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Endoscopic Sleeve Gastroplasty: A Non-Surgical Way to Take Control

A non-surgical, scar free solution for lasting weight loss.

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What is the Endoscopic Sleeve Gastroplasty?

The Endoscopic Sleeve Gastroplasty (ESG) is a cutting-edge, non-surgical weight loss procedure that helps patients reduce their stomach volume without incisions or external scars. Using an endoscope inserted through the mouth, sutures are placed inside the stomach to create a sleeve-like shape, limiting food intake and promoting early satiety.

Unlike traditional weight loss surgeries, ESG is performed entirely through the digestive tract, which means no abdominal cuts, less discomfort, and a faster recovery. Most patients return to normal activity within a few days, making it an excellent option for those looking for effective results with minimal downtime.

Did You Know?

Dr. Vanderwel is a leading ESG specialist, having performed more procedures than any other provider on the West Coast. He has also trained numerous surgeons and specialists in delivering safe, effective ESG treatments that maximize patient outcomes. Read his published research on ESG.

3D illustration of a stomach after endoscopic sleeve gastroplasty (ESG), showing internal sutures reducing the stomach volume without surgical removal.
Candidates

Is the ESG Right for You?

The Endoscopic Sleeve Gastroplasty is ideal for individuals who are looking for a less invasive alternative to surgery. It’s best suited for those who have struggled with weight loss through diet, exercise and medications alone, but who may not qualify, or feel ready for bariatric surgery. ESG works well for people with moderate obesity who are ready to commit to a lifestyle change.

Calculate Your BMI​
  • BMI 27+
  • Have tried diet, exercise and medications without long-term success
  • Are seeking a non-surgical or less invasive solution
  • Are committed to making healthy lifestyle changes
Benefits

Why Choose Endoscopic Sleeve Gastroplasty?

Non-Surgical and Incisionless

ESG is performed entirely through the mouth—no cuts, no scars, and no hospital stay. It’s ideal for those seeking effective weight loss without the risks of surgery.

Faster Recovery, Fewer Complications

Most patients return to normal activities within a few days. ESG has fewer side effects than traditional surgery and doesn’t alter your anatomy.

Durable Weight Loss with Lifestyle Support

By reducing stomach volume and promoting early fullness, ESG helps you lose weight steadily—especially when combined with long-term nutrition and behavior coaching.

PATIENT SPOTLIGHT — JENNIFER BLACK

"The ESG gave me my life back."

After struggling with her weight for years, Jennifer chose the Endoscopic Sleeve Gastroplasty (ESG) and went from 216 to 153 lbs—regaining her energy, confidence, and joy in everyday life.
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Testimonials

Endoscopic Sleeve Gastroplasty Before & After

Jennifer

Endoscopic Sleeve Gastroplasty

Misty 

Endoscopic Sleeve Gastroplasty

Ali 

Endoscopic Sleeve Gastroplasty

Providers

Providers that perform the Endoscopic Sleeve Gastroplasty

Mimi Tan, MD

Bariatric & Metabolic Surgeon, Board Certified General Surgeon

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Profile picture of Dr. VanderWel wearing scrubs in front of blue background

Brandon VanderWel, MD

Bariatric & Metabolic Surgeon, Board Certified General Surgeon

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Smiling male doctor in a white coat with a yellow tie and blue shirt, sitting in a bright medical office.

Robert Landerholm, MD

Board Certified General Surgeon, Bariatric & Advanced Minimally Invasive Surgery

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Our Process

How our Endoscopic Weight Loss Program Works

Step 1.
Schedule a Virtual Consultation

Meet with an endoscopic weight loss doctor to learn which procedure is right for you.

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Step 2.
Intake + Insurance Review 

Your Bariatric Pathway Coordinator (BPC) is here to help every step of the way—navigating insurance approvals, clinical milestones, or walking you through the self-pay process.

Step 3.
Procedure Day

Your journey begins today—and you’re in the best hands. Our streamlined outpatient approach means most patients are home the same day, recovering comfortably and confidently with support from our experienced team.

FAQ

Most Popular Questions

Am I a candidate for the endoscopic sleeve gastroplasty?

Endoscopic Sleeve Gastroplasty (ESG) is a great option for those seeking a less invasive alternative to surgery. It’s especially suited for individuals with moderate obesity who haven’t achieved lasting results through diet, exercise, or medications alone—and who may not qualify for, or feel ready to pursue, bariatric surgery. ESG offers an effective path forward for those committed to making long-term lifestyle changes.

Patients typically lose between 20–25% of their total body weight within 6 to 18 months after Endoscopic Sleeve Gastroplasty (ESG).

ESG is intended to be a long-term, durable solution. While the sutures are designed to hold their shape, frequent overeating can place stress on the stomach, potentially causing the sutures to loosen or the stomach to stretch over time. Long-term success depends on maintaining healthy eating habits and following post-procedure guidelines.

The sutures can “technically” be removed and the stomach would go back to it’s original shape.

Yes, the stomach can stretch slightly after ESG, especially if long-term lifestyle changes aren’t followed. However, the sutures used in the procedure are designed to be durable, and most patients maintain their results when they follow dietary guidelines and avoid frequent overeating. Our team provides ongoing support to help you protect your results and build sustainable habits.

Most patients return to work and normal activity within 2–4 days. Recovery is significantly quicker than traditional surgery since there are no external incisions.

Many patients report feeling full sooner after meals due to the reduced stomach capacity. Hunger may return gradually, so long-term success depends on mindful eating and support.

Most insurance providers do not currently cover ESG, as it’s considered a newer, investigational procedure. However, self-pay options and financing are available. 

ESG is generally safe, with fewer risks than surgery. Some patients may experience nausea, cramping, or acid reflux shortly after the procedure, but serious complications are rare.

Patients follow a staged diet, starting with liquids, then pureed foods, followed by soft solids, and eventually a regular balanced diet. Your care team will guide you through each phase.

Unlike surgical procedures, ESG doesn’t interfere with nutrient absorption. However, some patients benefit from multivitamins, especially during the early stages of recovery.

ESG is a non-surgical, incisionless procedure that uses sutures to reduce stomach size without removing any part of it. In contrast, the gastric sleeve is a surgical procedure where about 80% of the stomach is permanently removed. Gastric sleeve typically results in greater weight loss but has longer recovery. ESG has a quicker recovery but may offer more modest results.

The procedure usually takes 60–90 minutes and is done under anesthesia. All patients go home the same day.

Procedures we offer at Eviva

Our surgeons work closely with you to determine which weight loss procedure best matches your goals, medical needs, and lifestyle. From advanced laparoscopic techniques to non-surgical endoscopic procedures, each option we offer is backed by proven outcomes and long-term success. We also offer revision surgery for patients who’ve had prior procedures and need additional support.

Minimally Invasive Laparoscopic Surgeries

Gastric Sleeve (LapSleeve®)

3D illustration of a stomach after sleeve gastrectomy, showing the reduced, tube-shaped stomach with surgical sutures.
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Gastric Sleeve Resources

  • Overview: The gastric sleeve, or sleeve gastrectomy, is a laparoscopic procedure where approximately 80% of the stomach is removed, leaving a tubular “sleeve” that limits food intake.

  • How It Works: By reducing stomach size and removing the hunger-inducing hormone-producing part (fundus), it decreases appetite and promotes satiety.

  • Benefits: Patients typically experience a 25–30% total body weight loss. The procedure also improves conditions like type 2 diabetes, hypertension, high cholesterol, and sleep apnea.

  • Ideal Candidates: Individuals with a BMI over 35. It is also frequently performed on BMI between 30–35.

  • Recovery: Most patients go home the same day. Recovery involves a staged diet starting with liquids and gradually progressing to solids over several weeks.

Gastric Bypass

3D illustration of a stomach after gastric bypass surgery, showing the small pouch connected directly to the small intestine, bypassing the lower stomach.
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Gastric Bypass Resources

  • Overview: Gastric bypass is a laparoscopic procedure that alters both the stomach and small intestine to reduce food intake and calorie absorption. A small pouch is created at the top of the stomach and connected directly to the small intestine.

  • How It Works: The procedure limits how much food you can eat and bypasses part of the intestine to reduce calorie absorption. It also influences hormones involved in hunger and blood sugar regulation.

  • Benefits: Patients may lose 30–35% of their total body weight. Gastric bypass has strong results for resolving type 2 diabetes, GERD, and metabolic syndrome.

  • Ideal Candidates: Individuals with a BMI over 35, especially those with type 2 diabetes, severe acid reflux, or complex metabolic conditions.

  • Recovery: Most patients go home the same day. Recovery includes a gradual diet progression and routine follow-ups for long-term support.

Gastric Band (LapBand®)

3D illustration of a stomach with an adjustable gastric band in place, showing the band around the upper portion and connected to a port.
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Gastric Band Resources
  • Overview: The lap band involves placing an adjustable silicone band around the upper portion of the stomach, creating a small pouch to restrict food intake.
  • How It Works: The band creates early satiety by limiting how much food the pouch can hold. The tightness of the band is adjusted through a port placed under the skin.
  • Benefits: Less invasive with no stomach cutting or stapling. Adjustable and reversible. Typically results in 15–20% total body weight loss.
  • Ideal Candidates: Patients who prefer a reversible option or who may not qualify for sleeve or bypass procedures.
  • Recovery: Same-day discharge is common. Return to work within a few days. Band adjustments are performed in the clinic as needed.

Non-Surgical Endoscopic Procedures​

Endoscopic Sleeve Gastroplasty (Endosleeve)

3D illustration of a stomach after endoscopic sleeve gastroplasty (ESG), showing internal sutures reducing the stomach volume without surgical removal.
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Endosleeve Resources
  • Overview: The lap band involves placing an adjustable silicone band around the upper portion of the stomach, creating a small pouch to restrict food intake.
  • How It Works: The band creates early satiety by limiting how much food the pouch can hold. The tightness of the band is adjusted through a port placed under the skin.
  • Benefits: Less invasive with no stomach cutting or stapling. Adjustable and reversible. Typically results in 15–20% total body weight loss.
  • Ideal Candidates: Patients who prefer a reversible option or who may not qualify for sleeve or bypass procedures.
  • Recovery: Same-day discharge is common. Return to work within a few days. Band adjustments are performed in the clinic as needed.

Gastric Balloon

3D illustration of a gastric balloon placed inside the stomach to aid weight loss.
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Gastric Balloon Resources
  • Overview: A gastric balloon is a temporary device inserted endoscopically and filled with saline to occupy space in the stomach and limit food intake.
  • How It Works: The balloon takes up stomach space, promoting earlier satiety and reducing meal sizes. It is removed after approximately six months.
  • Benefits: Non-surgical and reversible. Can aid weight loss of 10–15% of total body weight when combined with lifestyle changes.
  • Ideal Candidates: Individuals seeking short-term weight loss support or those preparing for another procedure like surgery.
  • Recovery: Minimal downtime. Patients may experience nausea or discomfort for the first few days. Normal activities resume quickly.

Revision​ Procedures

Laparoscopic & Endoscopic Revision

Gastric Revision 3d Stomach
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Revision Resources

  • Overview: Revision surgery involves modifying or converting a previous weight loss procedure—such as converting a Lap Band to a Sleeve or Bypass—when initial results are inadequate or complications arise.

  • How It Works: Depending on the patient’s history and current needs, the revision may involve removing or modifying existing devices, reshaping the stomach, or rerouting the intestines.

  • Benefits: Offers a second chance at weight loss success. Can resolve issues such as inadequate weight loss, band slippage, reflux, or weight regain.

  • Ideal Candidates: Patients who had prior bariatric surgery but experienced complications, minimal results, or weight regain.

  • Recovery: Varies by procedure. Most are still performed laparoscopically with a focus on minimal downtime and tailored aftercare.

How can we help you?​