Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight-loss procedure that reduces the size of the stomach without surgery. It is performed using an endoscope, a long, thin, flexible tube equipped with a camera and a specialized suturing device, passed through the mouth into the stomach.
During ESG, a series of sutures are placed inside the stomach to reduce its volume and create a sleeve-like shape. This limits the amount of food the stomach can hold and slows the rate at which food leaves the stomach, helping patients feel full sooner and stay satisfied longer after meals.
Unlike traditional bariatric surgery, ESG does not require external incisions, removal of any part of the stomach, or permanent implantation of medical devices.
Reasons for ESG
Your physician may recommend ESG for the following reasons:
- Obesity requiring medical intervention
- A body mass index (BMI) generally greater than 30 kg/m²
- Difficulty achieving sustained weight loss through diet and exercise alone
- Weight-related health conditions such as type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, fatty liver disease, or joint pain related to excess weight
- A desire for a minimally invasive weight-loss option
- Patients who may not qualify for, or who prefer to avoid, bariatric surgery
Eligibility for ESG is determined through a comprehensive medical evaluation and consultation with your healthcare team.
Benefits of ESG
ESG provides a non-surgical approach to weight loss while helping patients achieve meaningful, sustainable improvements in health. Benefits include:
- Significant weight loss
- No external incisions
- Shorter recovery time compared with surgery
- Reduced stomach capacity and improved portion control
- Improvement in obesity-related medical conditions
- Preservation of normal stomach anatomy
- Reduced procedural risk compared with surgical bariatric procedures
Potential health benefits of weight loss after ESG
- Improved blood sugar control
- Lower blood pressure
- Improved cholesterol levels
- Reduced fatty liver disease
- Improved sleep apnea symptoms
- Increased mobility and physical activity
- Enhanced quality of life
How to prepare
Please inform your healthcare team if you have heart disease, lung disease, diabetes, bleeding disorders, liver disease, previous gastrointestinal surgery, allergies to medications, or any other significant medical condition.
- Do not eat or drink anything for at least 8 hours before the procedure.
- Inform your physician of all medications you are taking.
- Follow instructions regarding blood thinners, antiplatelet medications, diabetic medications, and insulin.
- Complete any required nutritional, psychological, or medical evaluations.
- Arrange for a responsible adult to drive you home after the procedure.
What to expect during the procedure
- An intravenous (IV) line will be started.
- You will receive anesthesia or deep sedation to ensure comfort during the procedure.
- An endoscope equipped with a suturing system is passed through the mouth into the stomach.
- The physician places a series of sutures inside the stomach to reduce its size and create a sleeve-like shape.
- No surgical incisions are required.
- The procedure generally takes approximately 60 to 120 minutes.
- Following the procedure, you will be monitored in a recovery area.
After the procedure
- Most patients return home the same day or after a short observation period.
- Mild abdominal discomfort, nausea, cramping, or fatigue may occur during the first few days.
- A gradual dietary progression will be prescribed, beginning with liquids and advancing to soft foods and regular foods over several weeks.
- Follow-up appointments with your physician and nutrition team are important for long-term success.
- Healthy eating and regular physical activity are essential for achieving and maintaining weight loss.
Contact your physician if you experience
- Severe abdominal pain
- Persistent vomiting
- Fever or chills
- Difficulty swallowing
- Shortness of breath
- Chest pain
- Signs of dehydration
- Gastrointestinal bleeding
Risks and possible complications
ESG is generally safe when performed by experienced physicians, and most patients recover without significant complications. Possible complications include:
- Abdominal pain
- Nausea and vomiting
- Gastroesophageal reflux symptoms
- Bleeding
- Infection
- Injury to the stomach wall
- Perforation
- Adverse reactions to anesthesia or sedation
- Dehydration
- Need for hospitalization or additional procedures
Understanding long-term success
ESG is a tool that assists with weight loss and works best when combined with long-term lifestyle changes. Successful outcomes depend on:
- Following dietary recommendations
- Maintaining regular physical activity
- Attending follow-up appointments
- Adhering to nutritional guidance
- Managing obesity-related health conditions
- Maintaining long-term behavioral changes
Most patients experience significant weight loss during the first year following ESG, with continued benefits when healthy habits are maintained.