Endoscopic Sleeve Gastroplasty (ESG) is a recently developed weight-loss procedure which shrinks the size of the stomach using an endoscopic suturing device without the need for surgery. ESG has been shown in early trials to lead to significant weight loss by limiting how much food can be eaten before you feel full. Because ESG is not surgery, but an endoscopic procedure, there is significantly reduced risks and more rapid recovery. Like other weight loss procedures however, ESG requires commitment to a change in life-style – healthier eating and some exercise.
ESG is not suitable for anyone who has gastrointestinal bleeding, a hiatus hernia larger than 3 or 4 cm, or who has had previous stomach surgery.
ESG is a new procedure, and you need to check with your health fund regarding coverage.
Early studies of ESG have shown a favorable safety profile. Some pain and nausea may occur for several days after the procedure, which can usually be well controlled with appropriate medications.
ESG is designed to be a permanent procedure, however it can to a large degree be reversed and converted to another type of anti-obesity procedure. However no long term information is yet available for ESG.
ESG is carried out in hospital under general anesthesia. An endoscope is passed through the mouth into the stomach. An attached suturing device allows placement of multiple internal stitches to alter the shape and capacity of the stomach. Usually about 12 sutures are placed, taking around 90 minutes. Most people go home the same day.
After the procedure, you remain nil orally for 8 hours. Then a liquid diet is started and continued for 3 weeks. After that there is gradual transition back to normal food. There is then regular follow up by the surgeon and multidisciplinary team. The amount of weight lost from ESG depends on both the shrinkage of the stomach capacity from the procedure (usually to about 20% of normal), as well as changing to a healthier lifestyle.
Early studies have shown promising results. A recent study of people undergoing ESG with a BMI averaging 38 showed average weight loss of 17.8kg at 6 months, and 19kg at 12 months. A second study of ESG in people with average BMI of 45 showed average 33kg weight loss at 6 months. It is expected that this degree of weight loss will lead to improvement in other diseases which may be present, such as diabetes, high blood pressure, sleep apnea and heart disease.
Endoscopy 2015; 47:164
Animation Of Overstitch Procedure