Endoscopic Sleeve Gastroplasty (ESG)

Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive, non-surgical weight loss procedure that has gained prominence as an effective alternative to traditional bariatric surgeries. By utilizing an endoscopic approach to reduce stomach size, ESG promotes significant weight loss with fewer risks and a quicker recovery time.

Procedure Overview

ESG involves inserting a flexible endoscope through the mouth into the stomach. Using an endoscopic suturing device, the physician places a series of sutures to fold and constrict the stomach, transforming it into a sleeve-like shape. This alteration reduces the stomach’s volume by approximately 70%, leading to earlier satiety and decreased food intake. The procedure typically lasts about 60 to 90 minutes and is performed on an outpatient basis, allowing patients to return home the same day.

Efficacy and Outcomes

Clinical studies have demonstrated the effectiveness of ESG in achieving substantial weight loss. The MERIT study, a multicenter randomized controlled trial, reported that patients undergoing ESG experienced an average total body weight loss of 13.6% at one year, compared to 0.8% in the control group receiving lifestyle modifications alone.  Additionally, a meta-analysis indicated that ESG patients achieved approximately 16% total body weight loss at one year, with excess weight loss around 60%.

Safety Profile

ESG boasts a favorable safety profile, with most patients experiencing mild to moderate gastrointestinal symptoms—such as nausea, cramping, and abdominal discomfort—that typically resolve within a week. Serious adverse events are rare, with reported rates of 1.9% for ESG compared to 14.5% for laparoscopic sleeve gastrectomy (LSG).  The minimally invasive nature of ESG contributes to a quicker recovery and lower complication rates compared to surgical alternatives.

Advantages Over Traditional Bariatric Surgery

Unlike surgical procedures like LSG, ESG does not involve incisions or removal of stomach tissue, preserving the stomach’s natural anatomy. This preservation facilitates future medical procedures, such as gastric cancer screenings or Endoscopic Retrograde Cholangiopancreatography (ERCP), if necessary. Furthermore, ESG is associated with a lower incidence of gastroesophageal reflux disease (GERD) and other complications commonly linked to surgical interventions.

Considerations

While ESG presents numerous benefits, it requires a commitment to lifestyle changes, including dietary modifications and regular physical activity, to maintain long-term weight loss. As a relatively new procedure, ongoing research continues to evaluate its long-term efficacy and safety. Patients should engage in thorough discussions with their healthcare providers to determine the most appropriate weight loss strategy based on individual health profiles and weight loss goals.