Endoscopic Sleeve Gastroplasty

Why people are choosing endoscopic sleeve gastroplasty (ESG) over a surgical sleeve gastrectomy?

One of the primary reasons people are choosing ESG first and foremost is that it is not a Gastric sleeve surgery! ESG is a completely endoscopic weight loss intervention, meaning that all the work is done from inside the body using an endoscope.

An endoscope is a flexible tube with a camera on the end. With ESG the patient is completely asleep for the procedure, and the endoscope is inserted through the mouth into the stomach and all the work is done.

The procedure takes less than 2 hours, and the patient wakes up with no scars! ESG is a nice option for some patients because the thought of surgery can be daunting for some patients because it is invasive and can have significant complications.

ESG involves suturing the stomach from the inside to plicate the folds and change its shape from a football to more of a banana shape. This reduces the stomach volume by 60-70%. Instead of cutting away the majority of the stomach as they do in surgery, ESG accordians the stomach down in a minimally invasive fashion.

Because ESG is an endoscopic procedure, it is done on an outpatient basis. Patients go home the same day as the procedure. ESG has been shown to be very safe and with very little recovery time.

Many obese patients do not qualify for bariatric surgery through their insurance. ESG is a new therapeutic avenue for obese patients who did not have any options before.

ESG has been shown to be extremely effective at achieving weight loss. Patients will lose about 20% their total body weight after ESG. ESG has been shown to be as effective for weight loss as surgical sleeve gastrectomy in patients with class 1 and 2 obesity.

ESG has been shown to make significant improvements in patients’ blood pressure, diabetes markers, and waist circumference

After ESG you only need to eat about 30-35% of your previous meals to feel full.

Frequently Asked Questions about Endoscopic Sleeve Gastroplasty Procedure

What are the advantages of Endoscopic Sleeve Gastroplasty over weight loss surgery?

ESG is a completely endoscopic procedure – meaning it is not a surgery. There are no cuts or incisions into the patient’s body. All the intervention is performed from inside the stomach with an endoscope.

Because ESG is an endoscopic procedure – the recovery time from the procedure is much less than surgery. It is performed on an outpatient basis, meaning that patients go home the same day as their procedure and do not need to stay in the hospital (as they do with bariatric surgery). Usually patients are back to work in 3-4 days.

ESG has been shown to have fewer complications than weight loss surgery

ESG is more effective than the lap band surgery and as effective as the surgical sleeve procedure in inducing weight loss in patients with mild to moderate obesity (BMI 30-40)

How much does it cost for Endoscopic Sleeve Gastroplasty in Dallas, Tx

The ESG procedure is not covered by insurance at this time and thus is a cash pay procedure. Our cash pay model includes all of the costs of the procedure itself along with 12 months of aftercare with a dietician and physician. While pricing varies, the cost is around $10,000.

Is there any side effect after Endoscopic Sleeve Gastroplasty procedure

After ESG about 50% of patients will experience abdominal cramping and nausea for about 3-5 days. This is a normal aftereffect because of the manipulation that has been done to the stomach itself. The rate of significant complications is about 2% which is less then conventional bariatric surgery. Currently no deaths have been reported with the ESG procedure.

What is the Success Rates for Endoscopic Sleeve Gastroplasty procedure in Dallas, Tx

ESG has been shown consistently in multiple large series to achieve on average 15-20% total body weight loss at about 12 months after the procedure. This number can be greater in motivated patients. The greatest amount of weight loss occurs in the first 6 months.

How long should i stay in hospital for Endoscopic Sleeve Gastroplasty procedure

ESG is an outpatient. The goal is for the patient to have zero days staying in the hospital.

My BMI just over 30 and should i do esg?

A BMI over 30 is the medical definition of obesity. Obesity is associated with multiple medical problems (high blood pressure, heart disease, diabetes, etc) and also many cancers and may reduce a patient’s overall life expectancy. Reducing body weight to a normal range has been shown to lower the rates of obesity-related diseases. Thus weight reduction is very important for obese individuals. If a patient with a BMI > 30 cannot lose weight with diet and exercise along, then ESG would be a good option to help them with achieving significant, long-term weight loss.

Which insurance provider covers ESG in Dallas, Tx?

Currently there are almost no insurance providers covering ESG. Thus ESG is a cash pay model. We are happy to attempt getting a prior authorization from the insurance company for approval.

What should I eat 2weeks after the ESG procedure?

For the first 2 weeks after ESG the patient is on a liquid diet. After 2 weeks, they progress to a solid diet.

How long does endoscopic sleeve gastroplasty last?

The procedures can vary significantly in length, depending on the individual case. Generally, most endoscopic sleeve gastroplasties last between one and two hours.

Is endoscopic sleeve gastroplasty permanent?

Endoscopic sleeve gastroplasty is a weight-loss surgery performed by shrinking the stomach through a tube inserted down the throat. This surgery is not permanent; the stomach can return to its original size if the patient does not maintain a healthy diet and lifestyle.

What happens to the stomach after ESG?

After an endoscopic sleeve gastroplasty (ESG), the stomach is much smaller. It can hold about 60-80% less food than before the surgery. This is because the abdomen is much narrower and shorter. A smaller stomach means you will feel full more quickly and won’t be able to eat as much. This can help you lose weight.

Is ESG surgery painful?

ESG surgery is minimally invasive, so most patients report only mild discomfort during and after the surgery. However, every candidate is different; some may experience more pain than others. Talk to your physician about pain management options if you’re worried about pain during your ESG surgery.

What can I eat after ESG?

After your ESG, you can eat anything you want – no restrictions. Just be sure to listen to your body and eat when hungry. Some people feel better after eating smaller, more frequent meals rather than large ones. And it’s always a best idea to drink plenty of water.

Is it FDA-approved endoscopic sleeve gastroplasty in Dallas, Tx?

Yes, endoscopic sleeve gastroplasty is FDA approved. The FDA has cleared this weight loss surgery as a safe and effective treatment for obesity. This surgery is also known as gastric sleeve surgery or vertical sleeve gastrectomy. It is a minimally invasive process that reduces your stomach size, helping you feel full faster and eat less.

What is the Obesity Epidemic?

Obesity has become an epidemic in the US with now 1 in 3 Americans meeting criteria for obesity. Obesity is measured the ratio of a person’s weight (or mass in kg) to their height – this measurement is called the body mass index (BMI). The rates of bariatric surgeries are also increasing. However many patients do not meet criteria for bariatric surgeries or do not want to undergo such an invasive and potentially risky procedure to lose weight.

What is Endoscopic Sleeve Gastroplasty (ESG)?

New technologies are allowing endoscopists to offer minimally invasive obesity interventions for these patients. One such technology is the performance of endoscopic suturing inside the stomach to reduce the volume of the stomach into a sleeve shape. This is similar to the concept of the surgical sleeve gastrectomy, but instead of cutting the stomach away, endoscopists just suture it down from the inside to make it smaller. Because Endoscopic Sleeve Gastroplasty causes patients to eat less, patients can lose on average over 50% of the excess body weight after one year. This is an exciting technology and option for obese patients, done on an outpatient basis.

Dr. Kedia has been performing ESG since 2014. He helped perform the first ESG procedure in New York City and has now brought this expertise down to to Texas

What can I expect during and after Endoscopic Sleeve Gastroplasty (ESG)?

All ESG procedures are performed under general anesthesia, thus the patient will not feel any pain or remember the procedure.  Once the patient is sedated, the endoscopist will insert the endoscope into your mouth where it will travel down your stomach where the ESG is performed with endoscopic suturing.  After the procedure the patient will recover from anesthesia and be discharged home.

It is common after the procedure to experience nausea, vomiting and abdominal pain after the procedure.  Patients may require medications for nausea and abdominal cramping temporarily to control symptoms.  These symptoms will usually resolve after a few days.

The most important aspect for the success of ESG is the patient’s aftercare.  Patients are highly encouraged to participate in a dietary, behavioral, and exercise program to optimize the success of their intervention and help maintain it for the long term.  Patients help navigate this program over 12 months after the procedure with the help of their doctor, dietician and nurse navigator.

ESG on average helps patients lose about 15-20% of their total body weight.

Ready to Learn More?

Are you interested in learning more about ESG, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.