Endoscopic Sleeve Gastroplasty*

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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.*

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Dr. Marvin with Dr. Shariaha, a pioneer in the ESG procedure, at New York Presbyterian Hospital. Dr. Marvin visited Dr. Shariaha in March 2016 to learn about the procedure.

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.

Dr. Marvin and the ESG Procedure

Dr. Marvin is an Endoscopic Sleeve Gastroplasty consultant for Apollo Endosurgery, Inc. He leads learning sessions on the ESG Procedure with fellow surgeons, both locally and traveling from out-of-state. To date, patients have traveled from 19 states to Houston to receive the Endoscopic Sleeve Gastroplasty procedure from Dr. Marvin.

Can the ESG Procedure be used for bariatric revision surgery?

Yes. The Endoscopic Sleeve Gastroplasty is also being used in weight loss surgery revisions, including the Laparoscopic Sleeve Gastrectomy. To find out if you’re a candidate for an ESG revision, contact us to schedule a consultation with Dr. Marvin, or click here to view Dr. Marvin discussing the ESG revision procedure with a patient who received Lap Band surgery in 2007 to learn more.

ESG Testimonials

nancy burman testimonial

Nancy Berman

Enjoying the outdoors with friends became that much easier for Nancy after a visit with Dr. Marvin.

deedee helmers testimonial

DeeDee Helmers

After consulting with Dr. Marvin, DeeDee has reinvigorated her life and her relationships.

ESG Video Library*

Dr. Marvin discusses technical aspects of ESG*

Dr. Marvin Interviews a Recent Recipient of ESG Surgery*

Before and After ESG*

Patient Interview: Lap Band Recipient Undergoes ESG Revision*

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Learn more about Endoscopic Sleeve Gastroplasty.

Sharalha research

Learn more about Endoscopic Sleeve Gastroplasty research.

Endoscopic Sleeve Gastroplasty (ESG)

Fact Sheet

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

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

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

Longevity is unknown – minimum of 24 months
Weight regain unknown

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

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)

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

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

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

Eat less*
Feel full faster*
Weight loss*

* Results will vary by person and are based upon the patient, the surgery type and the compliance with the aftercare program. As with any medical procedure or surgery, there are specific risks and possible complications. The testimonials, statements, and opinions presented on our website are applicable to the individuals depicted. Results may not be representative of the experience of others. Testimonials are voluntarily provided and are not paid, nor were they provided with free products, services, or any benefits in exchange for said statements. The testimonials are representative of patient experience but the exact number of pounds lost and experience will be unique and individual to each patient.

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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HSS Endoscopic Gastroplasty Disclaimer

1. Dr. Marvin does NOT guarantee specific weight loss for any weight loss procedure to any specific patient. Too many factors are involved to make accurate predictions. Weight loss estimates are based on data reported in the medical literature and/or Dr. Marvin’s practice experience.

2. Dr. Marvin can make NO guarantee of the longevity for endoscopic gastroplasty. Long term data is not available for this procedure. It is possible that the weight loss effect may decrease or be lost over time.

3. There may be a failure rate associated with Endoscopic Gastroplasty. Failure is defined as loss of the weight loss effect within the first 90 days after the procedure. Data from a large international center suggest the failure rate for this procedure may be 5-7%.

Make an appointment with Dr. Marvin for diagnosis and treatment.