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ESG

About

ESG, Endoscopic Sleeve Gastroplasty, is a non-surgical, incisionless, minimally invasive procedure that allows your gastroenterologist to reduce the overall size of the stomach to promote weight loss. Done under sedation, as an outpatient, the procedure is well tolerated and patients return to a normal routine after a few days of at-home recovery.

Who It’s For

ESG is ideal for patients who have a BMI of at least 30 and have not been successful with diet and exercise alone. It is also a solution for those who don’t want to undergo gastric bypass or those whose physical condition makes them ineligible for surgery. The most important criterion is to be committed to the program and follow instructions for the prescribed period of time. We recommend ESG for individuals who are looking for a long-term weight loss solution.

How The Procedure Works

ESG is a completely endoscopic procedure, performed from inside the stomach and without the need for abdominal incisions. Your physician will advance an upper endoscope (a camera attached to a flexible tube) through your mouth and into your stomach. The endoscope is equipped with a suturing system that allows placement of stitches in the stomach. The procedure takes approximately 60 to 90 minutes. After the procedure, the stomach is 70-80% smaller in size, which limits the amount of food that is eaten before feeling full, limits the amount of calories absorbed by the stomach, and also prolongs the time food remains in the stomach, extending the feeling of fullness.

How Much Weight You’ll Lose

Results vary for each individual undergoing an ESG. Typically, patients can lose as much as 50% of their excess body weight at six months post-surgery and at the one-year mark, many patients experience an 80% loss of excess weight. Off the scale victories also include improved blood pressure numbers, better blood sugar control, and even an improvement in sleep apnea.

Commitment to the program is the single greatest factor in success. Follow your doctor’s recommendations carefully and make thoughtful decisions on nutrition and exercise. Your NEW You physician will partner with you to help you achieve your weight loss goals.

ESG Success Story With Dr. McGowan

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Why Choose NEW You for ESG?

  • Endoscopic Expertise

    • ESG is one of the most technically challenging endoscopic procedures and requires a high level of endoscopic skill. Dr. McGowan, a board-certified Gastroenterologist and Endoscopist, has performed nearly 10,000 endoscopic procedures, ensuring that you are in the most experienced hands. He has received STAR Certification from the American Society for Gastrointestinal Endoscopy in endoscopic suturing and has trained with world leaders in ESG, including Dr. Vivek Kumbhari (Johns Hopkins University), Dr. Reem Sharaiha (Weill Cornell), Dr. Christopher Chapman (University of Chicago), and Dr. Sergey Kantsevoy (Mercy Medical / University of Maryland).
  • Bariatric Excellence:

    • WakeMed Cary Hospital, where Dr. McGowan performs ESGs, is an accredited Comprehensive Center for Bariatric Surgery, Blue Distinction Center for Bariatric Surgery, and Cigna Center of Excellence in Bariatric Surgery. Though your ESG is a same-day, outpatient procedure, you will have the backing of a comprehensive, knowledgeable, and award-winning Bariatric center.
  • 24/7 Physician Access:

    • Whether you live in North Carolina, or are traveling from another state, you will receive the highest level of concierge care, with 24/7 direct access to your physician. We remain committed to your success throughout your weight loss journey.

How does ESG compare to the surgical sleeve gastrectomy?

ESG

Laparoscopic Sleeve

Gastrectomy

Type of Procedure

Non-surgical, endoscopic Surgical

Is Hospitalization Required?

No; same day procedure Yes; 1-3 days

Return to Work

2-3 days 1-2 weeks

Average Excess Weight Loss

50-60% 60-70%

Average Total Body Weight Loss

20% 20-30%

Major Complications

Rare (<1%) 2-6% (0.11% mortality)

Reversible?

No No

Covered By Insurance?

No Yes (if eligible)

FAQ

WHAT IS ENDOSCOPIC SLEEVE GASTROPLASTY (ESG)?

ESG is an endoscopic, incisionless technique that reduces the size of the stomach through internal suturing. The stomach size is reduced by approximately 70% by internally “plicating” or folding the stomach with stitches. The procedure is sometimes referred to as the Accordion Procedure. After completion of the procedure, the stomach has a sleeve-like shape, similar to a surgical sleeve gastrectomy.

HOW IS ESG DIFFERENT THAN A SURGICAL SLEEVE GASTRECTOMY?

The key difference is that ESG is non-surgical. There are no incisions. It is performed entirely through the mouth using an endoscopic suturing system (Apollo Overstitch). This allows for a fast recovery and healing. The procedure is done on a same-day, outpatient basis. While ESG reduces the size of the stomach to a similar degree as a surgical sleeve gastrectomy, it does not involve removal of any portion of the stomach, which is a key difference.

HOW MANY SUTURES ARE PLACED IN THE STOMACH?

An average of 6-8 sutures are placed along the greater curve of the stomach. The exact number will vary based on the size and shape of the stomach.

WHAT HAPPENS TO THE SUTURES AFTER I HEAL? ARE THEY DISSOLVABLE?

Following the ESG procedure, the internal sutures will hold the stomach in the new, sleeve shape, until it fully heals. After the stomach heals, it will remain in the new shape and size. The sutures are no longer needed but will remain in place. They are very small and thin (like fishing line). They do not cause any symptoms and you would not know they are there. This is very similar to other internal surgeries, where sutures and staples remain in place afterward. Dissolvable sutures would not be strong enough for this type of procedure.

WHAT ARE THE MOST COMMON SIDE EFFECTS?

The most common side effects are nausea and abdominal pain. These are typically mild and treated with anti-nausea medications and pain relievers. Approximately one-third of patients will experience these symptoms.

WHO IS A CANDIDATE FOR THIS PROCEDURE?

Anyone who is obese and has not achieved their desired weight loss through diet and exercise. There is no specific weight or body mass index (BMI) required for the procedure, though most patients will have a BMI somewhere between 30 and 40. However, the procedure has been performed in individuals with higher BMIs who are not interested in pursuing surgical treatments.

WHO CANNOT HAVE AN ESG?

The main contraindication to ESG would be the presence a known stomach problem, such as a stomach ulcer, gastric cancer, or prior surgery that would interfere with the ability to suture the stomach. Major health problems or bleeding disorders would also be a contraindication.

HOW LONG DOES THE PROCEDURE TAKE?

Approximately 60-90 minutes. The procedure is performed under general anesthesia in an endoscopy suite. You will recover for approximately 2 hours after the procedure, when we will provide additional IV fluids and any necessary pain or nausea relief. You will then be discharged home.

WHEN CAN I RETURN TO WORK?

We recommend taking 2-3 days off after the procedure, to rest and recover.

HOW MUCH WEIGHT CAN I LOSE?

Actual weight loss will vary based on starting weight, motivation level, and adherence to our dietary recommendations. Current studies suggest an average weight loss of 20% total body weight.

IS THE PROCEDURE PERMANENT?

Once the stomach heals, it should remain in the same shape long-term. U.S. studies tell us that weight loss after ESG persists for a full 2 years. Longer studies are still needed to evaluate weight loss beyond the 2-year mark. The key to sustaining the weight loss is to adhere to the recommended diet. We advise that overeating can lead to weight regain and/or failure of the sleeve over time, as with any weight loss procedure.

HOW DOES ESG COMPARE TO OTHER ENDOSCPOPIC WEIGHT LOSS OPTIONS, SUCH AS ORBERA?

Orbera and Obalon are gastric balloon systems that promote weight loss by occupying space in the stomach. These are 6-month treatments, and are very useful for someone who needs help losing 30-50lbs. They are particularly helpful for those who need motivation, or a kickstart, to achieve weight loss. Many patients will maintain their weight after the balloon(s) is(are) removed, but there is no guarantee. ESG offers a long-term weight loss solution. The results are proven to be more durable than the intragastric balloons, and therefore may be a better option for those tend to re-gain weight, or “yo-yo,” after weight loss efforts. We recommend consulting with a physician to decide which option would be best for your goals.

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