Endoscopic Sleeve Gastroplasty ( ESG) – Know More About It!

Endoscopic Sleeve Gastroplasty ( ESG) – Know More About It!


By Dr. Tulip Chamany, Bariatrics

This is a weight loss procedure wherein the whole surgery is performed and completed via an endoscope –a tube with a camera introduced through the mouth into the stomach.

The indications for ESG are weight loss in those who have class I  and to an extent classes II obesity and unable to lose weight with diet and exercise.

The expected weight loss from this procedure could be — of excess body weight. This is the reason why this procedure will not hold good in morbidly obese individuals.

In this procedure of endoscopic sleeve gastroplasty, a special suturing device is attached to the double-channel endoscope. Instruments and sutures are passed through these channels and stitches/sutures are taken along the greater curvature of the stomach starting from the lower end (lower body) of the stomach extending proximally, just short of the fundus i.e the uppermost part of the stomach. The fundus is avoided in an attempt to prevent injury to the short gastric vessels and thus avoid bleeding. This converts the wide spacious stomach into a tube having comparatively much lesser volume i.e restriction in gastric volume.  This restriction in gastric volume is responsible for weight loss.

But this weight loss achieved by the ESG (endoscopic sleeve gastroplasty)  is not comparable to the weight loss achieved by the LGS ( Laparoscopic sleeve gastrectomy) as the restriction offered by the LSG is far better and much more than that offered by the ESG.

Secondly, the staplers applied while doing the LSG are full-thickness which is reinforced with full-thickness through and through sutures along the staple line. Thus the chance of stitches loosening or breaking through, and need to insert some sutures within a few months does not arise in the LSG.  Thirdly, the fundus which secretes major part of Ghrelin is removed in the LSG, unlike the ESG. Ghrelin is the prediabetic and hunger hormone. Hence the extent of the resolution of type II DM that the LSG offers will not be there with the ESG.

Thus in comparison, the LSG is far superior to the ESG in terms of weight loss, and durability.

However, the advantage of the ESG is that it is a scarless procedure and can be very helpful in those who have class I obesity  (unable to lose weight with diet and exercise), as the required weight loss will be achieved to bring the person back to ideal weight, which is very important so that a person can maintain the lost weight.

To summarize, you must not be stubborn about a particular weight loss procedure. You must see the pros and cons of each procedure. Most important is that the weight loss procedure must get you close to your ideal weight. This is the success to maintain weight over long years.