Endoscopic Sleeve Gastroplasty (ESG)
Frequently Asked Questions

What is Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic Sleeve Gastroplasty or ESG is a non-surgical technique that does not use incisions but reduces the size of the stomach by approximately 70% through the use of sutures.

The entire procedure is done through an endoscope that is lowered down the patient’s throat. An endoscope is a flexible hollow tube that has a camera mounted at the end. The surgeon can see exactly what they are doing in real-time as the image is projected onto a video monitor.

During ESG a special medical device (OverStitch suturing tool) is lowered down through the endoscope and used to reshape the stomach into a small pouch and secure it. ESG produces similar results to that of a surgical sleeve gastrectomy

How is ESG different than a Surgical Sleeve Gastrectomy/Vertical Sleeve (VSG)?

The main difference is that ESG is non-surgical and no incisions are used. The whole procedure is performed endoscopically through the mouth.

ESG reduces the size of the stomach like a Surgical Sleeve Gastrectomy (VSG) but unlike a surgical sleeve, no portion of the stomach is removed.

Endoscopy procedures offer faster healing and recovery, lower complication risks, and allow patients to return to normal life quicker. The procedure does not require a hospital stay and patients can go home the same day.

Am I a candidate for ESG?

Individuals who are obese, have a BMI of over 30 and have not been able to lose weight through diet and exercise are candidates for ESG.

Sometimes ESG is used to help a patient lose an initial amount of weight because they are in poor health and surgery is not presently an option for them.

Who is not a candidate for ESG?

Individuals who have known stomach problems such as ulcers, a very large hernia, bleeding disorders, or other major health problems may not be good candidates for ESG.

How long does an Endoscopic Sleeve Gastroplasty take?

The procedure normally takes under 45 minutes and then the patient is observed in a recovery room setting for a few hours before being discharged home.

When can I go back to work after ESG?

Most patients take off at least 3 days after having ESG to rest and become acclimated to their new stomach size. If the patient has a physically demanding job the surgeon will monitor their recovery and advise them when to return to work.

How much weight can I lose with ESG?

Patient weight loss results will vary based on their starting weight, motivation, commitment level, and adherence to their dietary plan.

Results can be anywhere between 25% of excess body weight and 70% of excess weight loss during a 6-18 month period.

Is ESG permanent?

Once the stomach heals after an ESG procedure, it will remain in that smaller re-shaped. Patients who adhere to their lifestyle changes and are committed to maintaining a healthy lifestyle, including diet and exercise, should sustain their weight loss.

Portion control is key in controlling future weight gain as overeating will stretch out the smaller stomach and allow patients to eat more. Continued over-eating will result in weight gain and may cause ESG sleeve failure.

Can the ESG sutures come loose?

Very rarely do ESG sutures fail but it has been reported, less than 1%. If needed additional sutures can be added to repair any issues.

How many stitches are used in the stomach during ESG?

Normally, the surgeon uses anywhere between 5 and 12 sutures along the curve of the stomach to hold the new shape in place. The final number of sutures placed will vary depending on the shape and size of the patient’s stomach.

Do the stitches used during ESG dissolve?

The sutures used during the ESG procedure are made from strong, durable Prolene and do not dissolve so are considered permanent unless removed by a surgeon.

What happens to the stitches as my stomach heals?

These sutures will continue to hold your stomach in the new “sleeve-like” shape until it fully heals and then they will remain where they are. The stomach will stiffen and should remain in that smaller shape for the long term if the patient continues to follow dietary protocol. The stitches themselves do not pose any long-term risk.

Can the stitches be seen on X-rays or MRIs?

Each stitch does have a tiny metal cap on the end that are visible by x-ray but they are tiny. has a tiny, metallic anchor at its end. These are visible by x-ray but tiny and are not a problem. They will not be affected during an MRI and do not worry, you will not set off any metal detectors!

What are the most common side effects after ESG?

The side effects are short-term, and usually mild and treatable by over-the-counter pain relievers and medication used for anti-nausea.

Patients also may experience fatigue for about two weeks as a result of the lower intake of calories.

Is there a risk of serious side effects with ESG?

Risks that are related to the EGS procedure are far lower than those associated with a surgical weight loss procedure but there are always risks when any procedure is performed. The risks associated with ESG are 0.5-1% and include infection, bleeding, or stomach injury.

What will it feel like after ESG?

All patients will feel what we refer to as “restriction” or a feeling of being full. Think about when you have overeaten and how you can feel somewhere between mildly uncomfortable to miserable. It is similar to that and will vary for each patient.

The restriction that is felt directly after the procedure will ease off a bit as the stomach heals and adjusts to its new size. Usually, patients have to ease back into eating solid foods.

Patients begin with liquids (very small amounts) at first, then move on to soft foods, and work their way back up to solids. It is important to eat slowly to give your body time to register that you are full. A recommended diet will be provided to you to ensure you consume a balanced diet.

What happens to the part of the stomach that is stitched up during ESG?

The part of the stomach that is sutured during ESG is known as “the greater curve” and the procedure makes this area thicker. The blood supply to that area of the stomach is not altered and there are no known long-term risks associated with suturing the stomach in this way.

Does ESG reduce the level of Ghrelin Hormone released?

Ghrelin is a natural hormone that is produced by the stomach and released into the body creating those annoying hunger pangs.

Gastric sleeve surgery removes a large portion of the stomach, which reduces the production of ghrelin initially, but studies show it returns to normal levels after several months.

ESG does not physically remove any of the stomachs but because the stomach is made much smaller, it will take significantly less food to “turn off” the release of ghrelin into the system.

Can I exercise or lift weights after having ESG?

While there are no “formal” exercises or lifting restrictions immediately after having the ESG procedure, it is recommended that you wait until you are able to consistently consume enough protein and fluids to support any form of strenuous exercise.

It is recommended that after having ESG you start with light walking which will help hasten recovery and work up to more demanding exercising. Typically most ESG patients take 3 to 4 weeks to acclimate to their new stomach size and have enough energy to be able to engage in an intense exercise program.

Is it safe to get pregnant after ESG?

Yes! It is safe to get pregnant after having ESG. In fact, losing weight may improve the patient’s fertility due to the metabolic changes that occur with weight loss.

During your initial consultation before your ESG procedure, you should make your doctor aware that you wish to become pregnant in the future so they can monitor and make recommendations based on your particular case.

In general, it is advised that patients allow their bodies time to heal and adjust to the smaller stomach size before becoming pregnant. Normally this is between 12 and 18 months but could vary by patient.

What can I do if I am unable to lose the amount of weight that I need to or if ny weight loss plateaus after having ESG?

You are not going to be left on your own to navigate through your weight loss journey. IBI Healthcare will be monitoring your progress and supporting you every step of the way responding or making changes to help you be successful.

During the first 12 months after ESG, it is common to have slower periods of weight loss even if adhering closely to the diet and exercise program.

The doctor may recommend nutritional changes or a weight loss medication to help in certain cases but some adjustments can be made to help keep your weight loss on track.

Can you have ESG more than once?

Yes, ESG can be done more than one time. It can be repeated to repair or tighten an existing ESG procedure.

If ESG does not work for me, can I have Bariatric Surgery?

Yes, the ESG procedure can be converted safely to Bariatric Surgery in most instances.