2025-03-01 · non-surgical, endoscopic, procedures
Endoscopic Sleeve Gastroplasty
Overview
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight loss procedure performed through the mouth without external incisions. Using an endoscope and suturing device, a physician reduces the size of the stomach by creating internal folds. This smaller stomach limits food intake and slows gastric emptying, helping people feel full sooner. ESG is considered a middle ground between lifestyle programs and bariatric surgery.
How the procedure is performed
The procedure is done under anesthesia and typically takes one to two hours. The physician places sutures inside the stomach to create a sleeve-like shape, reducing the stomach’s volume by about 70%. Because there are no external incisions, recovery is often faster than surgical options. Most patients go home the same day or after an overnight observation.
Benefits and outcomes
Patients often lose 15–20% of their total body weight within one year when ESG is combined with lifestyle changes. Improvements in blood pressure, blood sugar, and cholesterol have been reported. ESG is also appealing to people who want a less invasive option or who do not meet criteria for bariatric surgery. However, it still requires a commitment to long-term dietary changes.
Risks and limitations
ESG carries lower risk than surgery but still has potential complications, including bleeding, infection, or stomach injury. Nausea and abdominal pain are common in the first week. Because the procedure is newer than traditional surgery, long-term data are still evolving. Some people may need additional procedures if weight loss is insufficient.
Recovery and aftercare
Recovery typically includes a staged diet similar to bariatric surgery: liquids first, then pureed foods, soft foods, and finally small solid meals. Patients usually return to work within a few days to a week. Ongoing support from dietitians and behavioral counselors is recommended to optimize results.
Frequently asked questions
How is ESG different from sleeve gastrectomy? ESG uses internal sutures to shrink the stomach without removing tissue, while sleeve gastrectomy surgically removes part of the stomach. ESG is less invasive but may produce less weight loss.
Who is a good candidate for ESG? ESG is often considered for people with a BMI between 30 and 40 who want a minimally invasive option. Eligibility depends on medical history and goals.
How much weight can I expect to lose? Many people lose 15–20% of their total body weight in the first year when they follow a structured nutrition and activity plan.
Is ESG reversible? The sutures can be removed or revised in some cases, but ESG is generally intended to be a long-term intervention. Discuss reversibility with your provider.
What are the most common side effects? Nausea, cramping, and fatigue are common during the first week. Symptoms usually improve as the stomach heals and diet progresses.
Will I need vitamins after ESG? Because the intestines are not bypassed, nutrient absorption is largely unchanged. Still, many programs recommend a daily multivitamin due to reduced intake.
How long does the procedure take? ESG typically takes one to two hours, and most patients go home the same day. An overnight stay may be recommended in some cases.
Can I exercise after ESG? Light activity is encouraged soon after the procedure. More vigorous exercise usually resumes after two to four weeks, depending on your provider’s guidance.
Is ESG covered by insurance? Coverage varies and is less common than for bariatric surgery. Some patients pay out of pocket or use financing options.
What if I regain weight? Weight regain can occur if old habits return. Ongoing support, follow-up visits, and lifestyle adjustments can help maintain results.
Planning your next steps
Start by clarifying your goals beyond the scale. Think about improvements you want in energy, mobility, labs, or symptoms, and share those priorities with your care team. Review your medical history, current medications, and prior weight loss attempts so you can discuss how this approach fits into your overall health plan. A clear baseline helps you and your clinician measure progress objectively.
Build support systems that make the plan realistic. That might include meal planning, activity routines, sleep habits, stress management, and accountability check-ins. Tracking simple metrics such as hunger, energy, and adherence can reveal whether the approach is sustainable. Focus on small, consistent actions instead of perfection so the changes are easier to maintain.
Consider access, cost, and follow-up requirements. Ask about insurance coverage, out-of-pocket expenses, supplies, and the timeline for reassessment. Understanding how often you will be monitored and what adjustments are possible can reduce surprises later. A good plan includes checkpoints to evaluate safety, effectiveness, and quality of life.
Extra questions to consider
How do I know if this option fits my lifestyle? Look at your daily schedule, food preferences, travel routines, and stress levels. The best approach is one you can follow most days without constant friction. If an option feels overly restrictive or hard to sustain, discuss alternatives with your care team.
What should I track to know it is working? Track weight trends, measurements, and how you feel in daily life. Some people also monitor lab values, appetite, sleep quality, or exercise capacity. Choosing a few meaningful metrics helps you see progress even when the scale moves slowly.