Endoscopic Sleeve Gastroplasty (ESG)

Weight Loss Solutions at Robert Wood Johnson University Hospital

Endoscopic sleeve gastroplasty is an endoscopic procedure that involves going in through the mouth using an endoscope with a suturing device attached and performing a gastric volume reduction technique that reduces gastric capacity by creating an endoscopic sleeve. This is accomplished by using a series of stitches to fold the stomach on itself, effectively reducing the stomach volume by 70 percent. The result is the creation of a tube-shaped stomach similar to sleeve gastrectomy but without surgery and without removing stomach tissue and no scars. During the procedure, the patient is completely asleep with general anesthesia.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. Patients typically lose about 20 percent of their body weight with this procedure, in combination with dietary and lifestyle changes.

How is the ESG performed?

After receiving anesthesia, an initial endoscopic examination is performed. A thin, flexible tube equipped with a camera and light is passed through the mouth into the esophagus, stomach, and small intestine. Then a special endoscope with a suturing device attached is passed into the stomach. A series of full thickness sutures are placed through the gastric wall from the antrum to the fundus with the result being the creation of a sleeve shaped stomach. The suturing technique is intended not only to reduce the stomach diameter but also to shorten it substantially through an accordion effect. The procedure takes about 90 to 120 minutes. Most patients return home the same day or the following day after an overnight admission.

Do I qualify for the ESG procedure?

Ideal candidates for ESG:

• Have a body mass index (BMI) of 30 to 40; a higher or lower BMI may also be suitable
• Be willing to participate in a medically supervised program
• Have attempted weight-loss through diet and exercise without success
• Do not qualify for, or do not desire, bariatric surgery

What can I expect after the ESG procedure?

After the procedure, you are not allowed to eat or drink for eight hours. Subsequently you are started on a liquid diet, which is continued for two weeks. Then there is progression to small semisolid meals over 4 weeks and eventually to a regular healthy diet. Patients will also continue to follow-up with our multidisciplinary team of experts, including a gastroenterologist, nutritionist, endocrinologist, psychiatrist, and exercise therapist.

How much weight can I expect to lose?

It is important to understand that the ESG is a tool to aid weight loss and must be used in conjunction with diet, exercise, and a behavior modification program. The endoscopic sleeve gastroplasty is one of the most effective endoscopic procedures for primary weight loss. In conjunction with diet and exercise, on average, patients lose 40 to 70 pounds, or nearly 20 percent of their body weight. The most recent data has shown the weight loss achieved with the ESG procedure can last for greater than 2 years. ESG has also been shown to improve obesity related medical problems such as cholesterol, diabetes and high blood pressure.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires 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 risks of ESG?

This is a very safe and reliable weight-loss solution and recent studies have shown decreased hospital length of stay and a four-fold decrease in complications when compared to laparoscopic sleeve gastrectomy. ESG requires no surgery and the most common side effects last only for a few days. Among these problems are pain and nausea which are managed with medication. Most people feel better after two days. Major complications are rare.

Endoscopic sleeve gastroplasty is not appropriate for anyone who has gastrointestinal bleeding, a hiatal hernia larger than 3 centimeters or who has had prior stomach surgery.

Who is not a candidate for ESG?

Patients with the following are not candidates for the ESG procedure:

• Large hiatal hernia
• Previous gastric surgery
• Heartburn symptoms despite taking heartburn medications
• Prior open or laparoscopic bariatric surgery
• Inflammatory diseases of the GI tract
• Active ulcers in the stomach or small intestine
• Variceal disease
• Unwilling to participate in a medically-supervised diet and behavior modification program
• Alcohol or drug addictions
• Daily prescribed treatment with aspirin, anti-inflammatory agents, anticoagulants or other gastric irritants
• Currently are or may be pregnant or breast-feeding