Endoscopic Sleeve Gastroplasty

A newer, less-invasive procedure to reduce stomach size

Also known as the accordion procedure or the non-surgical sleeve, endoscopic sleeve gastroplasty (ESG) is a newer, less-invasive procedure that reduces the size of the stomach by 70-80% through the use of an endoscopic suturing device.

Endoscopic Sleeve Gastroplasty overview Essentially, the suturing prevents the stomach from widening or lengthening while eating and tends to decrease the appetite at least in part by decreasing the level of our hunger hormone.

This procedure may offer similar results to a laparoscopic sleeve gastrectomy (LSG) without the need for surgery or incisions, as long as the patient commits to healthier dietary and lifestyle changes. ESG is not intended to replace surgical options. It is a potentially less invasive alternative to treat obesity.

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Who qualifies?
Who qualifies for ESG?
  • 18 years or older.
  • Patients with a body mass index (BMI) of 30 or higher, who haven’t been able to maintain weight loss via diet and exercise alone.
  • Patients with obesity related medical problems, such as Diabetes, high blood pressure, high cholesterol/triglycerides, obstructive sleep apnea, etc.
  • Patients who are not ideal candidates for or do not desire bariatric surgery.
  • Patients willing to follow a prescribed diet, aftercare instructions, commit to healthy lifestyle changes and attend routine follow up visits.
Exclusion criteria
Exclusion criteria for the ESG procedure
  • Other factors contributing to weight regain, such as an eating disorder
  • Pregnancy or plans for pregnancy in the next 12 months
  • Large hiatal hernia over 3-5 cm
  • Severe acid reflux disease uncontrolled with medications
  • Previous stomach surgery
  • Weak immune system
  • Active substance abuse
  • Smokers
  • Bleeding disorders or daily use of a blood thinner
  • Any active medical condition that would preclude a safe endoscopic procedure
  • Cirrhosis
  • Family history of stomach cancer
Advantages of ESG
  • The procedure is non-surgical and therefore less invasive than laparoscopic sleeve gastrectomy (LSG). Due to the length of the procedure, however, anesthesia is required.
  • Since there are no incisions, there is little or no pain.
  • Recovery time is much less than with LSG. Typically, a patient can expect to go home the same day and be able to return to work within a day or two.
  • There are no lifting or exercise restrictions following the procedure.
  • Because the procedure is incisionless, there are obvious cosmetic advantages.
How is the ESG performed?

ESG is performed in an operating room at Prisma Health Baptist Hospital. This is an outpatient procedure that typically takes an average of 90 minutes and requires general anesthesia.

ESG is done using a gastroscope (flexible tube with a camera) that goes down the throat and into the stomach. An endoscopic suturing device that is attached to the scope allows multiple sutures to be placed in the stomach, changing the shape of the stomach and making it look like a tube. This restricts the amount of food/calories you eat.

After you awaken from anesthesia, you will spend some time in the recovery room. The majority of people get to go home the same day. On rare occasions, patients may require a short admission to the hospital for a day or so for observation.

Will this procedure be covered by insurance?

Unfortunately, due to the fact that ESG is a new procedure, it is usually an out-of-pocket expense and is not covered by most health insurance plans. Occasionally we may be able to get the procedure covered by insurance, but this may require a 3-12 month, medically supervised program prior to performing the procedure. Our office staff will help you figure out what is required by your insurance company.

How long will the results last?

Because ESG is a relatively new procedure, it is hard to predict how long weight loss will continue; however, several studies have shown that ESG can continue to provide effective weight loss (% TBWL of 19-21%) for up to 20-24 months. Committing to healthier diet and lifestyle can increase the success of this tool.*

What are the risks associated with ESG?

ESG is a very safe procedure with a 2% risk of serious adverse events. These risks include, but are not limited to: bleeding (< 1%), leak (< 1%), obstruction of the stomach, injury to the esophagus or spleen, pneumothorax or pneumoperitoneum, nausea, dehydration and complications related to general anesthesia. Complications, however, are very rare. Typically, most discomfort is noticed in the first day or two after the procedure, and it is usually due to sore throat from having the scope placed inside the esophagus. Other after effects may include nausea, bloating, cramps and occasional constipation. Because the procedure is still relatively new, questions remain about its long-term effectiveness and risks.

Pre- and post-procedure steps to consider

If you qualify, you may need to have various lab tests and exams completed prior to the procedure. You will also be required to undergo nutritional and psychological evaluations. These evaluations will provide further education and set up expectations. You will receive instructions on a pre-procedural diet and which medications you can take.

It’s helpful to plan ahead for your recovery after the procedure. For instance, you may arrange for help at home if you think you’ll need it. Recovery from this procedure generally takes a day or two.

After the procedure, especially when your nausea is under control, you will start a bariatric friendly liquid diet, which you will need to continue for one to two weeks. After that, you will be advanced to semi-solid foods, and then to a regular healthy diet. You also will be expected to maintain your routine follow up visits with your surgeon and our nutritionists.

It’s always possible, for various reasons, that you will not lose enough weight or you may regain the weight back, even if the procedure itself works correctly. To help avoid these issues, you must make permanent healthy dietary and lifestyle changes.

*Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity, Deepanshu Jain, Et al. Clin Endosc. 2017 Nov; 50(6): 552–561,  Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc. 2013;78:530–535, Sharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy. 2015;47:164–166, Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol. 2017;15:504–510, Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15:37–43.e1, Lopez-Nava G, Galvão MP, da Bautista-Castaño I, Jimenez A, De Grado T, Fernandez-Corbelle JP. Endoscopic sleeve gastroplasty for the treatment of obesity. Endoscopy. 2015;47:449–452.

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