Fear of surgical risks keeps many people who qualify for weight loss surgery, also called bariatric surgery, from receiving it. Endoscopic sleeve gastroplasty (ESG) is a new nonsurgical weight loss option to help adults with obesity lose weight and keep it off.
ESG is a minimally invasive weight loss procedure that’s effective, durable, and safe.
Endoscopic sleeve gastroplasty (ESG) is a nonsurgical weight loss procedure that makes your stomach 60% to 65% smaller, so it can hold less food. This type of bariatric surgery is known as a restrictive procedure — you eat less food, so your system absorbs fewer calories.
ESG also changes the shape of your stomach, so it empties into your intestines more slowly. With ESG, food stays in your stomach longer, so you feel full longer.
Obesity can impact your health and quality of life. People who have obesity face a higher risk of several chronic, or long-term, health conditions, including:
Losing weight with ESG can reduce your risk of these chronic diseases, and you may also need to take fewer medications to treat them.
People who've had ESG report feeling healthier. They also say they're able to walk and exercise easier than before the procedure.
UPMC offers surgical options for weight loss, including:
Benefits of ESG include:
For most people, ESG is also a potentially reversible and repeatable procedure. The surgeon can go in and remove or add the sutures or reverse the ESG procedure if you decide to try another bariatric surgery.
Surgeons can repeat ESG every few years if your stomach stretches out or the stitches loosen.
Surgeons also can use endoscopic sleeve gastroplasty to fix a previous LSG procedure that has stretched in size.
ESG is a Medicare-approved procedure for weight loss in adults. Please call your insurance provider to see if it is a covered procedure.
You may benefit from ESG if you:
Not everyone is a candidate for ESG. You may not be suitable for this procedure if you:
On average, people who have this procedure:
Most people begin noticing weight loss within three to four weeks. About 90% of weight loss occurs in the first six months, but it may take a full year to see the complete effects of the procedure.
To help boost weight loss, your doctor may prescribe appetite suppressants several months after the procedure. These older drugs are often less expensive and more widely available than the newer weight loss injectable medications. Often, when two or more weight loss modalities are combined, people experience greater weight loss benefits and can keep it off.
Endoscopic sleeve gastroplasty can have a lasting effect on weight loss. Studies have shown that 80% of the weight loss people experience with ESG stays off for up to five years.
Like other bariatric procedures, 10% of people either won’t lose much weight or may put some weight back on over time. That's why UPMC makes ESG part of a complete weight loss program.
Every weight loss procedure has risks and complications. Risks of ESG include:
A common concern is that the stomach will stretch over time, or stitches will fall apart. ESG creates folds with full-thickness bites along the outer wall of the stomach that fuse together. This makes it less likely for the stomach to stretch or for the stitches to come apart.
Your care team will provide instructions on how to prepare for ESG, including:
You're given general anesthesia for ESG. So, a family member or friend will need to drive you to and from the procedure. It can’t take place unless you have someone to help you get home.
Endoscopic sleeve gastroplasty takes place at the Minimally Invasive Bariatric and General Surgery at UPMC Magee-Womens Hospital.
ESG is an outpatient procedure. Most people go home the same day. In rare cases, such as if you have severe nausea, you may need to stay overnight in the hospital.
The procedure itself takes an hour to 90 minutes.
From the time you check in to the time you go home may be several hours. Your surgeon may ask you to arrive up to an hour beforehand to get you ready for the IV drip. You can also expect to stay an hour or two in outpatient recovery to make sure you're well enough to go home.
You'll first receive general anesthesia through an IV drip, so you won't feel any pain during endoscopic sleeve gastroplasty. You'll also get medication to prevent nausea and cramping.
Your care team will monitor your vital signs throughout the procedure. Even though endoscopic sleeve gastroplasty is not surgery, a surgeon will perform the procedure.
You may feel some abdominal pressure or cramping right after the procedure. ESG has a quick recovery time — most people feel better within two to three days.
Common side effects of ESG include:
You'll receive discharge instructions, including how to manage side effects and things to do and avoid during recovery.
In general, you:
Recovery includes a stepwise progression for what you can eat. How long you stay in each phase is geared toward your personal needs and includes:
You'll see your surgeon and care team five or six times in the first year after endoscopic sleeve gastroplasty. After that, you'll need to go for annual checkups.
Endoscopic sleeve gastroplasty is part of UPMC’s Comprehensive Weight Loss program. Your weight loss care team will include nutritionists who can help you make healthy lifestyle choices that support and maintain weight loss with ESG.
To adjust to a smaller stomach, you'll also need to change how and what you eat. Take smaller bites, eat more slowly, chew thoroughly, and stop eating after you feel satisfied. Overeating can lead to nausea and vomiting.
Your nutritionist can help you with a healthy eating plan that focuses on eating less carbohydrates, like bread and pasta, and more protein, like lean fish and poultry. Doctors also encourage people who have ESG to take a daily multivitamin.
Your discharge instructions will include who to call and when for follow-up care or any concerns. Call your doctor if you experience a fever or severe abdominal pain. While rare, it may be a sign of an infection or serious complication.
If you notice you aren’t losing weight or if it takes longer to feel full, talk to your doctor. While rare, your stitches may have come loose. If that happens, the surgeon can strengthen the stitches endoscopically.
Last reviewed by Bestoun Ahmed, MD on 2024-04-10.
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