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Endoscopic Sleeve Gastroplasty (ESG)

Endoscopic sleeve gastroplasty (ESG) is a term used to describe a relatively new weight loss process developed at the Mayo Clinic in 2012, and now utilized in numerous medical centers around the world. This non-surgical treatment option is performed by a bariatric surgeon using endoscopic techniques, which means specialized surgical instruments are employed to reduce invasiveness. While considered minimally invasive, the ESG procedure is still a more recent technique and results are not as definitive when compared to more predictable and robustly researched bariatric options, such as gastric sleeve surgery.

With the many advances in weight loss surgery, there are more options than ever to help patients find the best possible solution to help them attain a healthier lifestyle. While Dr. Bagshahi does not recommend ESG or offer the treatment at his practice, he is committed to identifying the most ideal weight loss system or procedure for your unique needs. He would be happy to speak with you in a consultation about more effective bariatric procedures to achieve your goals.

What is an Endoscopic Sleeve Gastroplasty?

Simply put, an endoscopic sleeve gastroplasty is a minimally invasive treatment option designed to mirror the gastric sleeve procedure. During an ESG, an endoscopic suturing device is inserted through the mouth to staple part of the stomach into a narrow, “sleeve” shape. This reduces the size and volume of the stomach and restricts the amount of food that can be consumed, allowing patients to still feel full even after eating smaller portions. That said, the gastric sleeve procedure typically achieves much more weight loss than an ESG, not to mention more long-term results that are supported by decades of clinical studies.

How Does Endoscopic Sleeve Gastroplasty Work?

The endoscopic sleeve gastroplasty procedure forms a tubular-shaped stomach that is substantially narrower, while shortening the length of the stomach by about 50 percent. It is believed that the reduction in stomach volume achieved after ESG is approximately 75 percent. In addition, ESG slows down the ability to empty the stomach, which improves appetite suppression and allows patients to feel full for a longer period of time.

What Are The Qualifications For An Endoscopic Sleeve Gastroplasty?

An endoscopic sleeve gastroplasty is certainly not a substitute for gastric sleeve or gastric bypass surgery, and is by no means long-lasting. ESG may be appropriate for obese patients who need help losing weight, for patients who are unwilling to have invasive surgery, and for patients who cannot safely undergo surgery. To qualify for the endoscopic sleeve gastroplasty procedure, you must:

Furthermore, an endoscopic sleeve gastroplasty may be a possibility for you if:

An endoscopic sleeve gastroplasty is a relatively new procedure, so its long-term efficacy and risk profile is unknown. Published data regarding patient monitoring exists for up to 20 months, with an average weight loss of 54% achieved in 12 months and 45% achieved in 20 months.

How Is An Endoscopic Sleeve Gastroplasty Performed?

An endoscopic sleeve gastroplasty is performed in a hospital under general anesthesia. During the ESG procedure:

The physical procedure lasts about 90 minutes, and most patients return home the same day. Some patients may require a short stay in the hospital for a day or less for observation after the procedure. Although the stitches placed cannot be dissolved, sutures can be loosened or disappear after several years. This can occur due to vomiting or overeating. While this possibility is not typically dangerous, it can reduce the effectiveness of the procedure over a period of several years.

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What is Recovery From an Endoscopic Sleeve Gastroplasty Like?

After an endoscopic sleeve gastroplasty, patients are usually transferred to the recovery room. A brief observation period often takes place to help ensure there are no immediate complications from surgery. Most individuals take one to three days off from work to recover before returning to their normal routine. Strenuous activity is prohibited for at least one week after surgery. While patients should be able to resume light activities soon, a full recovery from an ESG can be expected in approximately four weeks. 

Immediately after the ESG procedure:

While the success rate of ESG is not yet defined, Dr. Bagshahi can discuss treatment options with you that have been proven to achieve results that are comparable or typically superior to an ESG. He can refine your treatment plan to account for your unique needs and preferences.

What Results Can I Expect From an Endoscopic Sleeve Gastroplasty?

Results from ESG vary and are based on the patient, type of surgery, and compliance with the monitoring program. As with any medical intervention or surgery, there are specific risks and possible complications; however, studies have shown promising results. A recent study of patients who had an average BMI of 38 and underwent ESG showed that the procedure resulted in an average weight loss of 39 pounds (17.8 kg) after 6 months. After 12 months, the weight loss experienced was 42 pounds (19 kilograms).

In another study of patients with an average BMI of 45, the procedure resulted in an average weight loss of about 73 pounds (33 kg) in the first six months.

As with other procedures and operations that result in significant weight loss, the endoscopic sleeve gastroplasty can improve conditions that are often associated with obesity, including:

Endoscopic sleeve gastroplasty is designed to be permanent, but stitches can be removed (returning the stomach back to full volume) if necessary. 

How Long Does Endoscopic Sleeve Gastroplasty Last?

An endoscopic sleeve gastroplasty is relatively new (developed in 2012), but data shows permanent weight loss for 3 years. Weight gain is expected when the stitches used to narrow the stomach become loose or broken—this can often be avoided by not overeating or vomiting. Studies show that when combined with a comprehensive dietary and lifestyle program, ESG can lead to an average of 20 to 25% total body weight loss (TBWL) over 18 months (i.e. a 100 kg person would lose 20 to 25kg). One study has shown that people with a BMI between 30 and 40 experience comparable weight loss to bariatric surgery after 18 months.

What Will Life Be Like After an Endoscopic Sleeve Gastroplasty?

Like most weight loss procedures, an endoscopic sleeve gastroplasty is most successful when paired with regular exercise and healthy habits. After the procedure, patients generally adhere to the following guidelines: 

Diet After Endoscopic Sleeve Gastroplasty


Helpful exercise tips after an ESG include measuring achievements (calculating steps/distance/time) and setting goals. It can also be beneficial to work out with another person, such as a friend, loved one, or colleague.

How Much Does an Endoscopic Sleeve Gastroplasty Cost?

An endoscopic sleeve gastroplasty usually costs between $7,000 and $9,000. Health insurance can very often cover part or all of your weight loss procedure, and our knowledgeable office team will help you verify insurance coverage. We encourage you to reach out to your insurance representative to learn the full scope of your benefits and determine out-of-pocket costs. For expenses that medical insurance cannot cover, Bagshahi Bariatric and General Surgery accepts third-party bariatric surgery financing from trusted lenders like CareCredit®, United Medical Credit®, and Prosper® Healthcare Lending. These companies can offer qualified patients flexible payment plans with little or no interest rates within a given promotional period. With many short- and long-term arrangements to choose from, most candidates are able to find an ideal payment plan for their needs. 

What Are The Risks Of An Endoscopic Sleeve Gastroplasty?

The risk of complications after ESG is surprisingly low. This procedure has no documented deaths with more than 2,000 cases carried out worldwide. However, there are risks of bleeding and infection that amount to less than one percent. Other side effects after the endoscopic sleeve gastroplasty procedure include abdominal pain, nausea, cramping, and vomiting. That said, our practice maintains a unique program to reduce the risk of these complications—especially nausea and vomiting. Should they occur, side effects last for two to three days and usually go away.

To date, complications have been managed by endoscopes, drugs, or minor treatments. No complication has yet to require an operation, but there is a very small risk of secondary surgery being necessary.

Questions? Dr. Hossein Bagshahi has extensive experience in minimally invasive surgery and would be happy to discuss your options during a consultation. Please contact our Fort Worth bariatric practice for more information.