Endoscopic Sleeve Gastroplasty

Endoscopic sleeve gastroplasty is a new weight loss procedure. It’s designed to reduce the volume of your stomach. It’s done by endoscope, which means there’s no cutting or scarring. Endoscopy has fewer side effects than surgery.


Endoscopic sleeve gastroplasty reduces your stomach volume by closing off a portion with stitches.
Endoscopic sleeve gastroplasty reduces your stomach to a narrow sleeve by closing off the back portion with stitches.

What is endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty (ESG) is a weight loss procedure that reduces the volume of your stomach. It’s a nonsurgical alternative to gastric sleeve surgery and similar bariatric surgery procedures.

ESG allows a healthcare provider to access and modify your stomach without making any incisions. They access it by passing an endoscope (a long, thin tube with a tiny camera attached) down your throat into your stomach.

The endoscopist attaches a suturing device to the endoscope to close off a portion of your stomach with stitches. They bring folds of the stomach together, accordion-style, which is why ESG is sometimes called an accordion procedure.

This reduces your stomach to a tubular, “sleeve”-like shape, about 30% of its original size. The smaller size restricts how much you can eat, while the narrow shape makes it take longer for your stomach to empty.


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Who is endoscopic sleeve gastroplasty for?

Endoscopic sleeve gastroplasty is available to children and adults diagnosed with obesity. In adults, this usually means a BMI of 30+. Weight loss surgery, by comparison, is usually reserved for people with class III obesity.

If you’ve tried unsuccessfully to lose weight by other means, you might be ready to consider a weight loss procedure. ESG offers a middle option for those who might not qualify for or might not want to commit to bariatric surgery.

What health conditions does the endoscopic sleeve gastroplasty procedure help manage?

Obesity itself is a complex, chronic condition that tends to progress over time. It’s also associated with a wide range of adverse health effects, from cardiovascular disease to liver disease to Type 2 diabetes.

Losing weight may reduce the risk of these diseases in people with obesity. If you already have one of these diseases, weight loss can reverse its effects and remove the need for medications to manage it.


Procedure Details

What happens before ESG?

You and your healthcare provider will decide together whether you’re a good candidate for ESG. You’ll go through a health screening process, which may include some standard medical tests to make sure you can safely undergo general anesthesia.

A healthcare provider will ask about your health history, diet, lifestyle and weight loss goals. They’ll counsel you about the risks and benefits of the procedure and the long-term changes you’ll have to adopt to make it successful.

What happens during the procedure?

You’ll be asleep for the procedure under general anesthesia. A gastroenterologist or an endoscopic surgeon will insert the endoscope through your mouth and down your esophagus, into your stomach.

The endoscope releases gas into your stomach to expand it. The camera on the endoscope projects the inside of your stomach onto a screen. The endoscopist operates using special tools attached to the endoscope while watching the monitor.

Using a suturing device, they’ll place about eight to 10 stitches between the two opposite walls of your stomach and draw them together. When these walls close, you’ll be left with a narrow, tubular section of your stomach that’s still open.

How long does endoscopic sleeve gastroplasty last?

The procedure itself takes 60 to 90 minutes. After you wake up from the anesthesia, you can go home the same day. If you have symptoms afterward, such as pain or nausea, your healthcare team will treat you for them before you go.

How painful is endoscopic sleeve gastroplasty?

Most people have mild pain as their stomach heals. Some have more pronounced pain and nausea for a few days afterward. These side effects are often manageable with over-the-counter (OTC) medications. Your doctor can give you a prescription if needed.

Will I have to follow a special diet after the procedure?

Yes, you’ll be on a strict diet during your recovery period, which lasts about a month. This is to give your stomach the chance to heal. Your provider will give you all the details. You’ll start on a liquid diet and gradually progress to soft foods, and finally, solids.


Risks / Benefits

What are the benefits of endoscopic sleeve gastroplasty?

Benefits include:

  • Substantial long-term weight loss (average 15%-20%).
  • Remission of obesity-related diseases.
  • Fast operation and recovery period.
  • Little risk of side effects or complications.

What are the possible risks or complications of this procedure?

Risks include:

  • Temporary pain, nausea and heartburn.
  • Weight regain, gradually stretching your stomach out again.
  • Minimal risk of injury by the endoscope.
  • Minimal risk of reaction to the anesthesia.

Recovery and Outlook

What is the recovery time from ESG?

It takes about a month before your stomach is healed enough to eat normally. You’ll have to eat carefully during this time. But symptoms from the procedure often go away within the first week, and most people can return to work at this time.

What are the typical results from endoscopic sleeve gastroplasty?

Most people lose 15% to 20% of their total weight, or around 60% of their excess weight, over the first year. That’s more than enough to achieve remission of obesity-related conditions. Keeping up with a nutritious diet and healthy lifestyle helps to maintain your results.

Additional Common Questions

What is the difference between the gastric sleeve and endoscopic sleeve gastroplasty?

Both procedures aim to reduce the volume of your stomach, converting its original bean shape to a narrow, tubular “sleeve”. The sleeve concept is what’s known as a “restrictive” weight loss procedure because it restricts how much you can eat.

Endoscopic sleeve gastroplasty accomplishes this in a less invasive, but less permanent, way. Instead of cutting into your abdomen, it accesses your stomach using an endoscope. Instead of removing a section of your stomach, it closes a section off with stitches.

This makes ESG a little less effective. A surgical sleeve gastrectomy removes the part of your stomach where many of your hunger hormones are produced. Removing it helps regulate your hunger and metabolism. This is part of what makes gastric sleeve surgery work, and also what can cause side effects.

A note from Cleveland Clinic

The nature of obesity makes weight loss notoriously difficult. Due to the ways it changes your body chemistry, usual measures like diet and exercise tend not to work. Bariatric surgery has shown strong results, but not everyone is a candidate. And even if you are, it can be a daunting leap to take.

Only 1% of people recommended for bariatric surgery choose to have it. For everyone else, the lack of viable alternatives has long been a frustration. But endoscopic bariatric therapy (EBT) is now emerging as an alternative. Procedures such as ESG offer similar results to surgery by less-invasive methods.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 02/28/2023.

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