Endoscopic Sleeve Gastroplasty (ESG)

ESG is the latest weight loss technique that uses endoscopic suturing to shrink the stomach, and without surgery, results in no external scarring, minimal complications and a faster recovery. While it does not replace surgical sleeve gastrectomy, ESG nevertheless is a safe and effective option for weight loss.

Benefits of ESG
Besides the weight loss benefit, ESG also improves features of metabolic syndrome such as high blood pressure, sleep apnea or obesity, hypoventilation syndrome, diabetes, and lipid abnormalities. Given that ESG is a relatively new technique for weight management, researchers are still collecting additional long-term outcomes after ESG. It is expected that ESG will provide favorable outcomes for heart disease, osteoarthritis, chronic kidney disease, certain types of cancer, and stroke. 
Similar to other medical and surgical modalities, ESG is not effective without lifestyle changes, especially diet. Regular follow-up appointments are also necessary. Doctors will screen each patient carefully, but in general, the following attributes describe good candidates:
  • Age over 18,
  • A body mass index of 30-40
  • No history of eating disorders such as bulimia
  • No active and uncontrolled gastrointestinal bleeding or reflux
  • No other bleeding risks, such as hemophilia or the requirement to be on blood thinners other than aspirin uninterruptedly
  • For prior Roux-en-Y gastric bypass patients who have regained weight, we instead offer an endoscopic procedure called endoscopic transoral gastric outlet reduction
Patients will first undergo thorough medical screening (including blood work, an endoscopy, thyroid, cardio and respiratory function) as well as meet with the anesthesiologist, cardiologist and pulmonologist to assess the risk of complications during surgery. Then, for 8-12 hours before the procedure, the patient must refrain from eating and drinking.
An endoscopic camera is inserted through the mouth and into the patient’s gastrointestinal tract while under anesthesia. Similar to surgical/laparoscopic sleeve gastrectomy, the goal is to reduce stomach size, with the position of sutures marked before commencing. The beak-like suture device is then attached to the camera and inserted, sewing the front and back of the stomach together in a U-shape until it is smaller than the size of a banana. The procedure lasts approximately 90 minutes in total.
Patients will be put on a liquid diet for six weeks in order to allow the stomach to heal. In addition, acid reduction medications will help the healing process and prevent ulcers. Patients must follow up with their doctors and a nutritionist.

Why choose ESG?

Since this is an endoscopic procedure: 
  • There is no external scarring
  • There is less pain and risk of infection
  • Recovery takes one to three days, with an overnight stay in hospital
Although ESG is a safe procedure, side effects may include:
  • Nausea and vomiting which will go away in a few days (the doctor will give you anti-nausea medication both before and after the procedure)
  • Acid reflux, although it is much less common compared to that of surgical sleeve gastrectomy
  • Procedure-related complications (1-2% chance)
ESG can result in weight loss of up to 15% within one to two years, lasting at least five years, if the patient follows the guidance of doctors and the nutritionist.

The risk of diseases associated with obesity is also reduced, with less visceral fat, reduced blood sugar and triglycerides, lower blood pressure and better liver function. However, bad cholesterol or LDLs may not be much affected. 

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