Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive, non-surgical procedure designed to aid in sustained weight loss. Its primary purpose is to reshape and reduce the stomach’s volume, restricting food intake and encouraging earlier feelings of fullness. ESG offers an alternative for individuals seeking significant weight reduction without external incisions or the removal of any part of the digestive tract.
The Endoscopic Procedure
The Endoscopic Sleeve Gastroplasty is performed entirely through the mouth, making it an incisionless procedure. The patient is placed under general anesthesia while a specialized, flexible endoscope is guided down the esophagus and into the stomach, allowing the physician to visualize the interior on a monitor.
A specialized suturing device is attached to the endoscope, which is then used to place full-thickness stitches in the stomach wall. The physician places a series of sutures in a specific pattern, folding the stomach tissue inward like an accordion or curtain. Pulling these stitches tight cinches the stomach, reducing its overall capacity by approximately 70% to 80%.
This suturing process transforms the stomach from a large sac into a narrow, tube-like structure. The procedure typically takes between 45 minutes and two hours to complete and is considered less invasive than traditional surgical options. The durable, permanent sutures remain in place, with subsequent scarring helping to maintain the new, smaller sleeve shape over time.
Patient Selection and Suitability
Endoscopic Sleeve Gastroplasty is intended for patients who have struggled to achieve and maintain weight loss through diet and exercise alone. The procedure is offered to individuals with a Body Mass Index (BMI) of 30 or higher, extending up to a BMI of 50. This range includes patients with moderate obesity who may not meet the stricter criteria for traditional bariatric surgery.
A thorough medical and psychological evaluation is conducted before the procedure to ensure the patient is a suitable candidate. Patients with certain pre-existing gastrointestinal conditions, such as a large hiatal hernia, ulcers, or internal bleeding issues, may not be eligible. The process requires a commitment to long-term lifestyle and behavioral modifications, as the procedure is a tool to assist weight loss, not a standalone cure. ESG may also be considered for patients who are not candidates for other bariatric procedures due to health complications.
Mechanism of Weight Loss and Expected Results
The weight loss achieved with ESG is driven by a dual mechanism involving physical restriction and physiological changes. The reduction in stomach volume significantly limits the amount of food that can be consumed at one time. This smaller, tubular stomach leads to earlier satiety, helping patients feel full for longer periods. The reshaping of the stomach also affects the rate at which food empties into the small intestine, a process known as delayed gastric emptying.
This slower emptying contributes further to the feeling of fullness and reduced appetite. Studies also indicate that ESG can influence the body’s hormonal signals related to appetite. While the exact hormonal changes are still being researched, the procedure appears to favorably alter levels of gut hormones, which can help regulate hunger and satiety.
The combined effect of physical restriction, delayed emptying, and hormonal modulation results in substantial weight reduction. Patients can expect to lose between 15% and 20% of their total body weight (TBWL) within the first year following the procedure. This often translates to an average of 49% to 60% of excess weight loss (EWL) within 12 to 18 months. The weight loss outcomes are significantly greater than those achieved through lifestyle modifications alone, offering an intervention for obesity and its related health conditions.
Recovery, Risks, and Long-Term Aftercare
The recovery period after Endoscopic Sleeve Gastroplasty is fast due to its minimally invasive nature. Most patients are discharged either the same day or after a single overnight hospital stay. Common, temporary side effects in the initial days include mild nausea, vomiting, abdominal discomfort, and cramping, which are managed with prescribed medications. Most individuals can return to their normal daily activities, including work, within a few days.
While ESG has a favorable safety profile, some specific, though rare, complications are associated with the procedure. Potential risks include internal bleeding at the suture sites, perforation of the stomach or esophagus, and suture failure, which could lead to a loss of the restrictive effect. The rate of serious adverse events requiring hospitalization is low, typically around 2.6%.
Long-term success relies heavily on adherence to a comprehensive aftercare program, starting with a structured diet progression. Immediately following the procedure, patients must advance through phases over several weeks to allow the newly formed gastric sleeve to heal:
- Clear liquids
- Full liquids
- Pureed foods
- Solid food
Ongoing nutritional counseling and regular physical activity are required for weight maintenance. Vitamin supplementation is also necessary to ensure adequate nutrient intake following the procedure.