Endoscopy Sleeve Gastroplasty, also known as ESG, is a new completely endoscopic (non-surgical) procedure intended to mimic the anatomy of a traditional sleeve gastrectomy without surgery and without removing a large portion of the stomach. The procedure is performed completely through an upper endoscope and makes pleats within the stomach so that the inside portion of the stomach that holds food is almost the size of a sleeve gastrectomy. It is an extremely new procedure with limited long-term data or understanding of the improvements to one’s health such as diabetes or high blood pressure.

Disease Overview

Obesity is a chronic condition in which there is an excessive accumulation of fat in the body.
Obesity is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme or morbid obesity is a BMI of 40 or more.
Obesity is a global problem affecting people of almost all age groups, and is associated with increased risk of cardiac problems, diabetes, high blood pressure, breathing difficulties, and other diseases.


Endoscopy Sleeve Gastroplasty (ESG) is indicated for people with a BMI between 30-40, although it has been performed in people with a BMI over 40. The expectation is that most people will lose 15-20% of their total body weight with the procedure in the first year.


The procedure is performed under general anesthesia and takes 2-3 hours to complete. Between 8 and 10 stitches are used to make the stomach smaller, all through endoscopy and without abdominal incisions or removal of the stomach.

Advantages and Disadvantages of Endoscopic Sleeve Gastrectomy (ESG):


  • No surgery is required
  • Reduced stomach size makes you feel full sooner.
  • Done as an outpatient
  • Low risk profile


  • Irreversible
  • Not typically covered by insurance
  • Less effective in people than traditional surgery and unlikely to be of significant benefits in extremely large patients

Post-operative care:

Your doctor will prescribe pain relieving medications to keep you comfortable following the procedure.

  • You will be advised to take medication to reduce the amount of acid produced by your stomach.
  • You will be given medications to avoid nausea and vomiting that could break the stitches
  • Avoid strenuous exercises and lifting heavy weights until approved by your surgeon
  • You will start with liquids and advance to regular food over the first month.
  • Your dietitian will tailor a new diet regimen for you to follow.

Endoscopic Sleeve Gastroplasty

Risks and Complications:

As with any surgery there are potential risks and complications involved. The risks include blood loss, infections, problems associated with anesthesia, and deep vein thrombosis (blood clot in the leg), as well as injuries to the stomach or any organs or structures surrounding the stomach.