Endoscopic Sleeve Gastroplasty (ESG)

Pre-op and Post-op Instructions

The Federal Drug Administration (FDA) has approved the Apollo Overstitch device for tissue apposition in the United States.

Endoscopic Sleeve Gastroplasty is a newer procedure that can help patients lose weight without surgery. The weight loss results with this procedure are superior to the results obtained with diet and exercise alone, or those achieved with appetite suppressant medications. Once the procedure is completed, you will stay in the surgery center for approximately 4 hours for observation. Assuming there are no problems, the patient will be able to go home after the 4 hour observation period. Studies performed to date have demonstrated excellent weight loss results, however this requires a commitment to dietary modification and exercise. This procedure is intended to help you gain better control of portion size, but it does not “stop you from eating” nor does it keep you from ever “getting hungry”. It has also been shown that adherence to follow up with the dietitian and dietary recommendations will significantly improve success.

Qualifications for the Endoscopic Sleeve Gastroplasty procedure:

The ESG procedure is ideally suited for patients who:

Have a BMI >/= 30
However, the best results are seen with patients having a BMI 30-40
Have been unable to achieve their weight loss goals through diet and exercise.
Are uncomfortable with, or ineligible for, other types of weight loss surgery.
Are willing to participate in a medically supervised diet and behavior modification program.
Are considered to be at least 25 pounds overweight.

Conditions that would prevent a patient from having the procedure include:

Previous gastric surgery
Any inflammatory disease of the gastrointestinal tract
Potential upper gastrointestinal bleeding or other congenital anomalies
Large hiatal hernia or structural abnormality in the larynx or esophagus
Any condition that would hinder endoscopy
Unwillingness to participate in the supervised diet and behavior modification program
Drug or alcohol addiction
Pregnancy or breastfeeding
Past or present psychological disorders (untreated or non-compliant with therapy)
Regular use of blood thinners

The Endoscopic Sleeve Gastroplasty is ideal for patients who are moderately overweight and want to begin with a less invasive weight loss procedure. Patients who are ready to start a healthy, new lifestyle that incorporates regular exercise and dietary modifications will benefit greatly from a managed weight loss program. Sustained weight loss is achievable with the assistance of our support team, and we are committed to your long-term weight loss success!

Initial Visit for Endoscopic Sleeve Gastroplasty

Becoming a candidate will be based on several factors:

Your medical history
Your weight loss goals
Previous methods attempted to lose weight
Your commitment to our team’s managed weight loss program
Your comfort level with the endoscopic sleeve procedure
Depending on your personal medical history, additional recommendations may be made, such as clearance for general anesthesia by your primary care provider, labs, EKG, etc…
Completion of a psychological assessment

Prior to Your Procedure

You will be started on a clear liquid diet 2 days before the procedure. You should avoid food and liquid for 12 hours, as you will be sedated during the procedure. Typically this will mean nothing to eat or drink after midnight (except AM medications approved by your surgeon). We will also have routine labs drawn within 30 days of the procedure. Some patients will be asked to see their Primary Care Physician for clearance prior to the procedure.

The Day of Your Endoscopic Sleeve Gastroplasty

Your procedure will be at JourneyLite of Cincinnati, 10475 Reading Road, Cincinnati OH 45241. If you have any questions for the center, they can be reached at 513-259-2488. Maps/directions can be found at JourneyLite.com.

The procedure is generally uncomplicated and lasts 1-1.5 hours. You will regain awareness quickly and be monitored for approximately 4 hours until your doctor discharges you (same day discharge). Someone will need to be available to drive you home. You will be given detailed instructions on your aftercare. You cannot take an Uber, Lyft, or a taxi home.

After Your Endoscopic Sleeve Gastroplasty

We will start you on a clear liquid diet and monitor you for tolerance. The staff will get you up and walking the day of the procedure, this is IMPORTANT. You will have some discomfort for up to 7 days and we will use medication to help. You may also experience some nausea/vomiting or a sensation of spasms/cramps behind your breastbone. Again, medications will be used to help with these symptoms.

Nausea and vomiting is common in the first week after surgery.

You will be prescribed the following medications:

Prilosec (omeprazole):

Take one tablet daily. This helps reduce acid.

Zofran (ondansetron):

Dissolve one tablet under tongue every 6 hours for nausea.

Phenergan (promethazine):

Take 1-2 tablets by mouth every 4-6 hours for nausea.

Levsin (hyoscyamine):

Dissolve one to two tablets under tongue every 4 hours as needed for spasm or cramping.

If vomiting persists despite the use of these medications, please contact us for further instructions.

Endoscopic Sleeve Gastroplasty Post-op Diet

We recommend avoiding the intake of ANY fluids for 10 minutes prior to a solid meal, and for 30 minutes afterwards. This helps to reduce spasm and cramping.

Days 1-7 – clear liquids
- 100% fruit juice (apple, grape, cranberry)
- Clear broth (chicken, beef, and vegetarian)
- Sugar free popsicles
- Sugar free gelatin
- Water and/or ice chips
- Crystal Light or Sugar Free Kool-Aid
- Decaf Teas and Coffee
- JourneyLite Supplements: fruit drinks, gelatin, protein bouillon, and hot beverages)
Avoid the following items days 1-7
- Carbonated beverages
- Sugary drinks (sweet teas)
- Citrus juices (orange, grapefruit, pineapple) and tomato juices
- Juice drinks (Hawaiian punch)

Days 7-30 – Full liquid/Puree
- Protein shakes (Premier shakes, Atkins, Low Carb Slim Fast
- Yogurt (Carbmaster, Fit and Lite Greek High Protein)
- Milk (skim, 1%, skim milk, almond milk, soy milk) (all unsweetened)
- V-8 juice, tomato juice
- Scrambled eggs
- Sugar free pudding
- Cream soup, strained (cream of chicken, cream of mushroom, cream of broccoli)
- JourneyLite Supplements: protein shakes and pudding, oatmeal, mash potatoes, scrambled eggs, tomato soup)

Avoid the following items days 7-30
- Foods with chunks or large pieces
- Sugar desserts (ice cream, regular pudding, cream pies)
- Carbonated beverages

Some Helpful Tips:
- Plan 3 meals and 2 snacks.
- Watch your posture during meals and while drinking fluids. Sit tall and do not slouch. This will help with tolerance.
- Stop eating when you feel full (The sensation of a Hiccup means you are full and should stop). One additional bite may be too much.
- Do not drink 30 minutes before a meal and wait 30 minutes after to drink.
- No eating 3 hours prior to bed.
- Use your anti-nausea medications as prescribed by the physician.

As soon as you feel well enough (usually about 3-7 days), you may start an exercise program without restrictions. We recommend getting an activity tracker, such as a FitBit, and aiming for 10,000 steps per day. If you do this your weight loss will be greatly enhanced!

You should meet regularly with your support team to receive nutritional training and to monitor your progress. This will be an important part of your successful lifestyle change. For patients following the program, our goal weight loss during the first 6 months is 25-50 pounds. Higher-BMI patients will typically be on the high end of this range, and lower-BMI patients on the lower end. Please note that weight loss is not a guarantee with this procedure; there are some patients who do not follow the program and do not lose weight at all.

Schedule your follow-up visits at 1 week, and then once a month for 6 months. Discuss your follow-up schedule after that with your dietitian or provider. You are welcome to come in at any time if you are struggling with weight or are concerned that there is an issue.