Endoscopic Sleeve Gastroplasty (ESG) is a significant advancement in the non-surgical treatment of obesity. This minimally invasive approach achieves substantial weight loss without external incisions or the permanent removal of stomach tissue. ESG offers an alternative to traditional bariatric surgery for patients seeking a long-term solution. A common question concerns the procedure’s permanence: whether the stomach can be fully restored to its original state. This article examines the mechanics of ESG, addresses its reversibility, and explores options available if the treatment effect diminishes over time.
How Endoscopic Sleeve Gastroplasty Works
Endoscopic Sleeve Gastroplasty is performed using a specialized flexible tube, known as an endoscope, passed through the mouth and into the stomach. This device is equipped with a camera and a suturing system, allowing the physician to work entirely within the digestive tract. The procedure involves placing a series of full-thickness sutures along the greater curvature of the stomach in an accordion-like pattern.
These internal sutures are cinched tight, physically folding the stomach wall inward. This action reshapes the stomach, turning the large, sac-like organ into a much narrower, tube-like structure. The stomach volume is typically reduced by 70 to 80% of its original capacity. This reduction limits the amount of food a person can consume before feeling full and contributes to a prolonged sense of satiety.
The Question of Reversibility
The nature of the ESG technique makes reversal technically possible, though it is not considered a routine practice. Unlike surgical procedures, such as sleeve gastrectomy, which permanently remove stomach tissue, ESG alters the stomach’s shape solely through internal sutures. Since no tissue is cut, the original stomach structure remains intact beneath the sutures.
In theory, the sutures could be removed endoscopically, allowing the stomach to slowly return to its pre-procedure size and shape. However, ESG is intended to be a durable, long-term weight loss solution, with the sutures designed to remain in place indefinitely. Reversal is rarely performed unless a patient develops an unforeseen complication or has a medical need to restore the stomach’s original anatomy.
The feasibility of suture removal becomes more complex over time. As the stomach tissue heals around the internal stitches, the sutures can become embedded, and scarring may occur. This makes removal more challenging than simply clipping them, potentially requiring additional endoscopic or surgical intervention for full anatomical restoration. While the option for reversal exists, patients should view ESG as a permanent commitment to a new stomach shape and lifestyle.
Managing Loss of Restriction
The scenario that often prompts questions about reversibility is the gradual loss of restriction or weight regain years after the initial ESG. Over time, factors like poor dietary habits can cause the reduced stomach pouch to stretch, or the sutures may loosen, leading to a diminished feeling of fullness. This loss of effect is distinct from a full reversal, and physicians have specific options to address it.
One common approach is a revisional or repeat ESG, which involves using the endoscope to place new sutures or tighten existing ones. This procedure aims to restore the original size and restriction of the sleeve, often resulting in a renewed phase of weight loss. Revisional ESG is a safe and effective way to manage weight recidivism without converting to major surgery.
If the loss of restriction is significant, or if the patient requires greater metabolic benefits, the ESG can be converted to a traditional surgical weight loss procedure. Since ESG does not remove tissue, it does not preclude a later conversion to operations such as a laparoscopic sleeve gastrectomy or a Roux-en-Y gastric bypass. These follow-up treatments allow patients to progress to a more anatomically altered procedure if the non-surgical approach proves insufficient for their long-term health goals.