Endoscopic sleeve gastroplasty, called ESG for short, is a modern, minimally invasive approach to weight loss for individuals who may not qualify for surgery or prefer a non-surgical option. This technique reduces the stomach's size without any incisions or removal of tissue. Instead of using scalpels or making cuts, the procedure is performed entirely through the throat with an endoscope and specially designed tools. The result is a smaller stomach that holds less food and triggers early feelings of fullness. ESG is often a consideration for patients living with obesity who haven't seen sustainable results from lifestyle changes alone.
How does endoscopic sleeve gastroplasty work?
Internal suturing reduces volume
During the procedure, a flexible scope equipped with a camera and suturing device is inserted through the mouth. The stomach is then folded and stitched from the inside to reduce its size by as much as 70%.
Tissue is not removed
Unlike traditional sleeve gastrectomy, this procedure does not involve cutting or removing any part of the stomach. The internal folding technique preserves the natural structure while decreasing its capacity.
Fullness occurs sooner
In some cases, the reduced stomach size helps patients feel full much more quickly during meals. This, in turn, supports better portion control and helps reduce overall calorie intake for some individuals.
A short day procedure
The entire process usually takes around 60 to 90 minutes to complete. Most people return home the same day after surgery or after a precautionary overnight stay, depending on their response to the procedure.
What happens before the procedure?
- Thorough health assessments: Patients undergo medical evaluations that include blood work, a review of weight history, and sometimes psychological screening to assess readiness for lifestyle changes.
- Consultation with a dietitian: Guidance is provided to help patients understand the dietary adjustments required before and after the procedure. Long-term success depends on following these tailored plans.
- Pre-procedure fasting: A period of fasting is required before endoscopic sleeve gastroplasty to ensure the stomach is empty and reduce the risk of complications during endoscopic sleeve gastroplasty.
- Understanding the risks and benefits: Your healthcare provider will walk you through potential outcomes, the importance of follow-up care, and alternative weight loss methods so you can make an informed decision.
What is recovery like after ESG?
Quick discharge and recovery
Most patients return home on the same day or within 24 hours. Recovery is often faster and more comfortable than surgical alternatives, with less downtime overall.
Progressive diet stages
Recovery includes a structured diet that starts with clear liquids, then gradually shifts to puréed foods, soft textures, and finally regular meals over several weeks.
Mild digestive discomfort
Some temporary side effects, such as nausea, cramping, or bloating, may occur during the early recovery phase. These usually resolve on their own within a few days.
Follow-up appointments are key
Routine visits with a specialist help monitor progress and provide support with diet, exercise, and mental health, which are essential for long-term weight management.
Who is ESG recommended for?
Adults with moderate obesity
This surgical procedure is commonly recommended for individuals with a BMI of 30 or higher who have struggled to lose weight through conventional methods.
Those unsuitable for surgery
Patients with health risks that make surgery less safe, elderly people, or those who prefer a less invasive option often find ESG to be a suitable alternative.
People committed to lifestyle change
Success with ESG depends on making consistent dietary and behavioural changes. It’s best suited to those willing to commit to long-term support programs.
Patients seeking a less permanent option
Since no stomach tissue is removed, this procedure can be modified or reversed if necessary, offering flexibility not available with permanent surgeries.
What are the long-term effects and outcomes?
Sustainable weight loss
Many patients lose between 15% to 20% of their total body weight within 12 to 18 months following the ESG procedure, which can lead to improved health.
Improved chronic conditions
Conditions like type 2 diabetes, sleep apnoea, and high blood pressure often improve after ESG due to weight reduction and improved metabolic function.
Nutrient absorption remains normal
Unlike surgeries that involve intestinal bypass, ESG preserves the body’s ability to absorb vitamins and nutrients, lowering the risk of long-term deficiencies.
Lifestyle still plays a central role
The durability of weight loss and health improvements relies on ongoing lifestyle changes, including healthy eating, physical activity, and health support.
FAQs
Yes, if ESG does not lead to desired outcomes or if weight is regained over time, patients may still be eligible for other weight loss procedures in the future, including surgical options.
Most patients can begin light activity like walking within a few days. More vigorous exercise is typically resumed after a few weeks, once cleared by your doctor.
Emotional and behavioural support is often beneficial. Many ESG programs include access to psychologists or counsellors to help patients cope with changes and stay on track.
Weight loss achieved through ESG may improve fertility in some individuals, particularly where obesity has been a contributing factor. However, outcomes vary and should be discussed with a specialist.
Thinking about ESG but not sure if it’s right for you?
If you’ve been trying to lose weight without success, or you’re finding it harder to manage health conditions linked to obesity, it’s natural to feel unsure about what to do next. Learning more about less invasive options like ESG can give you a clearer understanding of what’s available and what might work best for your situation.
While weight loss can be challenging, especially when diet and exercise haven’t delivered the results you hoped for, ESG offers a modern approach that doesn’t involve surgery or long recovery times. Many Australians are now considering ESG as a practical next step to support long-term health and well-being.
You don’t have to face this journey alone. If you’re ready to explore your options or simply want to know whether ESG could be a good fit, speaking with a gastroenterologist in Sydney for an endoscopic investigation is a great place to start. With the right information and support, you can take the next step with confidence and clarity.
MEET DR. SUHIRDAN
Interventional Gastroenterologist and Hepatologist
Bsc (Med) | M.B.B.S. (Hons) | FRACP
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