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Obesity not only affects the quality of your life, but it is also a health hazard. Numerous studies show that excess body weight increases the risk of several illnesses and diseases, many of which can increase the mortality risk. These include type 2 diabetes, high blood pressure, and certain types of cancer. If you suffer from obesity and have not been able to get the desirable results from dieting and exercising, Endoscopic Sleeve Gastroplasty (ESG) is worth considering. It’s a popular weight-loss procedure that can give great results when combined with a healthy diet and regular exercise.

In this post, we’ll discuss ESG in detail, including how it is done and its benefits. So, let’s get started.


Endoscopic Sleeve Gastroplasty (ESG) – An Introduction

Endoscopic Sleeve Gastroplasty, also called the accordion procedure and the endoscopic gastric sleeve, is a relatively new type of minimally invasive weight loss procedure, in which an endoscopic suturing device is used to reduce the stomach size. There’s no surgery involved in this procedure, and it is ideal for those who:

  • have a body mass index of at least 30; and
  • have not been able to lose much weight from dieting and exercise alone

The ESG procedure can help you lose a considerable amount of weight. Since the procedure is minimally invasive, the risk of complications is lower compared to other weight loss procedures involving surgery. Plus, after an ESG, you can return to your daily activities fairly quickly.

It is important to note that ESG requires a strong commitment to a healthy lifestyle. To enjoy the long-term benefits of this procedure — or any other weight-loss procedure, for that matter — you must make permanent changes to your diet and exercise regularly.


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Why Endoscopic Sleeve Gastroplasty is Done

 ESG is done to make it easier for you to lose excess weight. Losing weight helps improve the quality of life and potentially reduce the risk of severe weight-loss complications, including:

  • High blood pressure
  • Type 2 diabetes
  • Heart complications, including stroke
  • Osteoarthritis
  • Gallbladder disease
  • Sleep apnea
  • Low HDL cholesterol, High LDL cholesterol, and high triglyceride levels
  • Certain types of cancer

Like other bariatric procedures, the ESG procedure is recommended when the person has tried dieting and exercising but couldn’t get the desired benefits.


Who Qualifies for Endoscopic Sleeve Gastroplasty

Like other weight-loss procedures, ESG is recommended for those suffering from obesity. It is meant for patients who have a BMI of 30 or higher and who have previously tried losing weight through dieting and exercise. ESG can also be beneficial for patients suffering from overweight (BMI between 25 and 30) particularly if they have one or more weight-related conditions, such as high blood pressure, diabetes, fatty liver, sleep apnea, or arthritis.

However, not all people with a BMI of 30 or higher qualify for ESG. To find out if you are the right candidate for ESG, your doctor will ask you to undergo a screening process. Plus, you must be ready to follow a healthy diet (as recommended by your doctor) and exercise regularly post-surgery.

ESG is not recommended for patients who previously had gastric surgery or patients who were diagnosed with an eating disorder.


Benefits of Endoscopic Sleeve Gastroplasty

Just like with other weight-loss programs, the amount of weight you will lose after ESG depends on your commitment to a healthy diet and regular exercise. Generally speaking, if someone undergoes ESG and follows all the doctor’s recommendations pertaining to nutrition and physical activity, they can expect to shed an averageof 18% – 20% of their total body weight in 12 months.

In addition to weight loss, ESG may considerably improve conditions usually linked to obesity, including, but not limited to, heart disease, high blood pressure, osteoarthritis, sleep apnea, and type 2 diabetes.


Risks of The Endoscopic Sleeve Gastroplasty

Because ESG is a non-invasive procedure, it has a better safety profile than other bariatric weight-loss procedures. After ESG, you may feel nausea and pain for a few days. Your doctor is likely to prescribe medicines for managing these symptoms. After some days, you can expect to feel better.



Preparing for Endoscopic Sleeve Gastroplasty

Before the procedure, you will receive specific instructions on how to prepare yourself for it. You might also need to undergo certain exams and lab tests.

Your doctor is likely to ask you to go on a high-protein, low-carb diet and increase fluid intake a few days before the procedure. The night before the weight-loss procedure, you will be asked to not eat food or drink liquid after midnight.


How Endoscopic Sleeve Gastroplasty is Done

ESG is performed as an outpatient procedure and usually takes less than an hour. Even though no surgical incisions are done during the procedure, you will be under general anesthesia. In other words, you will be unconscious for the full duration of the procedure.

The endoscopist advances an endoscope (a tube with a camera and a light on its tip) through the mouth to the stomach. The scope is equipped with a suturing device that allows the doctor to suture the stomach from the inside and decrease its size.

The sutures hold the stomach in a tube shape. When the stomach heals, it will remain in its new shape and size.

ESG can significantly decrease the size of the stomach. The stomach can accommodate smaller meals; but the rate at which the food empties from the stomach is also decreased, so a smaller meal lasts for a longer time. This allows the patient to follow a low-calorie diet without feeling hungry all the time.

Patients are discharged home the same day after being monitored in the recovery area for around 2 hours.



Diet Post Endoscopic Sleeve Gastroplasty

After an ESG procedure, it is important to follow your doctor’s recommendation regarding what foods to eat and what foods to avoid.

In the first 3 days after ESG, you will be on a Clear Liquid Diet with the goal to drink 48-64 fluid ounces per day. It is important that you take small sips and avoid gulping or drinking too quickly to help prevent discomfort. A good benchmark is to aim for 1-2 ounces of clear liquids every 15 minutes. The Clear Liquid Diet will consist of sugar-free, non-carbonated beverages that contain less than 10 calories per 8-ounce serving. The main goal of these first 3 days is to make sure you are staying hydrated.

Days 3-14: You will start a full liquid diet. While on the Full Liquid Diet, you can still drink everything listed on the Clear Liquid Diet, in addition to a protein shake with specific requirements. You will need to drink 2-3 protein shakes/day to meet your protein goal.

You will still need to get at least 64 ounces of sugar-free, non-carbonated liquids. You will still need to pace yourself and aim for 1-2 ounces every 15 minutes.


2 weeks after ESG – You can start taking semi-solid foods after 2 weeks. The consistency of food during this phase should be soft enough to mash with a fork. During the soft diet phase, you will need to continue with 1 protein shake per day in addition to choosing protein-based soft foods such as eggs, soft-baked white fish, canned chicken/tuna/salmon (mixed with mayonnaise or plain Greek yogurt to have the appropriate texture so that it can be mashed with a fork), deli meats (like chicken, turkey, or ham), and soft vegetable proteins like tofu. You will also be able to incorporate some real cheese, cottage cheese, ricotta cheese, Greek yogurt, legumes, lentils, or refried beans.


4 weeks after ESG – After 4 weeks, you can transition to a regular maintenance diet. This does not mean the same diet you used to eat before the ESG. Regular diet refers to the consistency of the food, but you still need to continue with high-protein food choices. As you transition to regular consistency foods you will notice you will not be able to eat quite as much as you did when you were eating soft foods. This is normal. This is the purpose. Your focus will continue to be a consistent meal pattern of 3 meals daily with 1 snack if needed.


Keep in mind that you must maintain a healthy diet post-ESG procedure. This procedure produces the best results when combined with healthy lifestyle changes, which include sticking to a healthy diet and getting adequate physical activity.

Maintaining a high level of physical activity is vital for weight loss after ESG. Research shows that people who exercise regularly, are able to shed more weight than those who don’t. Exercise also decreases the risk of weight regain. Regular physical activity reduces your risk of several health conditions, including, but not limited to, high blood pressure, heart problems, stroke, depression, anxiety, arthritis, certain types of cancer, and metabolic syndrome. In addition, it also promotes better sleep and boosts energy.


ESG Frequently Asked Questions


Does one need to take supplements post Endoscopic Sleeve Gastroplasty?

Patients need to take vitamin supplements particularly when on a restrictive liquid diet and while losing weight. We do recommend several vitamins, including multivitamins, Calcium, vitamin D, and vitamin B12. Taking these vitamins is important for healthy weight loss. ESG does not alter the absorption of the foods in the small bowel and therefore we do not see the vitamin deficiencies that occur in patients who undergo gastric bypass.


How much weight one can lose following Endoscopic Sleeve Gastroplasty?

ESG is a non-invasive weight loss procedure that restructures your stomach and makes it smaller. As a result of which, you feel satiated early and will likely eat less. However, the amount of weight loss depends on several factors, including your diet and lifestyle. You can expect to lose up to 20% of your total body weight within a year if you follow a healthy diet and exercise regularly.


How long one need to stay in the hospital after Endoscopic Sleeve Gastroplasty?

ESG is an outpatient procedure that does not require incisions or cutting the stomach. Patients are able to go home a 2-3 hours after the procedure.



A non-invasive weight-loss procedure, ESG is best suited for patients suffering from obesity who were not able to lose weight with diet and exercise alone. The procedure has minimal risk and can help you lose on average 18% to 20% of your total body weight within just 12 months, provided you follow your doctor’s diet and exercise recommendations.


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