Endoscopic Sleeve Gastroplasty

The latest minimally invasive weight-loss procedure is called endoscopic sleeve gastroplasty. During the procedure, a physician inserts a suturing device through the throat and into the stomach. The endoscopist then places sutures in the patient’s stomach to reduce its size. Overweight patients with a body mass index of 30 or higher who haven’t experienced significant weight loss with diet and exercise may benefit from this procedure.

Endoscopic sleeve gastroplasty supports weight loss by limiting how much food patients can eat. Since the procedure is minimally invasive, there is a low risk of complications and virtually no recovery time.

To experience significant weight loss after endoscopic sleeve gastroplasty, patients must commit to living a healthy lifestyle that incorporates a good diet and regular exercise.

The Goals of The Procedure

Not only does endoscopic sleeve gastroplasty support weight loss, but it also lowers patients’ risk of serious weight-related health problems, including:

  • Heart disease and stroke
  • Sleep apnea
  • High blood pressure
  • Osteoarthritis (joint pain)
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
  • Type 2 diabetes

Who Qualifies For Endoscopic Sleeve Gastroplasty?

The procedure is available to people:

  • Whose body mass index (BMI) is greater than 30
  • Who haven’t been able to maintain weight loss with lifestyle modifications alone
  • Who don’t qualify for or wish to undergo traditional weight loss surgery

Every patient will need to undergo a screening process to ensure they’re a good candidate for endoscopic sleeve gastroplasty. Not every overweight patient qualifies for the procedure.

During the screening process, the physician will explain the need to commit to healthy lifestyle changes, attend regular medical follow-up appointments, and receive behavioral therapy.

The procedure isn’t recommended for patients with a large hiatal hernia or an illness associated with gastrointestinal bleeding, such as peptic ulcer disease or gastritis.

The Procedure

Endoscopic sleeve gastroplasty utilizes general anesthesia and is done on an outpatient basis.

The physician will use a flexible tube with a camera and an endoscopic suturing device attached to the tip. The endoscope will be inserted down the patient’s throat and into their stomach. The physician will see inside the patient’s stomach thanks to the tiny camera and place the sutures inside their stomach without making any abdominal incisions.

The sutures will alter the structure of the stomach, forming a tube-like shape. This will restrict the amount of food the patient will be able to eat after the procedure and they will feel fuller sooner.

Patients can expect the procedure to take about 60 to 90 minutes.


Potential Risks And Side Effects

The procedure has a high safety profile. For a few days after endoscopic sleeve gastroplasty, patients may experience pain and nausea. Medication may help manage these temporary side effects.

Though the procedure isn’t designed to be temporary, it can be converted to other forms of bariatric surgery. Patients should speak to their physician to learn more about their options.

If patients commit to a healthy lifestyle, they can expect to lose 15% to 20% of total body weight within 12 to 24 months after the procedure.

FAQs About Endoscopic Sleeve Gastroplasty & The Apollo ESG System

What is Endoscopic Sleeve Gastroplasty (ESG)?
ESG is an endoscopic, incisionless weight loss procedure performed by a doctor, who sutures the stomach with a specialized device called the Apollo ESG™ System to make your stomach smaller.
How is the ESG procedure performed?
While you are asleep, a specially-trained doctor passes a suturing device and camera through your mouth. After they reach the inside of your stomach, the doctor sews it into a smaller shape.
How does it help people lose weight?
The procedure makes the stomach 70-80% smaller. You eat less food so your system absorbs fewer calories. Food stays in the stomach longer, and you feel full longer.
How is ESG different than a laparoscopic gastric sleeve, gastric bypass, or other bariatric surgery?
ESG is performed endoscopically, meaning there are no incisions or scars, and most patients can go home the same day.
What are the most common side effects?
The most common side effects are gastrointestinal symptoms such as nausea, abdominal pain, vomiting, constipation, burping, or diarrhea. These symptoms typically resolve within 30-60 days. All procedures have risk. Patients should talk with their doctor and understand all risks before having any procedure.
Am I a candidate for this procedure?
Apollo ESG™ is for adults with obesity (defined as having a Body Mass Index (BMI) between 30-50 kg/m2) who have not been able to lose weight or maintain weight loss through diet and exercise alone.
Who cannot have ESG?
Patients who are unable to have an upper endoscopy, are pregnant, are using certain types of blood-thinning medications or have malignant tissue, large hiatal hernia, potentially bleeding gastric lesions, or eating disorders are not eligible for the procedure. Talk to your doctor about whether you are a candidate for ESG.
When can I return to work after ESG?
Patients typically return to work in 2-3 days.
How much weight can I lose with ESG?
According to a large, randomized clinical study, patients lose an average of 14% of their body weight 12 months after undergoing the ESG procedure. Results will vary by person.
Are the sutures permanent or dissolvable?
The sutures are made of a durable, permanent material that does not dissolve. However, the sutures can break. In the event the sutures break, you may not feel as full after eating as you did immediately after the procedure. If this happens, another procedure can be done to replace the broken sutures and restore the sleeve.
Is the procedure permanent?
Over time, scarring and bridging tissue forms to maintain the smaller stomach size and sleeve-like shape. As with weight loss surgeries, the sleeve can stretch over time. In the event the sleeve stretches, you may not feel as full after eating as you did after the procedure. If this happens, a retightening procedure can be performed to place new sutures and restore the sleeve.
Is the sleeve reversible?
In the event that you cannot tolerate the sleeve, your doctor may consider reversal. Reversal soon after the procedure can typically be done by cutting and removing the sutures in your stomach. If more time has passed and scarring has formed, the sleeve could be reversed by a procedure to cut the bridging tissue and removing the sutures, if recommended by your doctor. Like with any procedure, reversal of ESG is associated with risks and should be discussed with your doctor before proceeding.
How much does it cost?
Healthcare providers work with patients one-on-one to determine payer coverage and financing options.
Will I have to take nutritional supplements or vitamins?
No, you are typically not required to take nutritional supplements or vitamins following an ESG. Follow your doctor’s instructions on any specialized diet plans during recovery and to maintain a healthy lifestyle
What are the potential positive health impacts of ESG?
ESG has not been specifically tested or FDA approved for the treatment of weight related health issues like diabetes or hypertension. However, in a clinical study that included some patients with diabetes and hypertension, most of the patients with those conditions lost weight. With the weight loss, they tended to show clinical improvement in those pre-existing conditions