General guidelines for Endoscopic Sleeve Gastroplasty

Why Endoscopic Sleeve Gastroplasty is performed:

General guidelines for Endoscopic Sleeve Gastroplasty: Endoscopic Sleeve Gastroplasty is designed for severely obese people and is intended to improve obesity-related illnesses and diseases. The surgery is primarily recommended for people who cannot lose weight through diet and exercise.

Endoscopic sleeve gastroplasty is a cutting-edge weight-loss procedure. It shrinks the size of your stomach using an endoscopic suturing device without the need for surgery.

The gastric sleeve is a weight-loss surgery that permanently removes about 75% of the stomach. Studies have shown that people who have this surgery lose about 65% more weight than people who have had gastric bypass surgery. People who get the surgery typically lose between 50 and 100 pounds in the first year after surgery.

Guidelines for before endoscopic Sleeve gastroplasty procedure

The hospital will provide communication to you a few days before your procedure to confirm what time you need to arrive. If you have any queries before receiving this call, contact the endoscopy schedulers at +214-941-6891.

Please Note: This unit treats both inpatients and outpatients, and emergencies may come up that could cause delays in the planned procedure. The unit’s arrival times are designed to prepare you for your practice. Is it crucial that you show up at your given time?

We appreciate your patience and understand that you want the best care possible. Unfortunately, due to the unpredictable nature of procedure units, we may not be able to provide you with the respect you deserve.

We ask that you be prepared to spend the day here in case we need to assess your condition further.

We may not consistently be able to predict when a procedure or recovery will require hospitalization, so it’s essential to be prepared to stay in the hospital if necessary.

Do not wear any valuables or jewelry on the day of your procedure, as we do not have a secured place for you to store them.

You will need to bring a driver with you to take you home, as you will not be able to take public transport for 24 hours after the procedure. We have limited space in our waiting area, so only one visitor will be allowed to stay during your process.

Evaluations

Before your surgery, your doctor may have you do some pre-procedural evaluations. These could include

• A nutrition evaluation
• A psychiatric evaluation.

Medications

• If you’re taking a prescription for high blood pressure, seizures, or prednisone, you can take it the morning of the process at least 2 hours before, with a small sip of water.
• If you have diabetes and taking a sugar pill or regular insulin, do not take it on the day of your procedure. If you are taking other insulin preparations, please contact your prescribing physician for instructions.
• Please consult your prescribing physician if you are taking Coumadin, Plavix, or other blood thinners for instructions on when to discontinue the use of this medication.
• If you are taking aspirin every day, keep taking it.
• If you have allergies, please let your doctor know.
• Attach the scopolamine patch behind your ear at around 6 pm the night before the procedure.

ESG Diet

The Endoscopic Sleeve Gastroplasty diet is a special diet created for you by the bariatric program dietitian. You must follow the guidelines for the endoscopic sleeve gastroplasty diet carefully for optimal results.

You must follow a clear liquid diet the day before your procedure. This means only consuming liquids that you can see through.

A clear liquid diet may consist of the following foods:

• Water
• Ice chips
• Vegetable broth
• Clear fruit juices without pulp
• Strained clear fruit juices
• Sodas
• Gelatin
• Tea
• Coffee

You shouldn’t eat anything after midnight.

Pre-Procedure Shopping list

Be sure to have these objects ready before surgery.

• Can of beef, chicken, or vegetable broth
• Sugar-free gelatin
• Sugar-free, non-carbonated beverage
• Sugar-free popsicle
• Liquid protein supplement
• Chewable or liquid multivitamin/mineral supplement
• Chewable or liquid calcium citrate with vitamin

Pre-procedure list for endoscopic sleeve gastrectomy

You mustn’t eat & drink anything after midnight the night before your surgery.

Bring with you on the day of surgery

1. A list of medications, vitamins, and supplements is currently being taken.
2. All records of any previous abdominal surgery or bariatric surgery
3. All x-rays and ultrasound reports.
4. A list of allergies to any medications or foods.
5. Any non-prescription drugs (vitamins, supplements, aspirin, etc.)
6. A list of any physicians or clinics you are currently seeing.
7. Instructions on what you should or should not eat or drink after surgery.

On the day of the ESG procedure:

Your procedure will be performed at Incisionless Weight Loss Surgery – Prashant Kedia. The clinic is located in Dallas, and the address is as follows:

221 W Colorado, Blvd. Pav II, Ste. 630

Dallas, TX 75208

If you think you strength be late for your assignment or have any questions on the procedure’s day, please call us at +214-941-6891.

Arrive at least 90 minutes before your planned procedure time. You will need to register and provide your medical history when you arrive.

At 6 am the day of the process, take the EMEND (aprepitant) capsule with a bit of water.

During Endoscopic Sleeve Gastroplasty

During the Endoscopic Sleeve Gastroplasty procedure, a small incision is made in the abdomen, with a long thin camera inserted to allow the surgeon to visualize the inside of the stomach.

The surgeon then creates a small, single-layer tube to create a new stomach pouch.

The stomach is then separated from the esophagus, and the gastro-jejunostomy is created, allowing the stomach to drain directly into the small intestine.

The doctor uses an endoscope to place approximately 24 sutures in the stomach, which leaves the stomach shaped like a tube and restricts the number of calories your body absorbs.

After Endoscopic Sleeve Gastroplasty

Once the process is entirely complete, you will be taken to the endoscopy unit to recover from the anesthesia. Your doctor will then discuss the process with you.

We advise that it is common to forget conversations had with your doctor after anesthesia. Therefore, we suggest having a family member present for this conversation at your request.

After the procedure, you may have a brief stay in the hospital or be discharged home if you feel well.

It is crucial to consume lots of fluids to rehydrate.

Side Effects of Endoscopic Sleeve Gastroplasty

There are very few side effects of the sleeve gastrectomy procedure. The most common side effects are dehydration and constipation, which can be easily treated. However, some people may knowledge the following side effects

• Stomach pain
• Nausea
• Trapped gas
• Fever

If you knowledge any of these symptoms after your procedure, they should go away within 24 to 72 hours. However, if they are severe or don’t improve, please let your doctor know or go to the emergency room.

After you leave the hospital, you will need to continue taking your medications

You will be given various medications, which are to be taken at different intervals. Please bring them regularly, as prescribed by your doctor.

You should take

• Antiacid medication (Prilosec, Nexium, or omeprazole) twice a day for two weeks.
• Antibiotics such as Augmentin or Levaquin as prescribed for three days
• Anti-nausea medication such as Zofran 4mg every 4 hours or 8mg every 8 hours

The following medications may be taken as needed:

Prescription pain medication will be given on the day of the procedures

Liquid Tylenol with codeine up to 15ml every 6 hours

Tramadol (crushed) 1 to 2 tablets every 6 hours

Nausea

• Levsin can be taken for up to a week, and the Scopolamine patch should be replaced every 72 hours.
• Zofran (Ondansetron) should be taken 5ml (4mg) every 4 hours or 8mg every 8 hours.
• Compazine (prochlorperazine) suppository should be taken 25mg (One suppository) every 12 hours.

Constipation

Take one capful of Miralax daily, dissolving it in four ounces of water.

Follow up

Call your doctor to schedule a follow-up appointment.

221 W Colorado, Blvd. Pav II, Ste. 630

Dallas, TX 75208

+214-941-6891

It is suggested that you follow up with your doctor according to the following schedule:

1-month: office visit

3-month: office visit

6-month: office visit

9-month: phone call

1-year: office visit

You should get your upper GI series (X-ray) scheduled within one week of your procedure.

Info and Dietary Guidelines

• Your new stomach pouch can hold up to 4 oz. of food.
• The diet progression in this packet is designed to promote weight loss and healing of your stomach pouch. Following it will help you achieve these goals.
• If you think you feel well enough to advance your diet early, it is still essential to follow the diet below.
• The procedure is a weight loss “tool.” Focus on healthy food choices and exercise to maximize your weight loss and maintain your nutritional health.
• You can help maintain optimal nutritional status after surgery by taking a chewable multivitamin and calcium + vitamin D supplement. After one month, you may switch to a medication form.
• You should not eat & drink anything after midnight the night before your procedure.

Post ESG diet plan

Days 1-2: Only consume clear liquids

Days 3-14: Full liquids, including shakes, soups, and stews

Week 3: Start to add soft foods like cooked vegetables, soft fruits, and mashed potatoes

Week 4: Continue to eat soft foods and add cooked vegetables and soft fruits

Week 6: Add starches like whole-grain bread and pasta

1. Post-Op Days 1 and 2

Clear liquids include water, broth, and juice. They’re usually easy to digest and don’t contain caffeine or carbonation.

• Try a Clear liquid protein supplement like Isopure’s Ready to Drink option
• Broth (chicken, beef, or vegetable) is always a great choice
• Sugar-free popsicles or fruit ices without pulp are perfect
• And for drinks, water, tea, or Crystal Light are great sugar-free non-carbonated options!

Don’t forget:

• The aim is to give your gastrointestinal tract a break and allow it to heal.
• Sip your beverages slowly and carefully throughout the day, no more than 2 ounces at a time.
• Don’t drink too much, or you’ll feel uncomfortable.

2. Days 3- 14

Fully Liquids

• All of the aforementioned clear liquids.
• Protein items are a great way to get your daily dose of protein. They are easy to make and can be taken on the go.
• Creamy soups or pureed soups (no chunks)
• Plain yogurts or plain Greek yogurt

3. Start of Week 3 (Day 15)

Advance your diet to include more soft foods, as tolerated. Soft foods are a great way to get extra protein into your diet, and they’re usually moist and easy to chew. Try to find sources of soft, diced, ground, or pureed protein, and add them to your meals as often as possible.

• All of the drinks and food mentioned above
• Eggs
• Ground poultry
• Soft, moist fish (fat-free gravy or bouillon/broth/light sauce to moisten if needed)
• Cooked beans or bean soup
• Tuna fish with light mayo
• Skim milk cottage cheese, skim milk ricotta cheese, or low-fat soft cheese.

4. Start of Week 4 (Day 22)

• It’s the fourth week, so advance your diet to include cooked or soft fruit and vegetables (as tolerated).
• Continue to eat soft foods, and add cooked, soft vegetables and smooth and peeled fruit to your diet.
• Recall to drink plenty of fluids and eat nutrient-rich foods.

5. Start of Week 6 (Day 36)

It’s week 6, so it’s time to start incorporating starches into your diet! Just remember to keep portions small and focus on whole grain options like quinoa, whole wheat bread, and brown rice.

And as always, include plenty of protein and veggies at every meal!

A few tips:

• Do not drink during mealtime. It is best to stay 30 minutes after each meal to consume liquids.
• Chew your food thoroughly (20 chews!), eat slowly, and take small bites.
• Eat protein first at meals, followed by vegetables, & lastly starch, if you are still hungry.
• Recall prioritizing protein foods over other foods if you want to meet your daily protein goal. For women, the goal is 60 grams, and for men, it is 70 grams. It’s okay if you don’t always reach your goal, but try to make protein a priority.

The goal is to drink 6-8 glasses or 36-64 ounces of fluids daily. This can include water, protein shakes, and other beverages.

Your body knows best – stop eating when you’re no longer hungry. You may only be able to handle a couple of tablespoons of food at each meal.

Supplements of required nutrients are necessary

1. Chewable supplement vitamin-mineral supplement (2x per day – confirm with your surgeon)
2. Calcium citrate with vitamin D, available in chewable or liquid form.

Shopping list

Prepare these items before surgery:

• Beef, chicken, or vegetable broth (canned or bouillon)
• Sugar-free gelatin
• Sugar-free, non-carbonated beverages
• Sugar-free popsicles
• Liquid protein supplements (added at full liquid phase/day 3)
• Chewable/liquid multivitamin/mineral supplement
• Chewable/liquid calcium citrate with vitamin D

FAQS

How much pain or nausea am I likely to experience?

The intensity of the pain differs from individual to individual. In general, the pain is sharp and feels like a cramp. It shouldn’t last for more than many days. The pain medication prescribed should help. You can alternate between Tylenol with codeine & tramadol (taken every 3 hours). You can also take liquid Tylenol as needed.

Three medications can be prescribed for nausea so that you can alternate between them. Nausea should only last for 2-3 days.

I’m feeling exhausted after the procedure?

You may be dehydrated. You need water that contains electrolytes. If you haven’t already, start taking a multivitamin. Be sure to drink little amounts of water every five to ten minutes.

Is it normal to have a fever?

You can take Tylenol every six hours, but remember that Tylenol is already present in codeine, so you don’t need to take both. It is normal if you have a fever after your procedure that lasts for the first three days. However, if your fever persists, please call the office.

What amount of pain is considered acceptable?

Discomfort is normal after a procedure, but if you experience pain that persists or worsens or has abdominal distension, you should call the office. Remember that you can take Tylenol with codeine or liquid Tylenol. You can alternate with tramadol.0

What does it mean if I have double vision?

If you experience any side effects from the scopolamine patch, remove the patch and call the office.

I’m constipated and haven’t had a bowel movement in a few days.

You might want to try increasing your Miralax dosage to twice daily and adding 1-2 senna tablets at bedtime. More, be sure to drink a lot of water throughout the day.

Is it ever okay to resume exercise?

You can start light exercise again on day 5, but no abdominal exercises. No heavy lifting until your 1-month follow-up visit.

I feel like I’m going to throw up, or my chest hurts?

If you take an acid medication once a day, increase it to twice daily. You may also & Zantac at night (start with 75 mg and increase as needed to 300 mg at bedtime).

I haven’t had enough to eat yet?

You need to increase your protein intake and eat more solids. Liquids will not make you whole. Once you start eating solids, your stomach will shrink to its standard size. Do not worry about the size of your stomach.

Do I not feel complete?

Do not overeat and test your capacity – your stomach is still tiny even if you do not feel affliction as a form of constraint. This will prevent your stomach from stretching and tearing.

Can I drink alcohol after the procedure, and will it affect my tolerance?

For the next three months, avoid alcohol altogether for the best chance of weight loss. After those three months, you can start to reintroduce alcohol into your diet but minimize it as much as possible. However, you may still have some tolerance for it, so proceed with caution.

When can I resume sexual activity?

No strenuous activity, but generally 2-3 weeks after the procedure.

When should I follow up with Nutrition?

It is your accountability to make appointments with the nutritionist – it is strongly recommended that you follow up at least 1-2 times a month. It is also recommended to call & set up these appointments in advance to get timely appointments.

Can I fly now?

You will be able to fly on the fifth day after your procedure. This is just to ensure that everything is okay. You will need to have had your upper GI series before your travels.

How soon will I be able to return to work?

How soon you return is entirely up to you. Some people come back the next day, while others may take a few days.

How effective is endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty is a weight loss surgery that makes the stomach smaller. This operation is considered one of the most effective. The sleeve gastroplasty lasts for several years. You can lose up to 70% of the fat that you have in your stomach, which is the most affected area of your body after you stop the diet.

Want to know about Endoscopic Sleeve Gastroplasty?