Endoscopic Sleeve Gastroplasty 2

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ESG vs. Native Stomach
ESG vs. Native Stomach Click to Enlarge
An Endoscopic Sleeve Gastroplasty is a minimally invasive procedure. It is a weight loss procedure offered to patients who are not candidates for bariatric surgery. Using an endoscope suturing device, the endoscopist constricts the stomach, resulting in a ‘sleeve.’ – Reem Shariaha MD

The Endoscopic Sleeve Gastroplasty or ESG is a new procedure that reduces the functional volume of the stomach. Little doubt exists that gastric restriction is a critical mechanism in achieving substantial weight loss; purely restrictive bariatric procedures, such as gastric banding and sleeve gastrectomy, have been shown to result in expected weight loss (%EWL) of 65.5% and 76.1%, respectively, at 12 months.

What is Endoscopic Sleeve Gastroplasty

Endoscopy is the visualization of gastrointestinal tract with a flexible endoscope. Recently a device was created that allows the intestinal wall to be sutured. This has many applications, but one of them is to suture the front wall of the stomach to the back wall. This prevents the stomach from widening and lengthening as the patient eats. During an ESG a channel is preserved along the lesser curve of the stomach similar in size to what is left intact after a laparoscopic (operative) sleeve gastrectomy or LSG. In essence the ESG is an even less invasive version of the minimally-invasive LSG.

Endoscopic Sleeve Gastroplasty Procedure Animated Video

The Advantages of Endoscopic Sleeve Gastroplasty Over Laparoscopic Sleeve Gastrectomy

The ESG has certain advantages over the LSG. It is not technically surgery, although it does require general anesthesia due to the length of the procedure. There are no incisions, and therefore, little or no pain after the procedure. Recovery time is much less. A typical patient should go home later the same day, and be able to return to work within 24-48 hours. Also, because it is incisionless, the ESG has no lifting or exercise restrictions afterwards, unlike the LSG which limits activity for several weeks. Cosmetically, the ESG has an obvious advantage. Patients who wish to keep the fact they have undergone a weight-loss procedure are also at an advantage. In addition, the overall cost of the ESG is less than LSG.

Endoscopic Sleeve Gastroplasty (ESG)

Fact Sheet

Main Features

NOT SURGERY – No incisions / No scars
Little or no pain
No physical restrictions after surgery
Quicker recovery than laparoscopy
Return to work 24-72 hours
No work restrictions

Who is a Candidate?

Any significantly overweight person
BMI > 28 with comorbidities

  • Diabetes
  • High blood pressure
  • High cholesterol or triglycerides
  • Obstructive sleep apnea
  • Family history of heart disease or stroke

BMI > 30 without comorbidities
People who don’t want surgery

Contraindications

General to anesthesia or surgery – e.g. bleeding disorders, cardiac risk of GETA
No procedure specific

Downside

Longevity is unknown – minimum of 24 months
Weight regain unknown

Diet after ESG

Low sugar clear liquids week 1
Soft low fat low sugar diet weeks 2-4
Low fat low sugar high protein diet after 1 month

Is it reversible?

The sutures inside the stomach DO NOT re-absorb. So, the procedure cannot be considered completely reversible
However, there are several patients reported who had a Laparoscopic Sleeve Gastrectomy after ESG without any problem (i.e. does not prevent further procedures)

Risks

Standard risk of general anesthesia
Bleeding < 1%
Leak < 1%
Obstruction
Injury to the esophagus
Failure to lose weight – Weight regain (unknown)

Exercise

Patients start an exercise program before ESG
Little to no interruption due to the procedure
Minimum of 150 minutes a week of some activity

  • Measure the exercise – steps/distance/time
  • Set goals
  • Exercise with someone else – family, co-worker

Procedure

General anesthesia in the operating room
1-3 hours
Sore throat for 48 hours after
Go home the same day

What to Expect

Eat less
Feel full faster
Weight loss – average 20% TBW (50% EBWL)
Control or eliminate other medical problems

Contact Us

Want to find out if you’re a candidate for weight loss with Dr. Marvin? Call us at (713) 993-7124 or complete the form below:

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