Endoscopic sleeve gastroplasty (aka ESG) is a minimally invasive weight-loss procedure that reduces the size of your stomach by 70% to 80%, without the need for surgery.
Unlike a sleeve gastrectomy (aka gastric sleeve surgery), which removes up to 90% of the stomach via small incisions in the abdomen, no portion of your stomach is removed with ESG.Â
The procedure is gaining popularity with people who have obesity that hasnât responded to traditional weight-loss measures like diet and exercise, as well as those who are morbidly obese and considered too high-risk for surgery.
This two-hour outpatient procedure is performed using an endoscope, a long, flexible tube with a tiny camera and an endoscopic suturing device attached. The camera, which is guided down your throat, allows the doctor to visualize your stomach from outside the body, eliminating the need for surgical incisions or scars. With the placement of seven to a dozen stitches, your doctor internally âplicatesâ or creates small accordion-like folds in the stomach, reducing it to the size of a banana.
ESG takes a three-pronged approach to facilitate weight loss, explains Dr. Steven Batash, a gastroenterologist in Rego Park, NY:
 One study published in 2017 found that ESG led to a total body weight loss of 21% after 24 months. It also showed a reduction in key indicators of hypertension, diabetes, and high triglycerides, which can predispose people to cardiovascular disease, the leading cause of death worldwide.Â
Weight-loss results break down this way, according to Dr. Batash:
Anyone whoâs obese and has not achieved their desired weight loss through diet and exercise is a candidate for ESG.
Thereâs no specific weight or body mass index (BMI) required for the procedure, though most patients will have a BMI somewhere between 30 and 40.
However, this procedure has been performed in people with higher BMIs who arenât interested in pursuing surgical treatments. âOf all patients eligible to undergo bariatric [weight-loss] surgery, only 1% take advantage,â says Dr. Batash. âThe universal reasons they give are that theyâre terrified of surgery, donât want to be cut open, and want all of their parts to stay in place. The ESG procedure, they say, âI will do.ââ
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RealSelf Tip: The procedure doesnât change how your body absorbs nutrients from the food that you eat, but because youâll be eating a smaller amount of food, talk to your provider about taking a multivitamin to supplement your diet.
The procedure is done with the aid of an endoscope, a long flexible tube with a camera that allows the doctor to see and operate inside your stomach without making incisions in your abdomen.Â
Hereâs what to expect:
The entire procedure typically takes 60â90 minutes, depending on various factors, such as how large your stomach is to start. If your case is complex, it can take longer.Â
Once the surgery is over, youâll be monitored for a couple of hours before being discharged. The effects of anesthesia can be felt for about 24 hours, so be sure to arrange for someone you trust to drive you home.
The endoscopic sleeve gastroplasty photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.
Thereâs almost no recovery time required after ESG.
Youâll be encouraged to get up and walk around after the procedure, to increase blood flow in the legs and prevent blood clots; however, vigorous exercise isnât advised for the first few weeks. Â
You will need to change the way that you eat for the first month:
Abdominal pain or nausea are common in the days following the procedure. In a 2018 study of 1,000 patients, 92.4% complained of such side effects during the post-op period. Both are managed with medication and the vast majority resolve within the first week, according to the Mayo Clinic.
The recovery for RealSelf member minnesotajen was very manageable. She says the pain after surgery was not unbearable, just a burning sensation in her stomach. By day four, she says, the pain had resolved and she was back to her usual routine, taking care of her kids.
The first month after ESG is when the most dramatic weight loss occurs: between 11 and 24 pounds, likely due to being on a no-solid-food diet.Â
People who have ESG typically lose 15% to 20% of their starting total body weight within the first year. If you commit to portion control and routine exercise, youâll likely experience continued weight loss.Â
For those who desire more weight loss, combination therapy using ESG and obesity medications has demonstrated weight-loss outcomes nearing those of bariatric surgery. In one double-blind study, ESG patients who received the diabetes drug semaglutide lost on average 28% of their total bod weight compared to the control group, which lost on average 20% of their total body weight.
Endoscopic procedures are considered very safe and less risky than surgery. Compared to surgical sleeve gastrectomy, the complication rate for ESG is quite low: 9% to 17% for sleeve gastrectomy, compared to 2% to 3% for ESG in one systematic review.Â
Most complications, such as pain and nausea, are mild to moderate. Serious risks like bleeding, infection, or tears in the stomach are very unlikely, occurring in less than 1% in one review of 11 studies.Â
âWeight loss with surgical bariatric procedures is very fast, and with the surgical sleeve, you can lose 25% to 35% of your total body weight,â says Dr. Batash. âThe price is complications, including severe acid reflux in up to 35% of patients.â
Gastric leak, which can be life-threatening, occurs up to 16% of the time after bariatric surgery; with ESG, the rate is .5%. âThe procedures are like night and day,â says Dr. Batash.
Updated June 23, 2022