Endoscopic Sleeve Gastroplasty (ESG) is a non-surgical procedure designed to assist with weight loss by reducing the size of the stomach. This method offers a less invasive alternative compared to traditional bariatric surgery, such as a laparoscopic sleeve gastrectomy. ESG achieves a similar effect of a smaller, sleeve-shaped stomach without requiring external incisions or the permanent removal of stomach tissue. It is generally considered for individuals who have struggled to achieve sustained weight loss through diet and exercise alone.
The Endoscopic Procedure
The Endoscopic Sleeve Gastroplasty is performed using a specialized flexible tube, known as an endoscope, which is passed through the mouth and down into the stomach while the patient is under general anesthesia. This approach means the procedure is entirely internal, eliminating the need for abdominal cuts or scars associated with traditional surgery. The endoscope is equipped with a camera and an endoscopic suturing device, allowing the physician to operate inside the stomach with precision.
The core of the procedure involves using the suturing device to place a series of durable, permanent stitches within the stomach’s lining. These sutures are placed in a specific pattern, often along the greater curve of the stomach, and then tightened. This action folds the stomach wall inward, creating a restrictive, banana-shaped tube that significantly reduces the stomach’s capacity.
The suturing technique effectively creates an “accordion effect,” reducing the stomach volume by approximately 70% to 80%. This reduction in size limits the amount of food that can be consumed and promotes an earlier and prolonged feeling of fullness. The procedure typically takes between 60 and 90 minutes to complete, and because no tissue is cut or removed, the natural digestive process is not altered.
Patient Selection Criteria
Candidacy for Endoscopic Sleeve Gastroplasty is determined by a comprehensive medical evaluation considering a person’s weight profile and overall health status. The procedure is recommended for individuals with a Body Mass Index (BMI) of 30 or higher, or those with a BMI as low as 27 if they have a weight-related health condition. The U.S. Food and Drug Administration (FDA) has approved ESG for patients with a BMI ranging from 30 to 50.
Qualification requires a documented history of unsuccessful attempts at supervised weight loss through diet and exercise programs. The procedure is intended as a tool to support lifestyle changes, not as a first-line treatment for obesity. Individuals with certain pre-existing gastrointestinal issues, such as a large hiatal hernia, severe gastritis, or ulcers, are generally not eligible.
Successful long-term outcomes rely heavily on a commitment to adopting permanent changes to eating and activity habits. The patient must be willing to participate in a multidisciplinary program that includes nutritional and behavioral support. This commitment is integral to the selection process, ensuring the patient is prepared to maximize the effects of the gastric restriction.
Recovery and Lifestyle Changes
The recovery period following an ESG procedure is notably shorter than traditional bariatric surgery due to its minimally invasive nature. Most patients are discharged the same day or after a short overnight stay for observation. The expected downtime for returning to work and resuming light daily activities is typically only one to three days.
Immediately following the procedure, patients follow a multi-stage diet progression to allow the stomach sutures to heal and the body to adapt to the reduced capacity. This progression starts with clear liquids, moves to full liquids (including high-protein shakes) for up to two weeks, and then gradually transitions to pureed foods, soft solids, and eventually a regular diet over several weeks.
Long-term success is dependent on a sustained commitment to dietary and behavioral modification. Patients must prioritize lean protein intake, chew food thoroughly, and avoid drinking liquids with meals to prevent discomfort and overfilling the smaller stomach pouch. Regular physical activity and consistent follow-up with a multidisciplinary care team are necessary to maintain the weight loss achieved.
Expected Outcomes and Risks
Endoscopic Sleeve Gastroplasty is associated with significant weight loss, with most patients achieving an average loss of 15% to 20% of their total body weight within the first one to two years. This weight reduction often leads to the improvement or remission of obesity-related health conditions, such as Type 2 diabetes, high blood pressure, and sleep apnea. The procedure’s efficacy is comparable to traditional surgical methods for individuals with a lower BMI but maintains a much lower risk profile.
The safety profile of ESG is favorable, with a substantially lower complication rate compared to more invasive bariatric surgeries. Patients commonly experience temporary side effects, including nausea, vomiting, and abdominal discomfort, which are usually managed with medication. These symptoms typically resolve within a few days to weeks.
Risks associated with the endoscopic method are rare but may include bleeding, infection, or suture failure, which could lead to the stomach stretching and weight regain over time. If suture failure or insufficient weight loss occurs, the procedure can sometimes be revised or converted to a different bariatric surgery option. The rate of serious adverse events is low, often reported in the range of 1% to 5%.