Endoscopic Sleeve Gastroplasty (ESG)


Endoscopic Sleeve Gastroplasty (ESG) is a term used to describe the new weight loss process developed at the Mayo Clinic in 2012, now used in numerous centers around the world. The procedure is non-surgical and performed by a specialized doctor using endoscopic techniques in an accredited hospital under general anesthesia.

Who is Qualified?

Endoscopic Sleeve Gastroplasty can be a possibility for you if:

  • you fail to meet all the requirements for traditional bariatric surgery, such as Roux-en-Y gastric bypass or vertical spleeve gastrectomy
  • You like a non-surgical alternative to weight loss
  • Have a body mass index of between 30 and 35

Is the Endoscopic Sleeve Gastroplasty right for me?

Endoscopic Sleeve Gastroplasty are a relatively new procedure, so long-term efficacy or risk profile is unknown. Published data exist for monitoring up to 20 months, with an average loss of 54% in 12 months and 45% for 20 months.

Although the sutures set are not rigid, the sutures can be loosened and there is a possibility for the ESG procedure to be repeated. The procedure is also reversible and can be converted into a bariatric surgery procedure.

The Endoscopic Sleeve Gastroplasty is certainly not a substitute for gastrectomy or gastric bypass, and is by no means long lasting. Its exact location is uncertain, but it may be appropriate for obese patients who need help to lose weight, patients who are unwilling to have invasive surgery, and patients who are not safe for surgery.

What to expect:

Endoscopic Sleeve Gastroplasty (ESG) is performed in a hospital under general anesthesia. Before proceeding, you will need to follow special instructions for preparation, which you will discuss in advance with your doctor.

During the ESG:

  • The procedure is performed using an endoscope, a flexible tube with a camera and an endoscopic sewing device, and this will be inserted down the throat to the abdomen.
  • A tiny camera allows the doctor handling the endoscope to see and operate inside your stomach without leaving a belly cut in your abdomen.
  • With the endoscope, the doctor puts about 12 sutures in the stomach. The sutures alter the abdominal structure, leaving it in the form of a tube. This limits the amount of calories your body absorbs and the amount of food you can eat.

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.

After ESG:

  • You must not eat for eight hours.
  • After the first eight hours, you will be able to start taking a liquid diet, which will continue for a week.
  • About two weeks after the procedure, you will switch to semi-solid food, then to normal and healthy nutrition.

To use the Endoscopic Sleeve Gastroplasty procedure, you must:

  • be 18 years old or older
  • Have a body mass index (BMI) of 30 or more
  • Be prepared to participate in a medically controlled weight loss program

How is Endoscopic Sleeve Gastroplasty done?

After sleeping, the expert inserts a camera (i.e. an Endoscope) through the mouth and into the stomach through a protective tube which protects the oesophagus from injury. After checking to ensure it is safe to continue, a series of stitches are made in the stomach to create a tube or banana shape that dramatically reduces the stomach capacity. The procedure lasts for about 50 minutes and the patient can be released from the hospital the same day of the operation.

Although the stitches cannot be dissolved, stitches can be loosened or disappeared after several years, which can occur by vomiting or overeating. While this is not at all dangerous, it can reduce the effectiveness of the procedure over a period of several years.

How does Endoscopic Sleeve Gastroplasty work?

The Endoscopic Sleeve Gastroplasty procedure not just forms a tubular-shaped stomach that is substantially narrower, yet in addition shortens the length of the stomach by about 50%. It is believed that the reduction in stomach volume after ESG is about 75%. In addition, ESG slows down the ability of emptying the stomach, which additionally improves appetite suppression and allows the patient to feel full for a longer period of time.

How effective and how long does Endoscopic Sleeve Gastroplasty last?

Studies show that the Endoscopic Sleeve Gastroplasty procedure, when combined with a comprehensive dietary and lifestyle program, leads to an average of 20-25% TBWL over 18 months (Total Body Weight Loss; i.e. a 100 kg person would lose 20-25kg on average).  One study has shown that for people with BMI between 30 and 40, this procedure behaves as well as a surgical procedure in terms of weight loss for 18 months.

The Endoscopic Sleeve Gastroplasty is planned to be permanent, but stitches can be removed (returning the stomach back to full volume) if your specialist chooses it will be required later on.

Endoscopic Sleeve Gastroplasty is relatively new, developed in 2012, but the data show permanent weight loss for 3 years. Body weight gain is expected when the stitches become loose or broken, but this can be avoided by avoiding overeating and vomiting.

What are the side effects and risks?

Side effects after the Endoscopic Sleeve Gastroplasty procedure can include abdominal pain, nausea, cramping and vomiting, but BMI maintains a unique program to reduce the risk of these side effects, especially nausea and vomiting. These side effects last for 2-3 days and usually go away.

The risks of complications are surprisingly low. This procedure has not documented deaths with more than 2000 cases that have been carried out worldwide. There are risks of bleeding and infection, but the overall risk is less than 1%.

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 this being necessary.

Diet after Endoscopic Sleeve Gastroplasty

  • During the first week, take Low sugar clear liquids
  • Second to fourth weeks, you take soft low fat low sugar diet
  • Low fat low sugar high protein diet is required after 1 month


  • Patients start an exercise program before the ESG
  • Little or no interruption due to the procedure
  • At least 150 minutes per week of activity
  • Measure exercise – steps / distance / time
  • Set goals
  • Work with someone else – family, colleague


The results vary by individual 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.

But studies have shown promising results. A recent study of people with an average BMI of about 38 showed that endoscopic sleeve gastroplasty resulted in an average weight loss of 17.8 kg (39 lb) 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 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:

  • Gastroesophageal reflux disease
  • Heart disease or stroke
  • hypertension
  • Severe sleep apnea
  • Type 2 diabetes


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