Endoscopic Sleeve Gastroplasty for Weight Loss

Dr. Christopher McGowan
November 3, 2020

For most people, a weight loss program represents an ongoing process that may take months or even years before success can be truly felt (if ever). Even after spending countless hours on treadmills or lifting weights and diligently preparing healthy food, noticeable results may still be far off and seemingly out of reach. At True You Weight Loss, it is our mission and defining purpose to help you lose the weight that has been keeping you from living the life you want to live. 

To help people achieve their weight loss goals, we offer a variety of minimally invasive, non-surgical procedures. Recent studies and our own extensive experience have shown that one of the most effective ways to lose weight (and keep the weight off) is through the use of a non-surgical and minimally invasive procedure called endoscopic sleeve gastroplasty (ESG). This safe and effective service is a specialty of True You and has helped hundreds of people lose the weight they couldn’t lose through traditional methods.

What is Involved in an Endoscopic Sleeve Gastroplasty?

This complicated-sounding medical term is actually a relatively simple procedure that involves reducing stomach volume in order to promote weight loss. Reduced stomach volume means that you will feel full sooner after eating, and, as a result, you will intake far fewer calories. Over time, of course, eating fewer calories forces your body to switch to fat reserves in order to get the energy it needs.  

Unlike traditional gastric sleeve bariatric surgery (laparoscopic sleeve gastrectomy or gastric bypass, for example), ESG doesn’t require large incisions as in open surgery nor even the small incisions required for laparoscopic surgery. Instead, ESG relies on the use of gastrointestinal endoscopy, a process involving a long, flexible tube that can be inserted through the mouth. Endoscopes are so versatile because they include a tiny camera and lights and typically carry small tools that are used in various procedures. The use of an endoscope makes the procedure quick, painless, and far less prone to the kinds of complications and side effects that can accompany actual surgery.

In ESG, stomach size reduction is achieved by stitching together part of the stomach wall with sutures. Once stitched together, the sutures create a bunching effect that resembles an accordion, which is why ESG is sometimes referred to as an “accordion procedure.” When complete, the stomach will have been reshaped into a narrow sleeve that typically represents a 70%-80% reduction in stomach volume.  

As noted, the ultimate goal of stomach size reduction is to reduce the number of calories that are able to be consumed. With the size of the stomach being at 20% of its normal size, you will feel full faster and thus eat less; this can be a game changer for people who have trouble controlling the urge to overeat. With the new stomach size, you have a much better chance to make the necessary eating habit changes on a permanent and long-term basis.

ESG Compare

Who Can Benefit from ESG?

Endoscopic sleeve gastroplasty is a weight loss procedure recommended for patients who are considered obese or morbidly obese, which is typically defined through the use of body mass index (BMI). Determined by comparing a person’s height and weight, BMI is useful for indicating the relative likelihood of obesity. For example, a BMI under 18 is considered underweight, between 18-24 is considered normal, 25-29 is overweight, 30-39 is obese, and anything over 40 is considered morbidly obese. 

At True You, a good candidate for ESG is a patient with a BMI of 30 or more and who hasn’t had success losing weight with traditional diet and exercise regimens. Moreover, ESG is an excellent alternative if you don’t want to take on the added risks of bariatric surgery. Similarly, it can also be an alternative for those who simply can’t have surgery because of other medical conditions that would make invasive surgery especially risky.  

What Results Can be Expected from ESG?

The reason True You is so passionate about offering endoscopic sleeve gastroplasty is because of the results; beyond being a safe procedure with quick recovery times, patients can expect to experience significant weight loss. According to a recent international study, the 12-month total body weight loss (TBWL) for ESG patients was 17%; as an example, a person who was 400 pounds could expect to have lost around 68 pounds one year after the procedure was performed. 

ESG WeightLossChart blog

Comparatively, our patients have actually seen even better results than that; based on internal studies, our patients have experienced an average of 23% total body weight loss after one year. That means that the same 400-pound person could lose nearly 100 pounds. An important element of these statistics is that the weight loss is sustainable over time. In many cases, the new eating habits that emerge because of the smaller stomach size become essentially permanent. This is especially important for those who have experienced the ups and downs of “yo-yo dieting” and have struggled to keep the weight off. 

The loss of weight will undoubtedly be the most noticeable result, especially as your clothes start to fit better and a slimmer figure in the mirror becomes the norm. The other expected results, however, are perhaps even more valuable; once you start losing weight, a variety of other changes related to overall health will start to emerge. Losing weight is associated with lowering high blood pressure, longer life, better mobility, reducing high cholesterol, and other health indicators. Losing body weight has also been known to have a beneficial effect on heart disease, sleep apnea, and type 2 diabetes.

How Does the Procedure Work?

Because of how relatively safe and non-invasive it is, the endoscopic sleeve gastroplasty is considered an outpatient procedure. What this means practically is that you will be able to arrive for the procedure and be on your way home within a few short hours; indeed, the procedure itself typically only takes about 30-45 minutes. Recovery time will vary from person to person, but most patients report feeling some minor discomfort in their stomach during the few days following the procedure. 

As noted earlier, ESG is a wholly endoscopic procedure, so there is no need for any kind of incision. Even though it isn’t invasive, general anesthesia is used to ease any discomfort associated with the endoscope itself. Once sedated, the endoscope is fed down the esophagus and into the stomach. With an endoscopic suturing device attached to the end of the tube, stitches are used to bind together two parts of the stomach and create a sleeve shape. The entire procedure is done with visuals sent by the endoscope’s camera.  

Endoscopic Sleeve Gastroplasty (ESG): 3 minute narrated procedure

Living With a Sleeve Gastroplasty

Once the procedure is complete, you can recover at home and resume normal routines after a few short days. For long-term weight loss success, the key to ESG is commitment; the patients who have the most success follow our recommendations for diet and exercise modifications. Because of the smaller stomach size, you won’t be able to eat the same amount of food, so it will be necessary to adjust your eating habits to see the maximum weight loss progress.    

An endoscopic sleeve gastroplasty is permanent, so it is important that you see the procedure as a tool to assist with weight loss rather than a magic wand that makes the fat go away. The sutures will remain inside your stomach wall and won’t need to be removed, but they pose no threat by staying inside. Over time, the sides of the stomach that were bound together with the sutures will heal together and become the new wall of the stomach and the reduced stomach size will remain reduced.

Are There any Potential Complications?

With open or laparoscopic surgery, there are a number of possible complications simply because the surgeon has to make incisions in the body. With an endoscopic sleeve gastroplasty, those risks aren’t a factor, but there is a small chance that other complications may arise. In terms of a national average, these complications occur 2.2% of the time, but the complication rate for True You’s patients is less than 0.5%. Overall, though, the side effects are generally mild; patients report feelings of discomfort in the abdomen and sometimes nausea and lethargy as the body adjusts to fewer calories being consumed. The majority of patients only experience these mild side effects for a few days after the procedure. 

Why Choose True You for Endoscopic Sleeve Gastroplasty?

As the founder of True You and a triple board certified physician in Internal Medicine, Gastroenterology, and Obesity Medicine, I have performed hundreds of ESGs. Additionally, True You offers a personalized approach to meeting your weight loss goals that can’t be found in large hospitals. In fact, a recent study in Obesity Surgery, a leading scientific publication in bariatric surgery, looked at outcomes from community gastroenterology practices compared to large hospitals; what they found is that procedures performed in community practices like True You either met or exceeded the weight loss results of those performed in hospitals.  

There are other weight loss surgery options available, but they are often much more involved, more risky, and more expensive. Choosing an endoscopic sleeve gastroplasty is a big decision, but it’s a safe choice that can both prolong and enhance your life. But it requires commitment and a willingness to make some lifestyle changes. With the help of the True You staff and our non-surgical weight loss options, though, you can be well on your way to making your weight loss goals a reality and fully experience life.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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