ESG or Endoscopic Sleeve Gastroplasty

ESG or Endoscopic Sleeve Gastroplasty: What Are The Benefits And Outcomes?

January 25, 2023

What is ESG or Endoscopic Sleeve Gastroplasty?

ESG or Endoscopic Sleeve Gastroplasty is a novel procedure that gives the weight loss benefit of a weight loss procedure without surgical incisions.

The ESG is an endoscopic procedure where a suturing device is attached to an endoscope to suture the stomach from the inside. This decreases the size and capacity of the stomach and slows the speed at which food empties from the stomach. Although this procedure does not help patients achieve as much weight loss as a traditional sleeve gastrectomy, it provides great results without any surgical incisions and most patients go home the same day as the procedure.

Why is it done?

The ESG is done to help patients lose weight and decrease the risks of weight-related health problems like diabetes, high blood pressure, sleep apnea, heart disease and stroke and fatty liver disease.

Who is Endoscopic Sleeve Gastroplasty for?

The ESG is a good choice for patients who have a BMI>30, who have not been successful at achieving weight loss with diet and exercise alone. It is also a good option for patients who are not eligible for a traditional bariatric procedure because their BMI is below the threshold for insurance coverage. It is also an excellent option for patients who do not wish to pursue a surgical weight loss procedure.

How is it done?

A suturing device is attached to the end of an endoscope which is passed through the mouth into the stomach. This device is used to reduce the size of the stomach from the inside.

How successful is it?

With the ESG, a suturing device at the end of an endoscope is used to suture the walls of the stomach and create a tubular structure, similar to what is achieved in a surgical sleeve gastrectomy. The capacity of the stomach is reduced like in the sleeve gastrectomy, so the amount of food that can be consumed is reduced. This leads to 50% excess weight loss at 12-18 months. That equates to about 15-20% total body weight lost.

What is the benefit?

The biggest benefit is that the recovery period is short and as there are no surgical incisions to heal from, so you can go back to your normal life and work quickly. The procedure can be done in an ambulatory surgery center or endoscopy suite and most patients would be able to go home the same day. Some patients may require an overnight stay for monitoring.

On average, patients can expect to lose 15-20% of body weight by 12-18 months. This weight loss often leads to significant reduction or in some cases, complete resolution of weight related health problems like diabetes, high blood pressure, sleep apnea, heart disease and stroke, fatty liver disease.

The procedure can be reversible for most patients if necessary or if greater weight loss is desired, it can be converted to a surgical sleeve gastrectomy.

What are the risks?

Most studies have shown that the procedure has low risks. There can be nausea and pain for a few days that can be managed with medications. There is a very low risk of bleeding, infection and tears in the stomach that may require surgery to correct.

Is it for me?

The ESG may be the best option for you if:

  • Your BMI is over 30
  • You have not been successful with achieving weight loss with diet and lifestyle modification alone
  • You would like to lose 50% excess weight loss or 15-20% of total body weight loss
  • You are interested in a minimally invasive procedure that can help you achieve your weight loss goals but do not feel a surgical procedure is right for you
  • You want a low-risk, same day procedure that requires a short recovery period

Most health insurances plans do not cover the ESG.

Interested in proceeding?

If the ESG is appealing to you, please contact your weight loss physician to find out if you would be a candidate for the ESG. As this is a newer procedure, not all weight loss physicians may offer it. Find the right surgeon who can help you make the right decision to get you to your weight loss goal. At New York Bariatric Group, we have many surgeons who perform the ESG and would be happy to assist you on your weight loss journey.

Dr. Alph Emmanuel is board-certified in General Surgery and joins New York Bariatric Group as a general and bariatric surgeon.

ESG or Endoscopic Sleeve Gastroplasty


Following a year of practice in general surgery, Dr. Alph Emmanuel completed a fellowship in Bariatric, Minimally Invasive and Robotic Surgery at the Magee Women’s Hospital of University of Pittsburgh Medical Center, one of the oldest training programs in the field of bariatric surgery. Dr. Alph Emmanuel is board certified in General Surgery and joins New York Bariatric Group as a general and bariatric surgeon.