Endoscopic Sleeve Gastroplasty (ESG): A Patient Information Guide
Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive, incision‑free weight‑loss procedure designed for adults with obesity who have not achieved sufficient results through diet, exercise, or medical therapy. It reduces stomach volume using internal sutures placed through an endoscope, helping patients feel full sooner and eat less. ESG has gained global acceptance as a safe, effective option for selected patients seeking a non‑surgical alternative to bariatric surgery.
What ESG Is and How It Works
ESG uses a flexible endoscope inserted through the mouth into the stomach. A suturing device attached to the endoscope places stitches inside the stomach wall, creating large folds that reshape the stomach into a narrow, sleeve‑like tube. This reduces stomach capacity by approximately 70–80%, limiting food intake and enhancing early satiety.
Unlike surgical sleeve gastrectomy, no stomach tissue is removed, and there are no external incisions. The procedure is performed under general anesthesia.
Who ESG Is For
ESG may be appropriate for adults who:
- Have a BMI ≥ 30 (or ≥ 27.5 for certain ethnic groups).
- Have not achieved sustained weight loss through lifestyle changes.
- Prefer a minimally invasive option or do not qualify for traditional bariatric surgery.
ESG is not suitable for individuals with:
- Large hiatal hernias
- Active gastrointestinal bleeding, gastritis, or peptic ulcer disease
- Certain anatomical or medical contraindications identified during screening
Expected Benefits
Weight Loss
Clinical guidance shows ESG can lead to:
- 18–20% total body weight loss within 12–24 months when combined with lifestyle changes.
- ~40% excess weight loss reported in some patient information leaflets.
Improvement in Obesity‑Related Conditions
ESG may help improve:
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Sleep apnea
- Joint pain
- Metabolic dysfunction–associated steatotic liver disease (MASLD/MASH)
Recovery Advantages
- No external cuts or stapling
- Shorter hospital stay (often same day or 1 night)
- Faster return to daily activities compared to surgical bariatric procedures
The Procedure Step‑by‑Step
- General anesthesia is administered.
- The endoscope is passed through the mouth into the stomach.
- A suturing device places stitches along the stomach wall.
- These stitches create folds that narrow the stomach into a sleeve shape.
- The procedure reduces stomach volume by 70–80%.
Total procedure time is typically under 90 minutes.
Risks and Possible Complications
ESG is considered safe, but all medical procedures carry risks. Reported complications include:
- Pain, nausea, or vomiting in the first few days (usually controlled with medication)
- Sore throat from the endoscope
- Aspiration (food or fluid entering the airway)
- Abdominal pain or dehydration
- Bleeding (around 1 in 500 cases)
- Peritonitis or abscess formation
- Pneumothorax (air in the chest cavity)
- Rare perforation of the stomach or esophagus (around 1 in 5000 cases)
Most symptoms resolve within days, and serious complications are uncommon.
Recovery and Aftercare
Hospital Stay
- Many patients go home the same day; others may stay one night depending on recovery.
Diet Progression
Your care team will guide you through:
- Clear liquids
- Full liquids
- Soft foods
- Gradual return to solid foods
Lifestyle Commitment
Long‑term success requires:
- Permanent dietary changes
- Regular physical activity
- Behavioral therapy when recommended
- Ongoing medical follow‑up
Is ESG Reversible?
NICE notes that ESG is potentially reversible because no stomach tissue is removed. However, some clinical sources emphasize that the stomach cannot always be restored to its exact original shape, and sutures may not be fully reversible in practice. (This is an inference based on differences in clinical descriptions.)
Questions to Discuss With Your Healthcare Team
NICE recommends patients consider:
- How many appointments are required
- Expected benefits and likelihood of achieving them
- Risks and their probabilities
- Whether hospitalization is needed
- Alternatives if ESG is not suitable
- What happens if complications occur or results are insufficient
Summary
Endoscopic Sleeve Gastroplasty is a safe, minimally invasive weight‑loss procedure that reduces stomach volume using internal sutures. It offers meaningful weight loss and improvement in obesity‑related conditions with faster recovery than surgical options. ESG is best suited for motivated patients willing to commit to long‑term lifestyle changes and regular follow‑up.
References
- University Hospitals Coventry & Warwickshire. Endoscopic Sleeve Gastroplasty – Patient Information Leaflet. 2024.
- Mayo Clinic. Endoscopic Sleeve Gastroplasty – Tests & Procedures Overview. 2026.
- National Institute for Health and Care Excellence (NICE). Endoscopic Sleeve Gastroplasty for Obesity – Public Information (HTG711). Updated Feb 2024.