Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive, outpatient, non-surgical, incision-less weight loss procedure. The endoscopist sutures the stomach from the inside to reduce its size, which results in long-lasting weight loss. The procedure is very well tolerated. The patients are not admitted to the hospital, and they return to their normal routine after a few days.
ESG is most suited for patients who were unable to achieve the desired weight loss with diet and lifestyle changes. It is also suited for patients who do not want to undergo surgery or who do not meet the criteria for traditional bariatric surgery.
The perfect candidate for ESG is a patient with a BMI between 30 and 40 who is committed to the weight loss program and willing to adapt to a healthier lifestyle.
The procedure is done endoscopically, so no incisions are needed. The endoscopist advances an endoscope (a tube with a camera and a light on its tip) through the mouth to the stomach. The scope is equipped with a suturing device that allows us to suture the stomach from inside. This way, we can decrease the size of the stomach by about 70-80%. The stomach can accommodate smaller meals; but also the rate by which the food empties from the stomach is decreased, so a smaller meal lasts for a much longer period of time. The patient can follow a low caloric diet without feeling hungry all the time.
Most people lose around 18 to 20 percent of their total body weight at 1 year after the procedure. Most of the weight loss occurs early on but it is maintained. Five years after the procedure, people have maintained a 15% total body weight loss. The key is to adopt a healthier lifestyle in the long run.
ESG has the lowest complication rate compared to other bariatric procedures like gastric balloon, lap band, gastric sleeve, and gastric bypass. Serious complications are very rare, but include gastric leak, perigastric fluid collection, pneumothorax, and pulmonary embolism. It is extremely rare for any of these complications to require additional procedures or surgery to treat. No patient has died as a result of complications with ESG.
The ESG is performed with a suturing device on the end of an endoscope to collapse the majority of the stomach from the inside. There are no incisions and nothing is removed.
The Laparoscopic Sleeve Gastrectomy is performed with a camera and long instruments through small incisions in the abdominal wall. The majority of the stomach is detached and completely removed from the body through one of the incisions.
Recovery time after the ESG is usually 2-4 days. Complications are very rare but include gastric leak, perigastric fluid collection, pneumothorax, and pulmonary embolism. It is extremely rare for any of these complications to require additional procedures or surgery to treat. No patient has died as a complication of the ESG.
Recovery after Sleeve Gastrectomy is usually 1-3 weeks. Complications are also rare and include gastric leak, post-operative bleed, and pulmonary embolism. These complications usually require additional procedures or surgery to treat. The chance of death after LSG is very low (0.04%), but not zero.
Weight loss after the ESG is good, usually 30-60% excess weight loss. The LSG has excellent weight loss results, usually 50-80% of excess weight loss. Following a program for making healthy changes in your nutrition, activity, and mindset are critical to both procedures.