the stomach tissue adapts to its new, smaller configuration, making a complete return to the original anatomy more complex. In cases where conversion to a surgical procedure is sought, surgeons may encounter extra-gastric adhesions or alterations in stomach wall thickness, which can complicate the subsequent surgery.
Life After ESG Reversal
A significant consideration after ESG reversal is the potential for weight regain, as the restrictive mechanism of the procedure is removed. Patients who undergo reversal will need to re-engage with rigorous dietary and exercise plans to manage their weight effectively.
For individuals who experience unsatisfactory outcomes after reversal, or for those who regain weight, further weight loss interventions may be explored. These can include revisional endoscopic procedures, such as another ESG, or in some cases, conversion to a surgical bariatric procedure. Continued support from a multidisciplinary team, including dietitians and medical professionals, remains important for navigating the ongoing weight management journey.