Frequently Asked Questions About Endoscopic Sleeve Gastroplasty

Published on: September 8, 2023

Table of Contents

Frequently Asked Questions About Endoscopic Sleeve Gastroplasty


In recent years, the medical community has witnessed significant advancements in weight-loss interventions, with Endoscopic Sleeve Gastroplasty (ESG) emerging as a notable innovation. Originating as a less invasive alternative to conventional bariatric surgeries, ESG offers individuals a surgical solution with reduced recovery time and potential complications[1]. Essentially, ESG involves reducing the size of the stomach using an endoscope inserted through the mouth, thus bypassing the need for external incisions[2]. 

The global obesity epidemic, now affecting almost 13% of the world’s adult population[3], necessitates varied and customisable weight loss solutions. Understanding ESG becomes crucial for individuals exploring weight loss alternatives in this context. It offers a blend of effective weight loss, improvements in obesity-related conditions, and an enhanced quality of life for many[4]. 

Yet, as with any medical procedure, it’s essential to approach ESG comprehensively, weighing its benefits against potential risks. Many potential candidates grapple with questions regarding its efficacy, the procedure, post-operative care, and long-term outcomes. Moreover, understanding how ESG positions itself within the broader realm of bariatric procedures is vital for those making informed decisions about their health[5].

This article addresses these pressing questions, guiding readers through the intricacies of ESG. By providing evidence-based answers, we aim to empower individuals in their weight loss journey, ensuring they make decisions rooted in knowledge and understanding.


What is Endoscopic Sleeve Gastroplasty?

Definition and Procedure

Endoscopic Sleeve Gastroplasty (ESG) is an innovative, less-invasive weight loss procedure to reduce stomach size. Unlike traditional bariatric surgeries that involve external incisions, ESG utilises an endoscope—a flexible tube equipped with a camera and surgical tools. This endoscope is inserted through the mouth into the stomach, where it sutures the stomach, reducing its volume and limiting food intake[6].

Differentiating ESG from Traditional Bariatric Surgery

The primary distinction between ESG and its traditional bariatric counterparts, such as the gastric bypass or gastric sleeve, lies in the method of approach. Traditional surgeries require abdominal incisions with potential external scarring and extended recovery periods. In contrast, ESG is entirely endoscopic, leaving no external scars and often leading to quicker recovery[7]. This procedure also provides potential candidates with a middle ground between non-surgical weight loss interventions, such as diet and exercise or medications, and more invasive bariatric surgeries[8]. 

Moreover, given that ESG doesn’t involve permanent changes to the stomach anatomy, as seen in procedures like gastric bypass, it can be reversed or modified if necessary. However, it’s essential to note that the choice between ESG and other procedures should be based on individual medical history, weight loss goals, and discussions with healthcare professionals[9].

In summary, ESG offers a promising alternative to traditional bariatric surgeries. It’s minimally invasive, has fewer complications, and can be an effective tool in the fight against obesity. As with any medical intervention, understanding its benefits and potential risks is crucial before opting for the procedure[10].

Who is a Candidate for ESG?

Eligibility Criteria

ESG has specific eligibility criteria, targeting individuals who’ve struggled with conventional weight loss methods but might not qualify for or wish to avoid more invasive bariatric surgeries. Generally, a candidate for ESG would have a Body Mass Index (BMI) between 30 and 40, suggesting that they fall within the obese category[11]. However, certain exceptions may apply, especially in cases where obesity-related health conditions are present, even if the BMI is slightly below or above this range[12].

It’s important to note that candidates must be prepared to make lifelong dietary and lifestyle changes like other weight loss procedures. A commitment to post-procedure guidelines, including diet, exercise, and regular follow-up visits, is essential for the success of ESG[13].

Contraindications and Exclusions

While ESG offers a less invasive weight loss alternative, it’s only suitable for some. Individuals with certain gastrointestinal conditions, previous stomach surgeries, or chronic anti-inflammatory medication use may be advised against this procedure due to heightened risks[14]. Additionally, those with severe heart or lung conditions might be excluded, as the sedation required for the procedure could pose risks.

Moreover, patients seeking rapid or highly significant weight loss might be better suited for more intensive bariatric surgeries, given that the weight loss potential for ESG, while effective, might be less than that of traditional surgeries[15]. A thorough medical evaluation and open discussions with healthcare professionals are pivotal in determining the best course of action tailored to an individual’s needs.

How is ESG Performed?

Step-by-step Process

Endoscopic Sleeve Gastroplasty (ESG) represents a leap in medical innovation due to its minimally invasive nature. To initiate the procedure, the patient is sedated to ensure comfort. An endoscope, equipped with a tiny camera and surgical instruments, is inserted through the patient’s mouth and guided down into the stomach[16].

Upon reaching the stomach, the specialist uses the tools on the endoscope to place a series of sutures in the stomach lining. These sutures are strategically placed to reduce the overall volume of the stomach. By cinching the stomach together with these sutures, its functional size is significantly reduced. This leads to a feeling of fullness after consuming smaller portions of food, thus aiding in weight loss[17].

Equipment and Duration

Modern advancements have equipped gastroenterologists with high-definition endoscopes, enhancing the precision of the procedure. These endoscopes, combined with specially designed suturing devices, allow for meticulous placement of sutures, ensuring the stomach’s volume is optimally reduced while maintaining its integrity[18].

The duration of the ESG procedure typically ranges from 60 to 120 minutes. However, this can vary depending on the individual’s anatomy and any unforeseen complications. Despite the relatively short duration, it’s advised that patients plan for observation and recovery time post-procedure, often requiring an overnight stay at the medical facility[19].

While ESG offers a novel, less invasive weight loss solution, understanding the mechanics behind its performance is crucial for potential candidates. This knowledge allows for realistic expectations and informed decision-making when considering the procedure as an option for weight loss[20].

What are the Benefits of ESG?

Weight Loss and Health Outcomes

Endoscopic Sleeve Gastroplasty (ESG) has proven to be an effective intervention for weight loss. On average, individuals who undergo ESG can expect to lose between 15% to 20% of their initial body weight within the first year post-procedure[21]. This weight reduction can have profound positive effects on overall health. Studies have found that alongside weight loss, many ESG patients experience improvements in obesity-related conditions, including type 2 diabetes, hypertension, and sleep apnea[22]. Decreasing these comorbidities enhances the quality of life and can reduce the risks of long-term health complications.

Minimally Invasive with Reduced Recovery Time

One of the most significant advantages of ESG over traditional bariatric surgeries is its minimally invasive nature. Because ESG is performed endoscopically through the mouth, it eliminates the need for external incisions. This results in less post-operative pain, reduced scarring, and a significantly shorter recovery time[23]. Many patients can return to normal activities within a few days instead of weeks with more invasive surgeries.

Additionally, the absence of external cuts lessens the risk of post-surgical infections, further bolstering the procedure’s safety profile. The reduced invasiveness of ESG also means that patients often spend less time in the hospital post-procedure, leading to decreased healthcare costs and less disruption to their daily lives[24].

In summary, ESG presents an appealing option for those seeking an effective weight loss solution with minimal surgical risks. By delivering substantive weight loss and health improvements in a less invasive manner, ESG has positioned itself as a leading choice in modern bariatric interventions[25].


What are the Risks and Side Effects of ESG?

Common Side Effects

Like any medical procedure, Endoscopic Sleeve Gastroplasty (ESG) has potential side effects. Immediately post-procedure, patients might experience nausea, abdominal pain, and a sensation of fullness in the upper stomach[26]. These side effects are usually transient, resolving within a few days as the body adjusts to the newly structured stomach. Additionally, there might be minor bleeding at the suture sites, but this often resolves spontaneously without intervention.

Potential Complications

While ESG boasts a high safety profile, complications, though rare, can occur. One of the more significant risks involves the sutures. There’s a possibility of the sutures tearing or leaking, leading to the formation of a gastric fistula or perforation, conditions that would necessitate further medical or surgical intervention[27]. Infections, although uncommon due to the procedure’s internal nature, can also occur, especially if there’s a leakage from the suture sites into the abdominal cavity.

Another rare but noteworthy complication is the potential for gastric obstruction or narrowing at the sutured areas, which may require further endoscopic or surgical procedures to rectify[28].

Patients must remain vigilant post-procedure, promptly reporting any unusual symptoms to their healthcare provider. While complications are uncommon, early detection and management are critical to ensuring the best outcomes and patient safety[29].

In conclusion, while ESG provides a less invasive alternative with numerous benefits, potential candidates should be thoroughly informed of its advantages and associated risks. Open communication with healthcare professionals is pivotal for a holistic understanding and making informed decisions[30].

Recovery and Post-procedure Care

Immediate Post-ESG Care

Following the Endoscopic Sleeve Gastroplasty (ESG) procedure, patients typically require observation for several hours to ensure no immediate complications. While most individuals can return home the same day, some might be advised to stay overnight for monitoring[31]. The initial post-procedure days might come with sensations of nausea, pain, or discomfort, but these are generally manageable with over-the-counter or prescribed medications.

Dietary modifications are vital immediately after the surgery. Patients are usually placed on a liquid diet for a few days, followed by a gradual introduction of soft foods. It’s imperative to adhere to the dietary recommendations provided by the healthcare team to ensure optimal healing and reduce the risk of complications[32].

Long-term Care and Lifestyle Adjustments

Long-term lifestyle changes are pivotal for sustained weight loss and health benefits post-ESG. Regular follow-ups with healthcare providers, typically at one, three, six, and twelve-month intervals in the first year, are advised to monitor weight loss progress and address any concerns[33].

Dietary habits post-ESG should be a cornerstone of the recovery journey. A balanced diet, portion control, and avoiding overeating are crucial to preventing complications and ensuring the procedure’s success [34]. Alongside diet, integrating regular physical activity into daily routines can augment weight loss outcomes and boost overall health.

Mental and emotional well-being is another aspect of post-ESG care. Some patients might grapple with body image issues or emotional eating patterns. In such cases, counselling or support groups can be beneficial in navigating these challenges[35].

In summary, while ESG offers a promising start to weight loss, its long-term success hinges on dedicated post-procedure care, lifestyle modifications, and holistic well-being.

How Effective is ESG in Long-term Weight Maintenance?

Sustained Weight Loss Post-ESG

Endoscopic Sleeve Gastroplasty (ESG) has showcased promising results regarding initial weight loss, but its efficacy in long-term weight maintenance remains a topic of keen interest. Research indicates that individuals who undergo ESG tend to maintain a significant portion of their initial weight loss for an extended period. Studies have demonstrated that many patients retain a weight loss of about 15% to 20% even after two to three years post-procedure[36]. Such sustained weight loss is noteworthy, especially when juxtaposed against conventional weight loss methods, often resulting in weight regain within a year.

Factors Influencing Long-term Success

While the procedure plays a pivotal role, the long-term success of ESG is significantly influenced by the patient’s commitment to post-procedure guidelines and lifestyle modifications. Adherence to dietary recommendations, consistent physical activity, and regular medical follow-ups can enhance the chances of prolonged weight maintenance[37].

Furthermore, psychological factors can also play a decisive role. Some patients might revert to old eating habits or grapple with emotional eating, which can jeopardise the weight loss achieved through ESG. In such cases, seeking counselling or joining support groups can be instrumental in addressing underlying emotional triggers and fortifying weight maintenance strategies[38].

It’s essential to understand that while ESG offers a robust foundation for weight loss, its long-term efficacy is often a collaborative result of the procedure and the patient’s dedication to a healthier lifestyle[39]. Thus, a multi-pronged approach encompassing medical, behavioural, and psychological aspects is the key to reaping the enduring benefits of ESG[40].

Does Insurance Cover ESG?

The Landscape of Insurance Coverage

The financial aspect of medical procedures, including Endoscopic Sleeve Gastroplasty (ESG), often looms large for many patients. While ESG is a recognised bariatric intervention, insurance coverage can vary significantly based on the insurer and geographical region[41]. ESG is relatively new in certain areas, leading some insurance companies to categorise it as an ‘experimental’ or ‘investigational’ procedure. As a result, they might not offer coverage. On the other hand, given the mounting evidence of ESG’s efficacy and safety, many insurers recognise its value and extend coverage benefits[42].

Steps to Determine Insurance Eligibility

For patients considering ESG, engaging with their insurance providers to proactively understand coverage nuances is crucial. Here are some steps to follow:

  1. Policy Review: Begin by thoroughly reviewing your insurance policy, focusing on the section related to weight loss or bariatric interventions. Some policies explicitly list procedures they cover, while others might necessitate further clarification[43].
  2. Direct Communication: Contact your insurance provider directly. Ask specific questions regarding ESG coverage, potential copayments, and any prerequisites for procedure approval, such as mandated dietitian consultations or psychological evaluations[44].
  3. Documentation: Maintaining a documented history of previous weight loss attempts, associated health complications, and recommendations from primary care physicians or specialists is beneficial. Such documentation can strengthen the case for insurance approval, especially if ESG is deemed medically necessary[45].


In conclusion, while the insurance landscape for ESG is evolving, patients should take a proactive approach. By understanding their policy, communicating with insurers, and keeping a thorough record, they can navigate the financial aspects of ESG with clarity.

How does ESG Compare to Other Bariatric Procedures?

ESG versus Traditional Bariatric Surgeries

Endoscopic Sleeve Gastroplasty (ESG) is often juxtaposed against more traditional bariatric surgeries like gastric bypass and sleeve gastrectomy. One of the primary distinctions lies in the method of intervention. ESG is endoscopic, meaning it’s less invasive, involves no external incisions, and utilises a flexible tube with a camera (endoscope) inserted through the mouth[46]. Traditional bariatric surgeries, on the other hand, often require larger incisions or laparoscopic techniques.

Regarding weight loss, while gastric bypass and sleeve gastrectomy typically result in more significant weight reduction, ESG offers substantial weight loss benefits with a lower risk profile and shorter recovery time[47].

ESG versus Non-Surgical Interventions

When comparing ESG to non-surgical weight loss interventions, such as diet, exercise, or weight loss medications, ESG generally showcases higher and more consistent weight loss outcomes. While lifestyle modifications are foundational for weight management, many individuals need help with long-term adherence. ESG, by altering the stomach’s structure, provides a physiological tool that complements behavioural efforts, leading to more sustained weight loss[48].

Additionally, ESG doesn’t come with the risks of pharmacological side effects compared to weight loss medications. Moreover, while medications often have to be taken long-term, ESG is a one-time intervention with enduring benefits[49].

In conclusion, ESG offers a middle ground between traditional bariatric surgeries and non-surgical interventions. It combines the tangible physiological benefits of surgical procedures with the reduced invasiveness and risks associated with non-surgical approaches, making it an attractive option for many seeking a balanced weight loss solution[50].


Endoscopic Sleeve Gastroplasty (ESG) represents a groundbreaking evolution in weight loss interventions. Striking a balance between the efficacy of traditional surgical procedures and the minimal invasiveness of non-surgical treatments, ESG offers a unique, patient-friendly approach to combat obesity[51]. As research continues to underline its benefits, it’s clear that ESG not only aids in substantial weight loss but also enhances the patient’s quality of life by mitigating obesity-related complications[52]. Nevertheless, as with any medical procedure, understanding its intricacies, potential risks, and post-procedure care remains paramount. The financial implications of ESG, mainly concerning insurance coverage, further highlight the need for thorough patient research and consultation with healthcare professionals[53]. The journey of weight loss is deeply personal, and while ESG offers a promising path, the commitment to a healthier lifestyle will always remain the cornerstone of sustained success[54]. In a world grappling with the obesity epidemic, innovations like ESG play a pivotal role in offering hope and tangible solutions to millions[55].


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