An Incision-less Endoscopic Procedure

Endoscopic Sleeve Gastroplasty (also known as ESG, or “the accordian procedure” is a new endoscopic weight loss procedure. With an ESG, we can reduce the volume of the stomach without removing any of it, and without making any incisions.

The procedure is most commonly performed with the Overstitch 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, yielding better long term results than similar procedures in the past.

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 success relies on healthy eating habits, regular exercise, and long term follow up.

The procedure is done under general anesthesia in an endoscopy suite on an outpatient basis. Patients are typically back to work in a few days to a week, 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. It is best utilized on lower BMI patients, in the 30-40 range.

As with any new weight loss procedure, we still await long-term conclusive data on the efficacy of this procedure. Although short-term results have been promising, intermediate data shows a reasonably high rate of suture failure and/or weight gain. Due to this fact, we are not currently offering ESG’s but will continue to monitor the scientific literature and any advances in technology that could improve durability and reduce risk of the procedure.