While you are asleep, Dr. Chapman places an endoscope into your mouth, which is advanced down the esophagus and into your stomach. A suturing device is attached to the endoscope and allows the insertion of sutures in a specific pattern to constrict the stomach, resulting in it becoming a “sleeve” shape.

This series of sutures is then tightened, constricting the overall usable volume of the stomach. Patients generally go home the same day or the following day after an overnight observation. They are instructed to follow a specific diet for a brief amount of time afterward. Once a patient's stomach volume is restricted, he or she will consume smaller portions of food. In conjunction with diet and exercise, the ESG procedure can result in an average weight loss of nearly 20% total body weight loss – typically ranging from 40 to 60 pounds.

ESG is designed for patients who are obese, having a BMI of greater than 30, and who are either not ideal candidates for or do not desire bariatric surgery.

The endoscopic sleeve gastroplasty is one of the most effective endoscopic procedures for primary weight loss. Although there are no guarantees for weight loss outcomes, on average, patients lose 40 to 60 pounds, or nearly 20% of their body weight. Recent research and my own personal experience with patients has demonstrated that the weight loss achieved with the ESG can last for years and may improve other medical complications brought on by excess weight, including high cholesterol, diabetes and high blood pressure. The most important factor for sustained weight loss is continued follow up and adherence to the recommend dietary changes. We recommend working with a psychologist to help with long term behavioral and motivational changes.

The ESG procedure should be considered an internal endoscopic surgery. The rate of major complications associated with the endoscopic sleeve is very low (approximately 2% to 3%). However, complications can occur and include anesthesia reaction, aspiration, bleeding, infection, perforation, leak, injury to an adjacent organ and blood clots. Some patients might experience abdominal pain, nausea, vomiting and constipation and may need to be observed overnight in the hospital after the procedure to manage symptoms. The majority of the symptoms resolve in 2 to 3 days, and most patients return to their baseline within 5 to 7 days.

Typically, patients are eligible for the ESG procedure if their body mass index (BMI) is between 30 and 40. However, in certain cases the procedure is performed on patients with a BMI under 30 or over 40 who are not candidates for or do not desire surgical options. Patients are not eligible if they have bleeding disorders or are cannot stop blood thinning medications. There are also certain situations in which a consultation is required. These include a family history of stomach cancer, personal or family history of blood clots, use of immunosuppressive drugs or history of inflammatory conditions of the upper GI tract (such as Crohn’s disease). Rarely (approximately 5%) something is identified during the endoscopic procedure that prevents or requires delay of the ESG procedure.