Choosing an Endoscopic Sleeve Gastroplasty (ESG) for Effective Weight Loss
For some people, eating right and exercising are not enough to help them lose weight. Some people may consider bariatric surgery; however, others don’t want to go through an intensive surgery with a longer recovery time.
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that offers many of the same benefits as traditional bariatric gastric sleeve surgery with fewer incisions and a significantly shorter recovery time.
What Is Endoscopic Sleeve Gastroplasty?
Endoscopic sleeve gastroplasty (ESG) was approved for use by the U.S. Food and Drug Administration in 2022 and has since gained popularity as a weight-loss aid without the need for major surgery.
Think of ESG as a less invasive version of traditional gastric sleeve surgery — the stomach is reformed into a much smaller tube through an endoscopic procedure using a special suturing device.
Your new gastric sleeve can decrease your stomach’s normal volume by as much as 80%, allowing it to accommodate only about one cup of food and liquid at each meal. You will feel full quicker, which prompts you to eat less and can lead to weight loss.
What to Know Before Choosing Endoscopic Sleeve Gastroplasty
- How Does ESG Work?
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An ESG is an endoscopic procedure where a very small camera on a flexible tube is passed down your throat and into your stomach. Your doctor — typically a gastroenterologist, bariatric surgeon or bariatric endoscopist — uses a special suturing device to create folds from inside your stomach, creating a gastric sleeve that is much smaller than your original stomach. The entire ESG procedure takes between 45 and 90 minutes to complete.
Because your stomach is much smaller, you physically won’t be able to eat as much as you used to. That means you can focus on smaller meals and successfully reduce your caloric intake. Additionally, it takes less food to feel full and you generally stay fuller for a longer period.
All of this can lead to weight loss — most people who have an ESG can expect to lose between 15 and 20% of their pre-procedure total body weight in their first year. How much weight you lose depends on your body and if you make healthy lifestyle changes and stick to them, such as exercising and focusing on eating healthy foods.
The weight loss caused by ESG can also help improve and lower your risk for weight-related health conditions, such as:
- Depression
- Gastroesophageal reflux disease (GERD)
- High blood pressure
- High cholesterol
- Joint pain
- Nonalcoholic fatty liver disease
- Sleep apnea
- Type 2 diabetes
- Benefits of Endoscopic Sleeve Gastroplasty
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When comparing ESG to traditional bariatric procedures, there are several benefits, including:
- An outpatient procedure where most patients can go home the same day
- Minimally invasive — no incisions required
- No scarring
- Potentially reversible procedure
- Recovery of only a few days, rather than a few weeks
- Return to routine, work and daily activities in just a few days
- Significant weight-loss potential
- Shorter procedure time than conventional weight-loss surgery
- Usually less expensive than traditional bariatric surgery
- Who Is a Candidate for ESG?
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Just like any type of weight-loss procedure, ESG is not for everyone. There are certain criteria you’ll need to meet to be considered for ESG, such as:
- Attempts at losing weight with diet and exercise only
- Body mass index (BMI) between 30 and 50
- Dedicated to making healthy lifestyle choices for the rest of your life
- Having realistic weight-loss goals
- Wishing to have a minimally invasive procedure rather than traditional bariatric surgery
- What to Expect During the Procedure
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If you’re interested in having an ESG, your first step would be to make an appointment with a weight-loss specialist to discuss this type of gastric sleeve surgery and have a health screening to ensure you’re a good candidate.
If you choose to have an ESG, your doctor will provide you with some pre-procedure instructions, which will include fasting for at least eight hours before your scheduled procedure time.
On the day of your ESG:
- You will check in with the weight-loss team to let them know you’re there.
- They will take you back to the procedure room and will answer any last-minute questions you may have.
- You will be placed under general anesthesia for the duration of the procedure.
- Once asleep, your doctor will thread a very thin, flexible wire with a tiny camera attached at one end down your throat and into your stomach.
- Your doctor will then use a special suturing device to decrease the size of the stomach by folding it inwards to create a gastric sleeve.
- Once the surgery is completed, you’ll be wheeled to a recovery room as you wake up from the anesthesia, and to monitor you for any signs of complications.
- In most cases, you’ll be able to go home the same day as your procedure.
- Post-Procedure Care
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In addition to a pre-procedure to-do list, your medical team will also provide you with a post-procedure checklist of what you can and can't do after your ESG. One of the biggest items on your aftercare list will be what you can and can't eat. Generally, your post-procedure meals will include:
- Clear liquids only for the first 24 to 72 hours
- Liquid diet for the first one to two weeks
- Semi-liquid and very soft foods for weeks two through six
- Transition to a regular diet around week nine
Other items on your post-ESG care list may also include:
- Consider meeting with a nutritionist to learn more about how to eat after your ESP.
- Don't drive for the first 24 hours after the procedure.
- Don't lift anything too heavy for the first four to six weeks.
- Eat very slowly to give yourself time to adjust to your new stomach size.
- Focus on lean proteins and stay away from fatty or sugary foods.
- Start a gentle exercise regimen between 24 to 48 hours after your procedure.
- Stay hydrated by constantly drinking water — steer clear of carbonated beverages, like soda.
- Stay home from work for the first two to five days post-procedure.
- Take any prescribed medications for nausea or pain.
- Wait at least one week before attempting any rigorous exercise.
Let Us Help Guide Your Weight-Loss Journey
At AdventHealth, we understand that losing weight is hard. Our bariatric and weight care services can help you make the right personalized weight-loss decision that fully meets your needs and will guide you every step of the way. You’ll also have the benefit of being fully connected to our wide range of health services, helping to ensure your weight-loss journey is one that fulfills your body, mind and spirit.
If you're interested in learning more about an ESG gastric sleeve procedure, make an appointment today with one of our bariatric and weight care experts near you.
FAQs About Gastric Bypass Surgery
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Q:Question: How long does the ESG procedure take?
A:Answer:An ESG procedure normally takes between 45 and 90 minutes.
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Q:Question: What is the recovery time after endoscopic sleeve gastroplasty?
A:Answer:Most patients can get back to easy daily activities within a few days post-procedure. Most people will take about four weeks to completely recover from an ESG.
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Q:Question: Are there any risks or complications associated with ESG?
A:Answer:Just like any medical procedure, an ESG does have the potential for some complications, including:
- Abdominal pain
- Adverse reaction to general anesthesia
- Infection
- Internal bleeding
- Nausea
- Stomach leaking
- Stomach lining injury
- Tears in the stomach
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Q:Question: How much weight can I expect to lose from an ESG?
A:Answer:Most patients, on average, lose between 15 and 20% of their starting weight during their first year following their operation. However, how much weight you lose depends on whether you adhere to making healthy lifestyle modifications, including eating a healthy, high-protein diet and exercising regularly.
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Q:Question: Is endoscopic sleeve gastroplasty covered by insurance?
A:Answer:ESG gastric sleeve procedures are generally not covered by health insurance. However, some insurances will cover the procedure to help reverse obesity-related issues. Make sure to check your plan or call your insurance provider to learn whether your procedure may be covered.
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Q:Question: What should I expect during my first consultation for ESG?
A:Answer:During your first meeting with your weight-loss team, your doctor will take a medical history, including what you’ve done in the past to try to lose weight. They’ll perform a quick medical exam and may order some lab tests. Your doctor will also explain in detail how an ESG works and will ask you about your expectations for after the procedure. All this will help them determine whether you’re a good candidate for an ESG.
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Q:Question: Will I need to follow a special diet after the procedure?
A:Answer:Yes, your bariatric team will provide you with full instructions on what you can and can't eat after your ESG. In most cases, you'll be asked to stick to a clear liquid diet for the first 24–72 hours, full liquids for the first two weeks and soft foods for a few weeks after that before transitioning to a normal diet that focuses on protein and a small amount of food for each meal.
Not adhering to these dietary restrictions can negatively impact how well your stomach heals after the procedure.