Endoscopic Sleeve Gastroplasty (ESG)
A minimally invasive, endoscopic weight-loss procedure that uses a suturing device to fold and stitch the stomach from inside, reducing its size and volume by about 70%.
Mechanism:
Smaller stomach → holds less food
Slower emptying into the intestines → prolonged fullness
Fewer calories absorbed → gradual weight loss
How ESG Differs from Surgery
ESG: No cutting/removing stomach tissue; sutures fold stomach like an accordion → reversible.
Laparoscopic Sleeve Gastrectomy: Removes a large portion of the stomach → permanent.
Who May Need ESG?
Adults with BMI ≥ 30 (obesity)
Failed lifestyle modifications (diet/exercise)
Want less invasive alternative to bariatric surgery
Motivated to follow a long-term lifestyle, diet, and exercise program
Benefits
Effective for weight loss and improving obesity-related illnesses:
Hypertension
Type 2 diabetes
Fatty liver disease
Sleep apnea
Heart disease
Reversible and repeatable (can be redone if sutures loosen or stomach stretches)
Can help restart weight loss after previous sleeve gastrectomy
Contraindications
Active stomach ulcers
Large hiatal hernia
Bleeding disorders
Treatment
- Weight-loss procedure
- ESD → larger or early invasive mucosal lesions
- EFTR → deeper or complex lesions requiring full-thickness removal