Endoscopic Sleeve Gastroplasty Diagram (ESG)

Endoscopic Sleeve Gastroplasty (ESG) is an incisionless weight loss procedure designed to reduce stomach volume endoscopically. An endo surgeon performs this procedure through the mouth with a suturing probe in individuals with weight problems.

Patients who are unsuccessful in getting in shape with diet and exercise can drop 15-20% of their total body weight with the endoscopic sleeve gastroplasty. Health benefits can include relief of diabetes, hypertension, sleep apnea, joint relief, and self-confidence.

The ESG therapy has less risk of operative complications with faster recovery compared to the traditional gastric sleeve. However, it does not yield the same amount of weight loss and is less effective in resolving comorbidities. Patients need to establish healthy eating habits, stay active and do regular exercise for long-term success.

Endo-bariatric procedures for obesity

For decades there hasn’t been a stepping stone between standard weight loss plans like diet, exercise, or medication and invasive surgical procedures like sleeve gastrectomy, lap band, or gastric bypass. Endobaraitric therapies, like the intragastric balloon and endoscopic sleeve gastroplasty, are a new paradigm that is quickly filling the gap. These new procedures offer highly-effective alternatives to laparoscopic surgeries with more expected fat loss than normal diet and exercise programs.

Colorful Professional Timeline Step By Step Graph

What is the ESG?

Endoscopic sleeve gastroplasty (ESG), also called the accordion procedure, is part of an emerging and advanced field in gastroenterology designed to emulate gastric sleeve surgery in a less invasive fashion. ESG is a non-surgical option that produces gastric restriction by decreasing the size of the stomach internally. A smaller stomach is formed by an endoscopic suturing probe called the Overstitch. The overstitch device folds the stomach with a triangular stitching pattern to create a banana-shaped tube. The stitching and folding technique is similar to gastric plication surgery.

The reduced gastric volume gives patients a sense of fullness and helps them practice portion control and lower calorie intake by eating less at each meal. However, ESG lacks the hormonal shift component offered by the classical sleeve gastrectomy that causes immediate hunger and satiety relief.

Endo-sleeve is a maturing treatment for overweight individuals. The trial data is promising, showing quick and considerable weight loss. Long-term data are needed to make ESG a prominent treatment for obese individuals.

Endoscopic Sleeve Gastroplasty (ESG) in Mexico $8,995 $6,995**

** Limited Quantity Available Starting March of 2022

Endoscopic Sleeve Gastroplasty (ESG) - Mexico Bariatric Center Endosurgery

How is ESG performed?

Patients are unconscious under general anesthesia, just like traditional laparoscopic surgery. The endo physician drops the probe, consisting of sewing, light, and camera, in the stomach orally through the mouth and esophagus.

First, the anterior and posterior walls of the stomach along the greater curve are marked using the argon plasma coagulator as a guideline for placement of the Prolene sutures. Approximately 12 running sutures, normally in a triangular pattern, connect the front and back of the stomach. Then, the sutures are tightened to bring the two walls together to create the sleeve effect.

The optimal locations and patterns for suturing to increase weight loss are still under research and study.

Endoscopic Suturing Device

Do I qualify for ESG?

Endoscopic gastroplasty targets the population of patients who do not easily qualify for surgical treatment of obesity. It is suitable for people afraid of going under the knife. To be a candidate for endoscopic sleeve gastroplasty, you should

  • Who have tried diet, exercise, and pharmacotherapy without reaching permanent weight loss
  • You need to be 18 to 62 years old and have a BMI between 28 and 39
  • Most follow a strict postoperative diet regime

Note! This procedure is not well-suited for patients with gastrointestinal bleeding, a large hiatus hernia, or previous abdominal surgery.

How much weight can I lose?

It is reported patients lose 15% of their starting weight loss (TBWL) after 6 months and 20% of their starting weight loss (TBWL) after 18 months. They lose an average of 50% of their excess weight (EWL) in two years.

Endoscopic Sleeve Gastroplasty Excess Weight Loss Timeline Bariaric Surgery

What are the Pros and Cons of ESG?

Pros

The main benefit of ESG is that is a non-surgical procedure with a better safety profile.

  • Lower infection
  • Faster recuperation to return to daily activities
  • No incisions or scars to heal
  • Shorter hospital stay
  • Lower BMI to quality
  • No cutting and removing tissues
  • Reversible (on certain conditions)

Cons

  • No hunger hormones (Gherlin) removed
  • New procedure without long-term statistics
  • Lower excess weight loss
  • More expensive
  • Stomach stretching
  • Potential risk of ulcers
  • Potential risk of partial openings of the stomach pouch
  • Weight regain

Risks and side-effects

ESG is a safe and well-tolerated procedure. There are possible mild pain, cramping, sore throat, belching, and nausea post-operation. Discomfort and tightness in the left upper quadrant where the stomach is located are reported by patients – the pain may radiate up to the shoulder and neck and is due to gas trapped.

Potential complications can include;

  • Stomach trauma
  • Bleeding
  • Leakage
  • Blood clots

Pre-op and post-op diet guidelines

Since the ESG is an endoluminal procedure, a 24-hour clear liquid diet is the only nutrition guideline to follow before the treatment begins. A strict post-op diet begins with clear liquids only immediately after ESG before slowly progressing towards pureed liquids, soft solids, and finally solid foods after 4 weeks. Patients must eat small portions slowly and wait 30 min to go back for seconds. Limitations on alcoholic drinks should be exercised after the ESG procedure.

Is ESG covered by insurance?

ESG is rather a new procedure and is not covered by medical insurance yet. Still, you should check with your insurance for coverage. Also, the insurance company may provide a list of endoscopic gastric sleeve providers near you.

The cost of endo ESG in the United States is averaging around $10,000. For individuals who cannot afford to pay the high fees of the procedure, destination care in Mexico is the last resort. Medical tourists can save up to 30% on Endoscopic Sleeve Gastroplasty in Mexico.

ESG vs. VSG

Vertical Sleeve Gastrectomy, or VSG, is one of the most effective tools for quick and sustained weight reduction. This laparoscopic procedure utilizes 3 to 5 small intra-abdominal incisions to create restriction as well as alteration of appetite control hormones. Through gastric resection, the size of the stomach is reduced by about 80% by cutting it along the great curvature.  In the non-surgical sleeve or ESG, the stomach is folded and plicated to achieve the 70% reduction in volume without hormone removal.

– Gastrectomy is a medical term used for surgically extracting part of the stomach tissue.
– Gastroplasty is a procedure that reduces gastric volume without any tissue extraction.

There are no external scars in the accordion procedure and can be done on an outpatient basis. To perform this procedure, you do not need a certified surgeon; a trained and experienced endoscopist physician is perfectly capable of executing it. The procedure takes about 60 minutes with a 1 to 3 day recovery time.

 

Endoscopic Sleeve Gastroplasty (ESG)

Vertical Sleeve Gastrectomy (VSG)

MethodNo incisions3-5 incisions
Stomach64-72% reduction in gastric volume80-84% removal of the greater curvature
AnatomyGastric fundus intactGut and metabolic hormones altered and gastric nerves severed
Gastric EmptyingDelayed causing early satietyEarly gastric emptying
Duration30 min45 min
Hospital1 day1 to 2 days
Time Off5 – 10 days1 to 2 weeks
Recovery2 – 3 weeks3 – 4 weeks
AdvantageHigher safety profile
Reduced complication rate
Recovery expedited
Common
Low Risk
More %EWL
FDA approved
DisadvantageNewer
No long-term safety or efficacy data
Less %EWL
Hair loss
Hormonal imbalance
Increases GERD/reflux
Weight Loss20 – 40% EWL60 – 75% EWL
Post-Op3 to 5 Meals/Day
800-1200 Cal
High-Protein
3 to 5 Meals/Day
800-1200 Cal
High-Protein
CandidacyBMI of 29+
“1st” Procedure
BMI of 30+
“1st” Procedure

What is Overstitch?

Overstitch Suturing Device - Endoscopic Sleeve Gastroplasty (ESG)Overstitch is a suturing system is a flexible tube with a tiny camera and suturing device attached. This device is made by Apollo Endosurgery as one of the alternative non-surgical endo procedures to fight the obesity pandemic. The applications of the overstitch system are ESG and TORe explained below.

Gastric Sleeve Revision to Mini-ESG

If sleeve gastrectomy does not result in adequate weight loss due to stretching, the size of the sleeved stomach can be restored endoscopically. The endo-bariatric surgeon sutures the stomach to recreate the restriction to manage weight regain.

Gastric Bypass Revision to ESG

On average, bypass patients regain 50% of the weight they lost. One of the main reasons for the weight gain after initial loss is gastric outlet enlargement, the connection between the pouch and the small bowl. The study shows that an increase in the gastric outlet diameter directly affects the patient’s weight gain.

Surgical reduction of the gastric outlet is technically complex. The overstitch allows doctors to resize the pouch to create restrictions endoscopically without any surgery. The revision of failed bypass surgery with overstitch is called Transoral Gastric Outlet Reduction (TORe) along with plasma treatment.

Take away

The endoscopic sleeve acts more like a gastric band (lap-band) and gastric balloon as it creates restriction and does not alter the anatomy of the gastric body. Prevalent laparoscopic surgeries like regular gastric sleeve and RNY gastric bypass make anatomical changes that affect hormonal balance for greater metabolic efficiency. The patients’ body set-point is restored following the laparoscopic surgery contributing to more sustained weight loss.

If you are disciplined and can live a healthy life after receiving an endo-sleeve, then this is the right procedure for you. Otherwise, you need to look into a conventional sleeve or RNY bypass surgery to slim down.

Mexico Bariatric Center® is the first medical tourism outfit in Tijuana, Baja, Mexico to offer this new and advanced option. Contact our expert laparoscopic and endoscopic bariatric surgery teams to see what is the option for you!