Endoscopic Sleeve Gastroplasty (ESG)

ESG is a new procedure that allows physicians to reduce the volume of the stomach without removing any of it, and without making any incisions.  The procedure is most commonly associated with the Overstitch device from Apollo EndoSurgery.  This device is used in combination with an endoscope, while the patient is sedated, to go down through the mouth and place sutures inside the stomach.  Unlike similar devices that have been used in the past, the Overstitch allows for much more secure “full-thickness” sutures to be placed.  This results in more durable sutures that are less likely to pull through in time.

The image above shows how these endoscopic sutures are placed to “tuck” the stomach in on itself, which results in a more narrow diameter and a shorter overall length of stomach.  The result is smaller portion sizes.  As with any weight loss procedure though, long term succes relies on healthy eating habits, regular exercise, and long term follow up.
The procedure is done under sedation in an endoscopy suite on an outpatient basis.  Patients are typically back to work in a few days and diet is advanced slowly from liquids to pureeed, then finally soft solid foods.
Short-term results of the ESG have shown that the weight loss for this procedure lies somewhere between that of gastric band and gastric sleeve.  At this point it is thought to be best utilized on lower BMI patients, in the 30-40 range.
As with any new weight loss procedure, we still await long-term data before we can say definitively that the lost pounds will stay off forever, but preliminary data is encouraging and it is always good to have new non-surgical treatments for the disease of obesity.
See more in this video from Apollo Endosurgery on the ESG Procedure: