Endoscopic Sleeve Gastroplasty (ESG)

Overview

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight loss procedure performed entirely through the mouth, requiring no surgical incisions. This approach offers an effective option for patients seeking weight reduction with fewer risks and a faster recovery compared to traditional bariatric surgery.  

Candidates

ESG may be right for you if you: 

Have a BMI more than 30  

Have a BMI lower than that with: 

• Weight-related conditions like type 2 diabetes or high blood pressure.  
• Failed weight loss after supervised diet treatment and exercise.

Prefer to avoid invasive surgeries.  

How does it work?

Unlike sleeve gastrectomy, ESG doesn't remove any part of your stomach. Instead, your doctor uses stitches to fold it into a smaller, tube-like shape, reducing its size by 60–80%. 

This slows how quickly food leaves your stomach, and you feel full after eating a small amount of food. After ESG, food stays in your stomach about 90 minutes longer, keeping you full for nearly an hour more than before.

Benefits

ESG was proved to be more effective for weight loss compared to lifestyle changes alone and less invasive than other bariatric surgeries. 

Weight Loss Results: 

• Patients can lose up to 60 % of their excess weight. 
• Weight loss can be maintained for an average 3-5 years.

Improving Obesity-related Conditions  

ESG works as well as sleeve gastrectomy at improving conditions linked to excess weight.

After 4 years, patients see significant improvements: 

• 90% resolve sleep apnea 
• 74% improve cholesterol levels 
• 66% reduce high blood pressure  
• 51% control or reverse type 2 diabetes

Common Misconceptions

ESG is the same as sleeve gastrectomy. 

They produce similar weight loss results, but ESG is far less invasive. Your stomach stays intact and nothing is removed. 

ESG is fully reversible. 

In theory, yes. Your doctor can remove the stitches endoscopically since no tissue is removed. However, over time your stomach tissue heals around the stitches, so it may not return to its original shape. There isn't enough evidence yet to confirm full reversibility. 

It replaces healthy habits.

ESG is not enough alone. Long‑term success still depends on diet, exercise and behavioral therapy. 

Risks

Sleeve gastrectomy is a relatively safe weight reduction operation. While complications are possible, the possibility is low, and they are typically manageable. 

Mild complications (60%)  

These include pain, nausea, and vomiting. They typically resolve within the first week.

Serious complications (1-2%)  

These may include gastrointestinal bleeding or fluid buildup near the stomach. Both happen in less than 1% of cases and are treatable

Results

Your weight loss timeline will look like this: