What Is ESG Surgery And More FAQ’s

What Is ESG Surgery And More FAQ’s

Endoscopic sleeve gastroplasty (ESG) is a procedure that is done to help an individual with a BMI of 30 or more lose weight. This procedure is also called “the accordion procedure” because the stomach is stapled together in folds to make it smaller. ESG basically accomplishes what a surgical sleeve gastrectomy does only without making any incisions. The stomach is made smaller which helps patients with portion control and causes them to feel full without eating too much.

Is ESG Considered a Surgical Procedure?

Endoscopic sleeve gastroplasty is considered a non-surgical procedure as it does not require any incisions. The patient needs to be asleep during the procedure and requires the use of general anesthesia. People are often confused and think when general anesthesia is used that it signals a surgical procedure but this is not the case. 

Can I Have ESG If My BMI Is Over 40?

Each patient is evaluated on a case-by-case basis however individuals that do not qualify for bariatric surgery are often good candidates for ESG. Individuals with a BMI over 30 are normally qualified to have endoscopic sleeve gastroplasty. 

What Makes ESG Work So Well?

Endoscopic sleeve gastroplasty makes the stomach smaller so it controls the amount someone can eat during one sitting. The re-shaped stomach also takes a bit longer to digest the contents so the feeling of “being full’ lasts longer. The quick recovery time from the procedure makes it possible for patients to resume their normal routine in a few days and incorporate exercise/physical activity after just one month.

How Much Weight Can I Lose With ESG?

Patients normally lose about 10% of their total body weight in the first three months and this motivates the patients to continue making healthy choices. Then over the next 9 months, most patients lose another 10-13%, so approximately 20-23% of their total body weight in a 12 month period. This means that an individual who was 250 pounds before ESG would most likely be around 192 by the end of the first year.  These are typical results so it is possible for a patient to lose even more or slightly less depending on their dedication to diet and exercise.  

What Can I Expect During Recovery From ESG?

For most patients, the recovery process from an ESG procedure typically lasts about 5 days. Most patients typically experience either no side effects or mild side effects that last about 3 days. 

What Are The Side Effects Of ESG Right After The Procedure?

Some of the side effects may be due to the use of general anesthesia during the ESG procedure and can include nausea and vomiting. These normally subside within a day or two. Other side effects may include some mild cramping, heartburn, reflux (including burping), and lethargy. Your doctor may prescribe medication for you to take to alleviate cramping and reflux which in turn can contribute to the feeling of lethargy so resting as much as you can is recommended.   

Can ESG Be Reversed?

Endoscopic sleeve gastroplasty is considered a permanent revision to the stomach. The sutures used during the procedure are made from polypropylene and do not dissolve.  

Can The Sutures Come Loose In My Stomach After ESG?

Historically, a very low percentage of patients have had issues with sutures failing after the ESG procedure. In some cases, by the 12-month point, one of the stitches had come loose but it did not affect the functionality or cause weight gain. It is important to understand that consistently overeating may put too much strain on the stitches and cause them to fail. 


Normally, after some time,  scar tissue will form and replace the need for the stitches however, In the rare event that some stitches do fail,  it does not completely reverse the ESG procedure. 

How Long Will I Have To Take Off Of Work To Recover From ESG?

After ESG, It is recommended that you plan for at least 3-5 days of inactivity to help your body recover. Depending on your job and the amount of physical activity it requires, you may wish to take between 3 days to a week off after your procedure. 

What Happens To The Part Of My Stomach That Is Stitched Up During An Endoscopic Sleeve Gastroplasty?

The bigger part of the stomach curve near the base is stitched together, making the stomach thicker in that area but it does not alter the blood supply at all.  When the stomach heals, it looks no different from the inside except it is smaller. To date, there have been no long-term risks associated with suturing the stomach in this way.

Will I Be On A Restricted Diet After My ESG Procedure?

After the ESG procedure patients are required to maintain a liquid diet for about 3 weeks. This is necessary to allow the stitches to heal and mature but, luckily the procedure shrinks the size of the stomach so most patients do not even feel hungry. After the initial 3 weeks, the diet progresses to pureed foods and then to soft foods with other foods being introduced gradually. Most patients are able to return to a normal diet by the fifth week however they will need to continue to restrict their portions. 

How Do I Make Sure I Do Not Eat Too Much After ESG?

As your diet returns to solids it is important to remember not to overeat or drink too much.  It will cause you to have unpleasant symptoms such as cramping or the emergence of reflux and heartburn.  Some good guidelines for ensuring success are: 

  • Eat small single portions using a small plate like a bread plate.
  • Use a small glass instead of a very large glass or tumbler to drink from. 
  • Serve your portion of food on your small plate and put the leftovers away before you sit down to eat.
  • If  you begin to feel full during your meal, stop eating, it is okay to leave some food on your plate.
  • Eat slowly. Your meal should take at least 20 minutes for you to finish.
  • Chew your food thoroughly and sip your liquid. Do not drink too quickly.
  •  If you have eaten your portion and you still feel hungry, wait at least 30 minutes. The connection between the brain and the stomach is delayed so eating more food before that connection happens increases the chances of eating too much and experiencing uncomfortable symptoms.

Will ESG Affect The Medications I Take?

After the ESG procedure, medications in pill form may take longer to act but it is not expected that the effectiveness of the medication will be affected by the ESG results. Anti-inflammatory medication such as Advil or Ibuprofen may irritate the stomach more than before the procedure. As your weight loss progresses you may find that some of your medication can be adjusted or is no longer needed because often losing weight can alleviate symptoms that were caused or aggravated by the extra weight you were carrying. Your doctors will be monitoring and adjusting any medications that you currently take if necessary. 

Am I On My Own After ESG Or Will I Get Help To Stay On Track?

It is important that you, as the patient, are committed to making lifestyle changes in accordance with doctor recommendations so you can achieve maximum weight loss results and improve your health. But, you will not be doing this alone, you will have access to as much support as you need. You will have peers who are also on the same journey experiencing similar issues, you will be meeting with a nutritionist, your doctor as well as a psychologist on an ongoing basis. You will have an entire team supporting you on your weight loss journey.

Can I Get Pregnant After ESG?

If you plan to become pregnant in the future, you should discuss this with your doctor at your initial consultation. It is advised that you do not become pregnant until at least 18 months after you have had the procedure to allow time for your body to adjust. There has not been enough data gathered on the result of pregnancy and Endoscopic sleeve gastroplasty so this represents an unknown risk.

If you are struggling with being overweight or suffering from health issues due to obesity and are ready to make a commitment to yourself and your health, call IBI today or schedule an appointment online at one of our three Atlanta locations or via telehealth. We are ready to commit to helping you reach your health and weight loss goals.

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