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.
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.
What are the Pros and Cons of ESG?
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)
- No hunger hormones (Plasma Ghrelin) 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
- Blood clots
Pre-op and post-op diet guidelines
Since 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 minutes to return 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 averages 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 a 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 it 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)
|Method||No incisions||3-5 incisions|
|Stomach||64-72% reduction in gastric volume||80-84% removal of the greater curvature|
|Anatomy||Gastric fundus intact||Gut and metabolic hormones altered and gastric nerves severed|
|Gastric Emptying||Delayed causing early satiety||Early gastric emptying|
|Duration||30 min||45 min|
|Hospital||1 day||1 to 2 days|
|Time Off||5 – 10 days||1 to 2 weeks|
|Recovery||2 – 3 weeks||3 – 4 weeks|
|Advantage||Higher safety profile|
Reduced complication rate
No long-term safety or efficacy data
|Weight Loss||20 – 40% EWL||60 – 75% EWL|
|Post-Op||3 to 5 Meals/Day|
|3 to 5 Meals/Day|
|Candidacy||BMI of 29+|
|BMI of 30+|
What is Overstitch?
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.
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!