Endoscopic Sleeve Gastroplasty | Endosleeve

The Endoscopic Sleeve Gastroplasty is a new and effective procedure that helps patients who may not be ready for surgery but are unable to achieve weight loss with diet and exercise alone.

What is the Endoscopic Sleeve Gastroplasty?

The Endoscopic Sleeve Gastroplasty (ESG) is a weight loss procedure that uses an endoscopic camera with a suturing device to reduce the size of your stomach. An internal suture pattern is used to collapse 70-80% of your stomach, but no portion of the stomach is removed and there are no incisions and no scars. The procedure is permanent but reversible if necessary. ESG patients have had good weight loss results, losing 30-60% of excess weight and usually have improvement or remission of diseases like type 2 diabetes, hypertension and other obesity related comorbidity diseases. The ESG is also known as the Endosleeve or the Accordion procedure. 

Graphic of EndoSleeve procedure

What are the results of the ESG?

After the ESG, the vast majority of patients experience 30-60% of excess weight loss. Studies have also shown that metabolic diseases like type 2 diabetes, hypertension, fatty liver disease, and hypertriglyceridemia, improve significantly, if not put into complete remission.

Is the ESG permanent? Is the ESG reversible?

Yes, the Endoscopic Sleeve Gastroplasty is permanent, but, it is also reversible. We use permanent sutures that do not dissolve and 5 year data has demonstrated that the procedure is durable. 
The ESG suture could be removed endoscopically if necessary to reverse the ESG procedure. It is very rare that this is needed, and is best to be done by an endoscopist who is experienced with performing the ESG.

Who qualifies for the ESG?

We always approach each patient individually and consider BMI, body composition, and the presence of diseases like hypertension, type 2 diabetes, hypertriglyceridemia, obstructive sleep apnea, polycystic ovarian syndrome (PCOS), and fatty liver disease.

If you have one of the below conditions, you may qualify for the procedure:

  • Unable to successfully maintain weight loss despite diet and exercise.
  • BMI greater than 30.
  • Body fat percentage greater than 35%
  • Metabolic diseases such as type 2 diabetes, hypertension, hypertriglyceridemia, obstructive sleep apnea, polycystic ovarian syndrome (PCOS), and fatty liver disease.

What is the recovery like after the Endosleeve?

After the procedure, most patients feel some abdominal discomfort and nausea, but are able to be adequately treated with oral medication. Patients are sipping fluids and walking within an hour of the procedure and go home within a few hours of the procedure. Most patients are able to return to work after just 2-4 days!

What does gastroplasty mean?

Gastroplasty means “stomach molding” and comes from the latin term “gastro-”, which means stomach, and “-plasty”, which means to mold. 
Conversely, gastrectomy means to remove a part of the stomach and derives from the latin suffix “-ectomy”, which means to remove. 
Endoscopic sleeve gastroplasty is the scientific name of a procedure that is performed endoscopically to remodel the stomach from the shape of a large bag into a tight sleeve. 
The endoscopic sleeve gastroplasty is also called the ESG, Endosleeve, or the Accordion procedure.

Will my diabetes and hypertension get better after the ESG?

Yes! Studies have also shown that metabolic diseases like type 2 diabetes, hypertension, fatty liver disease, and hypertriglyceridemia, experience significant improvement, if not put into complete remission.

What are possible complications after Endoscopic Sleeve Gastroplasty?

ESG has a the lowest complication rate compared to other bariatric procedures like gastric balloon, lap band, gastric sleeve, and gastric bypass. Serious complications are very rare, but include gastric leak, perigastric fluid collection, pneumothorax, and pulmonary embolism. It is extremely rare for any of these complications to require additional procedures or surgery to treat. No patient has died as a result of complications with ESG.

Is the ESG covered by insurance?

At this time, unfortunately, it is not covered by insurance. We have competitive pricing and have helped many patients find financing for this important investment in themselves.

How is the ESG different from the Intragastric Balloon?

Both of these procedures are performed endoscopically, meaning that there are no incisions or scars and you will go home the same day of the procedure. Both procedures work to provide a sense of fullness and decrease appetite.
The intragastric balloon systems, like the Obalon, Orbera, and Re-shape, are balloons that are temporarily placed in the stomach. The balloon usually remains in the stomach for 6 months. Some patients experience a significant amount of nausea. After the balloons are removed from the stomach, weight loss can be difficult to maintain.
The ESG is a permanent (but reversible if necessary) procedure that uses a suturing device on the end of an endoscope to permanently shrink the stomach. This reduces hunger and increases the sense of fullness. Studies have shown that the ESG has better weight loss, both in the short term and long term when compared to gastric balloons. Studies have also shown that the ESG is safer and has less side effects like nausea and heartburn. Approximately 10% of patients are unable to tolerate the intragastric balloon, requiring removal. It is extremely rare for ESG patients to require reversal for any reason.

How is the Endoscopic Sleeve Gastroplasty different from the Laparoscopic Sleeve Gastrectomy?

The ESG is performed with a suturing device on the end of an endoscope to collapse the majority of the stomach from the inside. There are no incisions and nothing is removed.
The Laparoscopic Sleeve Gastrectomy is performed with a camera and long instruments through small incisions in the abdominal wall. The majority of the stomach is detached and completely removed from the body through one of the incisions.

Recovery time after the ESG is usually 2-4 days. Complications are very rare, but include gastric leak, perigastric fluid collection, pneumothorax, and pulmonary embolism. It is extremely rare for any of these complications to require additional procedures or surgery to treat. No patient has died as a complication of the ESG.
Recovery after Sleeve Gastrectomy is usually 1-3 weeks. Complications are also rare and include gastric leak, post-operative bleed, and pulmonary embolism. These complication usually require additional procedures or surgery to treat. The chance of death after LSG is very low (0.04%), but not zero.

Weight loss after the ESG is good, usually 30-60% excess weight loss. The LSG has excellent weight loss results, usually 50-80% of excess weight loss. Following a program for making healthy changes in your nutrition, activity, and mindset are critical to both procedures.

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