Endoscopic sleeve gastroplasty

Endoscopic sleeve gastroplasty (ESG) is a new, non-surgical bariatric procedure that achieves a similar effect as gastric sleeve surgery. As it requires no incisions or cutting into the stomach, ESG is even less invasive than laparoscopic gastric sleeve surgery. The patient experiences little or no pain during the procedure and no scarring. An outpatient procedure, ESG is associated with an even quicker recovery time than minimally invasive surgical weight loss procedures.

Here's how ESG works:

• Procedure: During an ESG procedure, a flexible tube with a camera (endoscope) is inserted through the mouth and into the stomach. No incisions are made on the abdomen.
• Suturing: Once inside the stomach, the endoscope is used to place sutures or stitches along the inner lining of the stomach. These sutures help reduce the size of the stomach and create a sleeve-like shape.
• Reduced capacity: By creating a smaller stomach pouch, ESG limits the amount of food a person can comfortably consume, leading to reduced calorie intake.
• Feeling of fullness: The procedure also affects hormones that regulate hunger, leading to a feeling of fullness sooner during meals.
• Weight loss: Over time, this reduced calorie intake and increased feeling of fullness can result in significant weight loss.

Like gastric sleeve surgery, ESG restricts food intake without altering your normal digestion process. ESG may provide the added benefit of reducing the hunger hormone ghrelin. The procedure is not reversible but can be repeated if needed. For some patients, ESG can be used as a bridge to a more invasive bariatric surgery, such as gastric bypass.

At the Weight Loss and Metabolic Institute at Baylor St. Luke’s Medical Center, we specialize in ESG. Our team is happy to offer this new procedure that uses no incisions, leaves no scarring, and has a faster recovery period to patients who qualify.

Benefits of endoscopic sleeve gastroplasty

• Unlike traditional weight loss surgeries that require abdominal incisions, ESG is a minimally invasive procedure. It is performed through the mouth and doesn't involve major surgery, reducing the risk of complications and minimizing scarring.
• Patients undergoing ESG typically have a shorter hospital stay compared to traditional weight loss surgeries. Many individuals can go home on the same day or the day after the procedure.
• The recovery time for ESG is relatively short. Most patients can resume their normal activities within a few days to a week after the procedure.
• ESG is a reversible procedure, which means that if necessary, it can be undone, allowing the stomach to return to its original shape.
• ESG not only reduces the size of the stomach but also affects hormones that regulate hunger. This can lead to a feeling of fullness sooner during meals, helping individuals control their food intake.
• Weight loss achieved through ESG can lead to improvements in obesity-related health conditions such as type 2 diabetes, high blood pressure, and sleep apnea.
• Since ESG is performed entirely within the stomach, it leaves no external scars on the body.
• ESG serves as a tool to kickstart a healthier lifestyle. It encourages individuals to make better dietary choices and adopt a more active lifestyle to maximize weight loss results.
• ESG can be tailored to an individual's specific needs and weight loss goals, making it a flexible option.

Risks associated with endoscopic sleeve gastroplasty

Endoscopic Sleeve Gastroplasty (ESG) is generally considered a safe and minimally invasive procedure for weight loss, but like any medical intervention, it does carry some risks and potential complications.

• Nausea and vomiting
• Gastroesophageal Reflux Disease (GERD)
• Leakage
• Bleeding
• Infection
• Food getting stuck, resulting in an obstruction
• Failure to achieve desired weight loss
• Reversal difficulties
• Persistent hunger
• Complications from anesthesia

Recovering from endoscopic sleeve gastroplasty

• Hospital stay: Most ESG procedures are performed as outpatient procedures, meaning you can usually go home on the same day or the day after the surgery. In some cases, an overnight hospital stay may be required.
• Immediate post-procedure period: Immediately after ESG, you may experience some discomfort, including abdominal pain and bloating. This is normal and can be managed with pain medications prescribed by your bariatric surgeon.
• Diet progression: Your healthcare provider will provide you with specific dietary guidelines to follow during your recovery. Initially, you'll be on a liquid diet for a few days to a week, gradually transitioning to soft foods and then solid foods.
• Activity level: While you can typically resume light activities within a few days after ESG, it's essential to avoid strenuous exercise and heavy lifting for a few weeks to allow for proper healing.
• Follow-up appointments: You'll have follow-up appointments with your healthcare provider to monitor your progress and address any concerns or questions you may have. These appointments are essential for ensuring a successful recovery.
• Medications: You may need to take medications to prevent complications such as acid reflux or infections, especially during the initial recovery period.
• Lifestyle changes: ESG serves as a tool for weight loss, but achieving and maintaining results will require adopting a healthier lifestyle. This includes making better dietary choices and increasing physical activity.
• Weight loss: Weight loss after ESG is gradual and varies from person to person. You'll likely notice weight loss in the weeks and months following the procedure.
• Hydration: Staying well-hydrated is crucial during recovery. Adequate water intake helps with healing and overall well-being.
• Monitoring for complications: While ESG is generally safe, it's essential to be vigilant for any signs of complications, such as persistent pain, fever, or difficulty swallowing. If you experience any unusual symptoms, contact your healthcare provider immediately.

What diet do you follow after endoscopic sleeve gastroplasty?

1. Clear liquid diet:

• In the immediate post-ESG period, you'll start with clear liquids such as water, clear broth, sugar-free gelatin, and herbal tea.
• Sip slowly and avoid carbonated beverages.
• This phase typically lasts for a few days to a week to allow your stomach to heal.

2. Full liquid diet:

• After the clear liquid phase, you'll progress to a full liquid diet.
• Include items like milk, yogurt, protein shakes, creamed soups (strained), and pureed foods.
• Continue to sip liquids slowly and avoid high-sugar liquids.

3. Pureed diet:

• Gradually introduce pureed or blended foods that have a smooth consistency.
• Examples include baby food, mashed potatoes, pureed vegetables, and smoothies with protein.
• Pay attention to portion sizes and avoid foods with high sugar content.

4. Soft diet:

• As you progress, you can move on to a soft diet.
• Incorporate foods like scrambled eggs, oatmeal, well-cooked vegetables, and ground meats.
• Chew your food thoroughly to aid digestion.

5. Solid foods:

• Eventually, you'll return to a regular diet, but portion control and mindful eating will be essential.
• Focus on lean proteins, whole grains, fruits, vegetables, and low-fat dairy.
• Avoid high-calorie, high-sugar, and high-fat foods.

General dietary tips after ESG:

• Hydration: Drink plenty of water throughout the day to stay hydrated. Avoid drinking with meals to prevent overeating.
• Protein: Consume protein-rich foods as they help maintain muscle mass and promote a feeling of fullness.
• Portion control: Pay attention to portion sizes and avoid overeating. Smaller, more frequent meals may be easier to digest.
• Avoid high-sugar and high-fat foods: Sugary and fatty foods can lead to discomfort and may hinder weight loss.
• Slow eating: Take your time to eat slowly and chew thoroughly to aid digestion and prevent discomfort.
• Nutrient-rich foods: Focus on nutrient-dense foods to ensure you're getting essential vitamins and minerals.
• Regular meals: Stick to a regular eating schedule to establish a routine and maintain consistent energy levels.
• Limit snacking: Minimize between-meal snacks to avoid excessive calorie intake.
• Consult your bariatric surgeon: Always consult with your healthcare provider or a registered dietitian to create a personalized post-ESG diet plan that meets your specific needs and health goals.