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What is endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty (ESG) is a newer type of weight-loss procedure. Endoscopic sleeve gastroplasty reduces the size of your stomach using an endoscopic suturing device without the need for surgery.

This procedure may be an option if you're significantly overweight - a body mass index of 30 or more - and diet and exercise haven't worked for you.

The London Clinic weight management ESG Man struggling to button up shirt at his stomach

Dr Rehan Haidry, the clinical lead of the Endoscopy Unit and a therapeutic endoscopist learnt the procedure in Belgium and has been using the equipment for a variety of other indications that require endoscopic suturing.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. And the procedure is minimally invasive, reducing the risk of operative complications.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires a commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

What are the benefits of an ESG?

The ESG is a technique of oral stomach reduction through an endoscope, which offers a series of advantages over traditional stomach reduction, among which we can highlight:

  • Safe and minimally invasive technique
  • Less pain and risk of infection
  • Absence of external scars
  • Recovery in a shorter period • Short hospital stay

Why is an ESG carried out?

Endoscopic sleeve gastroplasty is performed to help you lose weight and potentially lower your risk of serious weight-related health problems, including:

Endoscopic sleeve gastroplasty and other weight-loss procedures or surgeries are typically done only after you've tried to lose weight by improving your diet and exercise habits. Endoscopic sleeve gastroplasty is less invasive and cheaper than other forms of bariatric surgery.

Who is ESG for?

Endoscopic sleeve gastroplasty is often an option for people who aren't candidates for other bariatric surgeries. The procedure is available to people whose body mass index (BMI) is above 30 who haven't been successful in maintaining weight loss with other methods.

But endoscopic sleeve gastroplasty isn't for everyone who is overweight.

A screening process helps doctors see if the procedure might be beneficial for you. And you must be willing to commit to healthy lifestyle changes, regular medical follow-up and participate in behavioural therapy.

Endoscopic sleeve gastroplasty isn't appropriate for anyone who has:

  • gastrointestinal bleeding
  • a hiatal hernia larger than three centimetres
  • had prior stomach surgery 

Given that endoscopic sleeve gastroplasty is a new procedure, it might not be covered by your health insurance.

What are the risks of having ESG?

in early studies on endoscopic sleeve gastroplasty, the procedure has shown a favourable safety profile. Pain and nausea may occur for several days after the procedure. These symptoms are usually managed with pain and nausea medications.

Most people feel better after two days. In addition, although it's not designed to be a temporary procedure, endoscopic sleeve gastroplasty can be reversed.

In some cases, it can also be converted to bariatric surgery. Because the procedure is still new and not in wide use, questions remain about its long-term effectiveness and risks.

How to prepare for ESG?

If you qualify for endoscopic sleeve gastroplasty, your health care team will give you specific instructions on how to prepare for your procedure. You may need to have various lab tests and exams before surgery.

You may have restrictions on eating, drinking and which medications you can take. You also may be required to start a physical activity program.

It's helpful to plan ahead for your recovery after the procedure. For instance, arrange for help at home if you think you'll need it. Recovery from endoscopic sleeve gastroplasty generally only takes a day or two.

What you can expect from ESG?

Endoscopic sleeve gastroplasty is done in the Endoscopy Unit as an outpatient procedure.

General anaesthesia is used for the procedure, so you'll be unconscious. The procedure is done using an endoscope, a flexible tube with a camera and an endoscopic suturing device attached. The endoscope is inserted down your throat into the stomach.

The tiny camera allows the doctor operating the endoscope (endoscopist) to see and operate inside your stomach without making incisions in your abdomen. Using the endoscope, the doctor places approximately 12 sutures in the stomach. The sutures change the structure of your stomach, leaving it shaped like a tube. This restricts the number of calories your body absorbs.

The procedure takes about 90 minutes. After the endoscopic sleeve gastroplasty, you'll awaken in a recovery room, where medical staff monitors you for any complications. The majority of people leave to go home the same day after recovering from sedation. Some people might require a short admission to the hospital for one day or less for observation after the procedure.





What happens After endoscopic sleeve gastroplasty

After the procedure, you generally won't be allowed to eat for about eight hours.

Then, you'll be allowed to start a liquid diet, which you need to continue for at least two weeks. Over four weeks, you'll move on to semi-solid foods, and then to a regular healthy diet. You'll also have medical check-ups and meet with a nutritionist and psychologist frequently after your procedure.

What are the results of an ESG?

Endoscopic sleeve gastroplasty can lead to significant weight loss. The amount of weight you lose also depends on how much you can change your lifestyle habits.

But studies have shown promising results. A recent study of people with an average BMI of around 38 found that endoscopic sleeve gastroplasty led to an average weight loss of 39 pounds (17.8 kilograms) after 6 months. After 12 months, weight loss was 42 pounds (19 kilograms).

In a study of people with an average BMI of about 45, the procedure resulted in an average weight loss of about 73 pounds (33 kilograms) during the first six months.

As with other procedures and surgeries that lead to significant weight loss, endoscopic sleeve gastroplasty may improve conditions often related to being overweight, including:

When weight-loss surgery doesn't work

It's possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don't follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.

Treatment cost

The London Clinic offers affordable, competitive self-pay packages for certain treatments.

Patients have the option to spread the cost of treatment with Chrysalis Finance.

Please call +44 (0)20 3613 7502 to speak to our helpful team to find out more and to book an appointment.

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