Q&A: Endoscopic Sleeve Gastroplasty (ESG)

Dr. Christopher McGowan
September 29, 2021

If you’ve been trying to lose weight through diet and exercise without much success, you’re not alone. Each year, millions of people make the attempt, but either they can’t lose much weight or they gain it back not longer after losing it. At True You Weight Loss, we are passionate about helping you break this cycle and finally shed those extra pounds. A healthy diet and regular exercise are important for a variety of health reasons, but sometimes a different approach is necessary to achieve a long term and sustainable weight. To do this, True You offers non-surgical weight loss solutions like endoscopic sleeve gastroplasty. 

What is an Endoscopic Sleeve Gastroplasty (ESG)?   

ESG is a state-of-the-art weight loss procedure that involves reducing the size of the stomach in order to promote weight loss. Unlike traditional bariatric surgery, ESG doesn’t require the kinds of incisions normally associated with open surgery or laparoscopy. Instead, endobariatric physicians use an endoscope, a flexible tube that is inserted through the mouth and fed down the esophagus. The endoscope is fitted with a camera and tiny tools that allow the entire procedure to be completed from inside the stomach and without the need for any incisions. 

How does ESG help you lose weight?

HowESGHelps 1

The reason weight gain happens in the first place is because people consume more calories than they expend through living and being physically active. This pattern leads to excess calories being stored as fat tissue. By reducing stomach volume through the ESG procedure, you will feel full more quickly than before since the stomach literally can’t hold more food in a single sitting. This feeling of satiety after eating a smaller meal is the key driver of weight loss because you’ll eat less but still feel full. Over time, the resulting caloric deficit will cause your body to burn fat stores to get the energy it needs. 

What is involved in the ESG procedure?

HowESGWorks 1

With the use of a special suturing tool mounted on the end of the endoscope, the physician stitches together two sides of the stomach in order to create a partition. This partition follows the greater curvature of the stomach, and, once sutured, the newly formed stomach resembles a banana-shaped “sleeve.” This reformation of the stomach represents an approximately 70-80% reduction in stomach volume, and it ultimately helps you reimagine your diet by making it very difficult to overeat.     

One of the most appealing features of an endoscopic sleeve gastroplasty is how quickly it can be performed; in most cases, the entire outpatient procedure is done under sedation and takes between 30 and 45 minutes. Moreover, because there are no incisions involved, the recovery time is also very short. Whereas a laparoscopic procedure like gastric bypass may take up to two months to fully recover from, patients who get an ESG are typically back to their normal routine after only a few days of recovery at home. 

How painful is ESG?

Even though the endobariatric physician will be suturing together a section of the inside of your stomach, you won’t feel pain or discomfort during the procedure. This is partly because of the nature of endoscopy and partly because you will be under sedation. Some patients do report mild abdominal pain in the days following the procedure, however, but this can be easily treated with over-the-counter pain relievers. 

What should I expect after the procedure?

Most patients will be able to go home after the procedure is complete and after a short, 1-2 hour recovery time. Food is generally restricted for the initial hours after completion, and then you will be given instructions to follow a liquid diet for several days. Solid food will follow closely behind, along with guidance from a registered dietitian and a diet plan that will help you take full advantage of the benefits of the procedure. 

Though the ESG procedure is a very effective way to help you lose weight, it will only succeed in the long run if you commit yourself to the process. This commitment includes modifying your eating habits on a long term basis. If, for instance, you gradually return to your old eating habits, it’s possible to essentially stretch out the stomach and undo the volume reduction that initially prompted weight loss.  

How much weight can you lose with ESG?

ESG weight loss chart

On average, patients who proceed with ESG will have lost about 20% of total body weight one year after the procedure. Because of how ESG contributes to helping change overeating habits, many patients lose over 70% of their excess body weight over the long term. These results make ESG the most effective non-surgical weight loss procedure available today. For example, if a person weighed 400 pounds prior to the procedure, they could expect to lose 80-85 pounds by the 12 month mark after the procedure. 

When will I start seeing results and how long do they last?  

Everyone is different, but many people begin to see results within the first three months after the procedure. As with any weight loss system, the body begins to switch to fat burning once there is a sufficient caloric deficit. Ensuring that the weight stays off on a long term basis, however, is highly dependent on the patient’s commitment to recommended dietary and lifestyle changes.  

What happens if I don’t lose as much weight as I expected?

Because everyone’s body is different, results may vary from person to person. It is also normal to have periods of slower weight loss. In any event, the True You staff will monitor your progress and check in regularly during the 12 months following the procedure. If even after diet and exercise changes your weight loss has stalled, there are additional steps such as medical nutrition therapy that may be advisable. Additionally, an ESG can be repeated or tightened if it has loosened since the initial procedure was completed.

Who is a candidate for ESG?       

A good candidate for ESG is any person who can be described as obese and hasn’t had success through traditional weight loss methods like dieting and exercise. Though there isn’t a body mass index (BMI) requirement for ESG (unlike some bariatric surgeries), most patients have a BMI between 30 and 40 or higher. It is also an excellent alternative for morbidly obese patients who can’t qualify for other procedures because of other medical conditions that make surgery especially risky. 

The endoscopic nature of this outpatient procedure makes it a much more accessible weight loss solution than essentially all other bariatric surgeries. Nevertheless, patients who have a known gastrointestinal problem such as a hiatal hernia or a stomach ulcer may not be good candidates. It also may be an inadvisable procedure for anyone with a bleeding disorder or another major health issue. 

Is ESG safe? Is it FDA approved?

ESG is performed with the Overstitch, a device approved by the Food and Drug Administration and is very safe, especially when compared to actual bariatric surgery. In fact, fewer than 1% of procedures result in any kind of major complications. The biggest risks are related to sedation, mild bleeding or leakage from the sutures, or irritation to the esophagus from the endoscope itself. Some patients may experience mild discomfort, nausea, or other minor gastrointestinal symptoms, but the vast majority of people feel better after a few days.   

What is the difference between ESG and VSG/LSG?

HowESGCompares 1

Endoscopic sleeve gastroplasty is actually very similar to a bariatric surgical procedure known as either vertical sleeve gastrectomy (VSG) or laparoscopic sleeve gastrectomy (LSG). The primary difference between these two procedures is the use of endoscopy vs laparoscopy. VSG/LSG use laparoscopy, a surgical method that requires small abdominal incisions to accommodate the insertion of the laparoscopy. An ESG procedure, by contrast, uses an endoscope and doesn’t require any incisions at all. 

Both an ESG and VSG/LSG involve a similar reshaping of the stomach into a sleeve shape. They both also rely on reduced stomach volume to promote a caloric deficit and subsequent weight loss. The other significant difference is that the partitioned section of stomach in an ESG is left inside the body as harmless but inactive tissue; in the laparoscopic version, though, the excess stomach tissue is actually removed completely. Both procedures are irreversible.

How much does ESG cost? 

An endoscopic sleeve gastroplasty is not covered by health insurance, but True You Weight Loss does offer financing options. The total cost of the procedure is $11,995 and includes the procedure itself and support before and after the procedure is completed. The full fee includes all of the following:  

  • Initial consultation 
  • Comprehensive bariatric nutrition consultation
  • ESG procedure (inclusive of all facility, anesthesia, and physician fees)
  • Unlimited one-on-one nutrition counseling
  • Unlimited medical follow-up
  • 24/7 direct physician access
  • Post-procedure nurse visit with IV hydration
  • 90-day complication coverage policy
  • 12-month re-suturing coverage
  • Physician-guided weight loss medication program

Can you get pregnant after ESG?

While a pregnancy is safe after fully healing and recovering from the procedure, patients are generally recommended to wait at least six months before getting pregnant. In fact, the metabolic improvements associated with losing significant weight can actually make it easier to get pregnant after the fact. 

What do experts say about ESG?

Though ESG (and endobariatric technique in general) is a relatively new procedure, it has been well received by the overall medical community. Indeed, multicenter studies have consistently indicated that ESG is both safe for patients and effective at helping them lose weight and keep it off. It has also gained notoriety for being an ideal weight management strategy for patients who struggle with traditional methods.   

Freedom is Waiting! 

At True You, we are dedicated to partnering with you on your weight loss journey to help you finally have the life you want. If, like most other people, you’ve tried the same old restrictive diets and unsustainable workout schemes, it may be time to consider an alternative approach. Contact us today to request a consultation! We’ll be able to answer any other questions about ESG or any of our other state-of-the-art non-surgical weight loss procedures.

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.

Get Monthly Updates About Nutrition and Advancements in Weight Loss

You might also be interested in:

Learn more about our non-surgical weight loss solutions with a quick consultation.

0% interest financing available.
Discover which solution is right for you.
Go over pricing & payment options.

Fill out the short form to learn more!

Request a Free Consultation

Subscribe to our newsletter for exclusive insights, success stories, and expert tips on non-surgical weight loss. Join our community and stay informed on the latest advancements in endobariatric procedures.
 True You Weight Loss | All rights reserved