The Five Most Important Things You Should Know About Endoscopic Sleeve Gastroplasty (Esg)

Endoscopic Sleeve Gastroplasty (Esg)

Are you one of the many people around the world trying to get rid of excess weight that’s troubling you? You are certainly not alone. Studies show that globally, over a billion adults are overweight and that over 600 million suffer from obesity. Obesity-associated conditions such as diabetes, coronary heart disease and non-alcoholic fatty liver can all yield to shorter life expectancy. However, these can all be improved with permanent weight loss.

It’s perfectly natural that you’d wish to feel good, both physically and mentally. The catch lies in the difficulty that one faces when it comes to achieving significant weight loss.  A strict diet, a rigid exercise routine and even medication often produce suboptimal results and leads to frustration. In comparison, bariatric surgeries yield much better results in managing morbid obesity.

Endoscopic Sleeve Gastroplasty (ESG) is a procedure that has been recently gaining popularity as an alternative to traditional bariatric surgery. It is one of the most appealing, affordable and most importantly safe weight loss procedures available today. If you have been considering ESG as a means to combat obesity, you have come to the right place. Keep reading to learn the 5 most important things you should know about endoscopic sleeve gastroplasty (ESG).


Even though bariatric surgery is the most effective and long-lasting treatment for obesity, not many people opt for this procedure. As a result, there has been an increasing demand for less invasive treatment options with fewer post-procedural complications. Endoscopic bariatric therapies emerged as a solution to this problem. They take away the need of ‘going under the knife’ for weight loss treatments, making them much more appealing for patients. These treatments also take much less time and are followed by a faster recovery period, saving patients time as well as money.


ESG was first introduced in 2013 as an innovative alternative to a procedure known as laparoscopic sleeve gastrectomy (LSG). LSG is a restrictive procedure that involves sectioning of the stomach. Here, up to 85% of the stomach is surgically removed via instruments inserted through small incisions made in the abdomen. As a result of stapling, the remainder of the stomach forms a tube or sleeve, thus restricting its original volume. Click here  to read more about LSG treatments offered at Healthy Weight Australia.

Similarly, ESG also restricts and reduces the volume of the stomach to form a sleeve, but is far less invasive than an LSG. This is achieved with the use of an endoscopic suturing device that is inserted down the patient’s throat, into the stomach. As a result, no incisions are made on the stomach. Instead, using the OverStitch endoscopic suturing device, the endoscopist stitches the walls of the stomach along its outer and inner curves, giving it the shape of a sleeve. This significantly decreases the size of the stomach. The procedure is carried out under general anesthesia and the patient will not feel any pain as they remain unconscious for the duration of the procedure. A typical endoscopic sleeve gastroplasty will take about one hour to 90 minutes. Due to minimal invasiveness, there is very little downtime post-procedure and discharge is possible within the same day.
walls of the stomach
A series of stitches are made on the walls of the stomach with the use of an endoscopic suturing device which decreases the size of the stomach.
Consequently, ESG is one of the most efficient and cost-effective end scoping bariatric therapies available. It is also minimally invasive, has a low risk of complications, and allows patients to quickly return to their daily lives.



The ESG procedure achieves weight loss through a mechanism known as restriction. By reducing the length of the stomach by around 50% and its volume by 75%, it restricts the amount of food that can be consumed. This will also force you to eat smaller portions achieving a reduction in the amount of calories consumed and digested. You will also stay fuller for longer as the passing of food through the stomach is prolonged.


While no weight loss solution is permanent, the effects of ESG last for about 2 years and is considered a long-lasting procedure. Weight loss can be achieved for up to 18 months post-procedure. However, if stress is caused to the stomach due to overeating or continuous vomiting, stitches may break over time.


Apart from weight loss, ESG may reduce the risk of several adverse health conditions associated with morbid obesity. These can include, coronary heart disease, high blood pressure, non-alcoholic fatty liver, osteoarthritis, type 2 diabetes and sleep apnea.



Recovery from an ESG is extremely quick and most patients are discharged on the same day as the procedure. However, depending on your condition, your doctor may keep you under observation for up to one day.


Following an ESG procedure, patients are not allowed to eat for a few hours. The patient will then be put on a hypocaloric liquid diet lasting up to 2 weeks. Patients then progress to semi-solids, which will continue for a further 4 weeks. Patients will be permitted to move on to a normal diet after this. These dietary changes will be under the supervision of our dietitians with HealthyWeight to help you navigate through the changes. Many patients find they are not terribly bothered by this diet as their appetite will be considerably reduced due to the ESG. You will notice a stark reduction of portion sizes that you consume compared to your pre-procedure meals.


Initially, only light walking will be advised, with a gradual increase in the intensity of exercise, encouraged in order to increase and maintain weight loss. Our exercise physiologist with HealthyWeight will support you through individualized assessments and exercise programs.

HealthyWeight offers the ESG procedure as part of a multidisciplinary support program. This include pre and post-operative consultations with our nurse practitioner, bariatric physician, surgeon, dietitian and exercise physiologist. To find out more about the programs we offer and what is included, click here.  


ESG is considered a highly effective weight loss treatment procedure. Over 12 months patients can see results in total body weight loss of 15%-20% and an excess weight loss of 60%. As with any successful weight loss program, a total commitment of the patient towards a healthier lifestyle will ensure optimum results.


Weight Loss
Before and after the ESG procedure.


While ESG is considered one of the safest weight loss procedures available, you might experience mild abdominal pains and/ or nausea which may last no more than 2 to 3 days. These are generally managed with medication as prescribed by your clinical team. Less than 2% of patients report severe adverse complications such as infection or bleeding.


ESG suitable candidates usually have a body mass index (BMI) of above 30. ESG is also an option for some individuals with a BMI of more than 40 who do not wish to undergo other bariatric surgeries. To reach optimal results, patients should also be willing to commit to healthy lifestyle changes and regular medical check-ups post-procedure. As bariatric surgery or treatment are never the first line of intervention for weight loss, patients may need to discuss their efforts and outcomes of weight loss from trying conventional dietary and exercise treatments.

To find out if you meet the criteria for an ESG, please book an initial bulk billed appointment with our nurse practitioner here or contact us to find out more. 


Once you have had initial appointments with the bariatric team including your surgeon at HealthyWeight Australia, you will be referred for necessary pre-operative blood tests and imaging investigations. They will advise you on any pre and post-procedural medications that may need to be taken. You will have an appointment with the dietitian who will provide you with detailed information on the pre-procedural diet. Depending on your level of physical activity and occupation, you may be advised to plan for a few days of rest before resuming normal activities.


To find out more about the ESG and the other weight loss options with HealthyWeight Australia click here.


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