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Also known as “Non-surgical Sleeve” or “Endosleeve” or “Accordion procedure”, Endoscopic sleeve gastroplasty is a newer type of weight-loss procedure. Endoscopic sleeve gastroplasty reduces the size of your stomach using an endoscopic suturing device without the need for surgery. This procedure may be an option if you’re significantly overweight — a body mass index of 30 or more — and diet and exercise haven’t worked for you.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. And the procedure is minimally invasive, reducing the risk of operative complications.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires a commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

Endoscopic Sleeve Gastroplasty may be right for you!

Booklet: Do you qualify for endoscopic sleeve gastroplasty

Who is a candidate?

The endoscopic sleeve gastroplasty (ESG) is a great option for patients who are obese (BMI > 30) and therefore are not ideal candidates for, or do not desire, bariatric surgery. The procedure can help obese patients with (or help prevent) diabetes, high blood pressure, high cholesterol or triglycerides, obstructive sleep apnea, and heart disease or stroke. Endoscopic sleeve gastroplasty is often an option for people who aren’t candidates for other bariatric surgeries. The procedure is available to people whose body mass index (BMI) is above 30 who haven’t been successful maintaining weight loss with other methods.

But endoscopic sleeve gastroplasty isn’t for everyone who is overweight. A screening process helps doctors see if the procedure might be beneficial for you. And you must be willing to commit to healthy lifestyle changes, regular medical follow-up and participate in behavioral therapy.

Endoscopic sleeve gastroplasty isn’t appropriate for anyone who has gastrointestinal bleeding, a hiatal hernia larger than 3 centimeters or who’s had prior stomach surgery.

What is ESG?

The ESG is a weight loss procedure that uses an endoscopic suturing device to reduce the size of the stomach by 70-80%. With reduced stomach size, patients will feel full sooner and the stomach will not be able to secrete as many hunger inducing hormones. The highlight of this procedure is that it is NON-SURGICAL. This equates to no incisions, no scars, and little or no pain after the procedure which usually lasts under two hours. In essence, the ESG is an even less invasive version of the minimally-invasive laparoscopic sleeve gastrectomy (LSG).

How is ESG done?

Endoscopic sleeve gastroplasty is done in the surgery center as an outpatient procedure. General anesthesia is used for the procedure, so you’ll be unconscious.

The procedure is done using an endoscope, a flexible tube with a camera and an endoscopic suturing device attached. The endoscope is inserted down your throat into the stomach. The tiny camera allows the doctor operating the endoscope to see and operate inside your stomach without making incisions in your abdomen.

Booklet: How Endoscopic Sleeve Gastroplasty Works
Booklet: Health Benefits Of Endoscopic Sleeve Gastroplasty

Using the endoscope, the doctor places approximately 12 sutures in the stomach. The sutures change the structure of your stomach, leaving it shaped like a tube. This restricts the amount of calories your body absorbs.

The procedure takes about 90 minutes. After the endoscopic sleeve gastroplasty, you’ll awaken in a recovery room, where medical staff monitors you for any complications.

The majority of people leave go home the same day after recovering from sedation. Some people might require a short admission to the hospital for one day or less for observation after the procedure.

How much does the procedure cost?

Visit Our Pricing Page. The cost not only includes the price of the product, but more importantly, the skill and expertise of the specialist or healthcare professional that is doing the procedure. Look for someone who is licensed and trained and has experience treating patients using this procedure. Given that endoscopic sleeve gastroplasty is a new procedure, it might not be covered by your health insurance.

When will I start seeing results?

Within the first month after the ESG procedure is where the most drastic weight loss occurs. This is most likely due to being on a no solid foods diet. The weight loss range is usually between 11-24 lbs for the first month. After one year of following a healthy diet, some patients have managed to lose an incredible 73 lbs.

How long will the results last?

Due to the ESG procedure being so new, there has not been enough time to gather data on its longevity. However, it is safe to say that it will last a minimum of 24 months.

Booklet: Weight Loss Through Endoscopic Sleeve Gastroplasty Surgery

What Are Experts Saying About ESG?

Booklet: Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index And Metabolic Complicationsin Obese Patients

Are there any risks associated with ESG?

Overall the ESG is a very safe procedure. The only risks involved include being under general anesthesia, bleeding ( < 1%), leakage ( < 1%), obstruction, and injury to the esophagus. However, these are very rare. The only discomfort you may have after the procedure is a sore throat and that is due to having the endoscope placed inside of your esophagus throughout the procedure. Because the procedure is still new and not in wide use, questions remain about its long-term effectiveness and risks.

How do I prepare?

If you qualify for endoscopic sleeve gastroplasty, your health care team will give you specific instructions on how to prepare for your procedure. You may need to have various lab tests and exams before surgery. You may have restrictions on eating, drinking and which medications you can take. You also may be required to start a physical activity program.

It’s helpful to plan ahead for your recovery after the procedure. For instance, arrange for help at home if you think you’ll need it. Recovery from endoscopic sleeve gastroplasty generally only takes a day or two.

What to expect after ESG?

After the procedure, you generally won’t be allowed to eat for about eight hours. Then, you’ll be allowed to start a liquid diet, which you need to continue for at least two weeks. Over four weeks, you’ll move on to semi-solid foods, and then to a regular healthy diet..

You’ll also have medical checkups and meet with a nutritionist and psychologist frequently after your procedure.


Endoscopic sleeve gastroplasty can lead to significant weight loss. The amount of weight you lose also depends on how much you can change your lifestyle habits.

But studies have shown promising results. A recent study of people with an average BMI around 38 found that endoscopic sleeve gastroplasty led to an average weight loss of 39 pounds (17.8 kilograms) after 6 months. After 12 months, weight loss was 42 pounds (19 kilograms).

In a study of people with an average BMI of about 45, the procedure resulted in an average weight loss of about 73 pounds (33 kilograms) during the first six months.

As with other procedures and surgeries that lead to significant weight loss, endoscopic sleeve gastroplasty may improve conditions often related to being overweight, including:

  • Gastroesophageal reflux disease
  • Heart disease or stroke
  • High blood pressure
  • Severe sleep apnea
  • Type 2 diabetes

Diet after ESG?

Booklet: Diet After The Endoscopic Sleeve Gastroplasty (ESG)

When weight-loss surgery doesn’t work

It’s possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don’t follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.

Need more information? Call us today and ask about ESG.

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