THE ENDOSCOPIC SLEEVE GASTROPLASTY (ESG): BENEFITS, RISKS, RESULTS AND COST

To fight against obesity, you can choose among various types of bariatric surgery or go for an Endoscopic Sleeve Gastroplasty (ESG).

Among the bariatric surgery options, you have the gastric band, the sleeve gastrectomy, and the gastric bypass surgery. In this case, the patients need to undergo a method called laparoscopy. This surgical technique involves making 3 to 4 small cuts in the abdomen. Then, through these small keyhole incisions, different instruments are introduced in the abdomen to perform the surgery.

But are you looking for a non-surgical technique instead? Today, people can choose non-surgical weight loss methods to achieve long-term results.

In this article, we will talk about the Endoscopic Sleeve Gastroplasty.

What is the Endoscopic Sleeve Gastroplasty?

The Endoscopic Sleeve Gastroplasty (ESG) is a non-traditional intervention that is considered an effective alternative to the established weight-loss options. It is a minimally invasive technique used for stomach reduction, which guarantees a reduced complication rate.

When you opt for this endoscopic procedure, there are no external incisions. Also, the ESG is performed as an in-and-out procedure under general anesthesia.

The ESG consists of creating a series of internal sutures in the stomach wall. This reduces the size of the gastric cavity and prevents its distension.

Consequently, this non-surgical weight-loss procedure is a restrictive technique.

After the ESG, you will feel full faster. In other words, this procedure generates preventive satiety. Also, the gastric emptying of the stomach will slow down. As a result, the procedure will alleviate hunger pangs.

Medically reviewed by Dr Osama Bahsas Zaky (Bariatric surgery specialist)
Written by Joaquín Pineda
Updated on June 28, 2021

What is the Endoscopic Sleeve Gastroplasty?

What are the Advantages?

Suitability.

Before Starting the Procedure.

During and After the Intervention.

Gastric Sleeve Cost.

Why Obese Patients must Seek Professional Help?

WHAT ARE THE BENEFITS OF ENDOSCOPIC SLEEVE GASTROPLASTY?

The Endoscopic Sleeve Gastroplasty is a procedure with no external incisions.

The intervention is not painful and entails a quick recovery. In most cases, the patient can expect to have a normal life after discharge. You just have to commit to a healthier lifestyle and making portion-size adjustments!

The latest publications related to endoscopic sleeve gastroplasty reported a loss of excess weight of 55.3% after six months. Also, you could lose 54.9% after a year and 62% at 18 months. So, this method ensures long-term success!

After the intervention, there is a follow-up program to reach the targeted total body weight loss. This approach aims to modify the nutritional habits and lifestyle of the patient with the help of a multidisciplinary team.

A summary of the Non-Surgical Gastric Sleeve Procedure would be:

It allows 80% to 90% reduction of the stomach volume without any abdominal incisions or scarring.
You will achieve a significant weight loss, ranging from 30% to 60% of excess weight after six months.
It is a quick, simple, and less invasive procedure.
It is completely reversible.
Fast recovery and reduced pain.
The technique adapts to the anatomy of the stomach.
The doctor will determine the length of your stay after the procedure.
You will be off work for a few days.
Confidentiality is guaranteed.

WHO IS A GOOD CANDIDATE FOR THIS PROCEDURE?

Bariatric surgery is for patients with a BMI > 40 kg / m² or BMI between 35-40 kg / m²with associated comorbidities. Thus, the Endoscopic Sleeve Gastroplasty is a less invasive option offered to patients suffering from moderate to severe obesity.

The ESG is perfect for patients who are not candidates for bariatric surgery based on body mass index (BMI) criteria or are fearful of having this invasive procedure due to the high risks and complications.

To sum up, you are an ideal candidate if:

You have Type I obesity (BMI between 30-35kg / m²). Patient must also have associated morbidities.
You have Type II obesity (BMI between 35-40kg / m²)
You have Type III (BMI > 40 kg / m²) or Type IV (BMI >50 kg / m²) obesity but reject surgery.

Patients who reject surgical treatment or present contraindications can book an appointment with us to receive a proper orientation.

WHAT IS THE PROTOCOL BEFORE AN ENDOSCOPIC SLEEVE GASTROPLASTY?

The preparation for the Non-Surgical Gastric Sleeve procedure includes a complete check-up. There is also a set of lab tests and consultations with the bariatric surgeon, psychologist, gastroenterologist, and nutritionist.

This multidisciplinary team will verify that there are no contraindications for the Endoscopic Sleeve Gastroplasty.

The protocol before the operation is:

Preoperative exams: Blood, urine, H. Pylori test, and digestive endoscopy. If you wish to save time, we advise you to take these tests at home. The results will be available after 5 to 6 days. So, it is better to perform them beforehand to avoid extending your stay in Barcelona.
Consultation with the Bariatric Surgeon:

To exclude any contraindications. The doctor will answer all your questions regarding the procedure.
To know the expectations. The doctor needs to know them before the intervention to explain the risks of the procedure and do the appropriate postoperative follow-up.
To know the medical history. The consultation will also allow us to determine your obesity degree and the presence of associated metabolic diseases or serious pathologies.

Consultation with a psychiatrist: It is necessary to exclude any mental illnesses, eating disorders, or drug addiction. They could limit or hinder the monitoring and effectiveness of your procedure. If the patient does not have a psychologist report, a consultation can be done on-site. The price of the check-up and the mental health report is 200 euros.
If the results are correct, we will schedule a preoperative anaesthesia consultation. The patient can also have the EKG and chest X-ray on the same day.

DURING AND AFTER THE INTERVENTION

The Endoscopic Sleeve Gastroplasty is performed as an outpatient procedure under general anaesthesia. It lasts a little bit more than an hour. You will be unconscious the whole time, so you will not feel anything.

The surgeon will pass the fiberscope and insert it down your throat. Then, he will introduce the instruments necessary to suture the stomach using a thread and a needle. Depending on the size and shape of the stomach, the specialist will adapt the number of sutures.

After the procedure, you will go to the recovery room. If all goes well, you will be discharge the next day.

Just like in classic gastric sleeve surgery, you will follow a suitable diet. This will prevent gastric leaks or stretching the sutures!

There will be a diet based on stages. In the first stage, you will only be allowed to drink liquids and then semi-liquids. Gradually, you will eat soft food in small quantities, with 3-6 meals a day. Finally, a few weeks after surgery, you will be able to return to a traditional solid diet and exercise after a month.

Just like any bariatric surgery procedure, the patient will have to eat reasonably and resume regular physical activity. Also, it is important to continue nutritional monitoring and not hesitate to seek help from a psychologist if difficulties arise.

Gastric sleeve surgery - endoscopic procedure Video

HOW MUCH DOES A NON-SURGICAL GASTRIC SLEEVE COST?

The Endoscopic Sleeve Gastroplasty procedure costs 10,700 euros.

At ServiDigest Clinic in Barcelona, this price includes:

Preoperative exams such as blood tests, EKG, and chest X-rays.
Digestive endoscopy and H. Pylori test.
Psychologist consult.
Preoperative preparation:
Preoperative anaesthesia consultation.
Intervention team fees.
Anaesthesia team fees.
1-day clinic stay.
Additional bed and meals if you have an accompanying person.
Medical supplies during the clinic stay.
All postoperative check-ups and follow-up for one year.

Private health insurance policies do not cover the Endoscopic Gastric Sleeve surgery. As private clinics or hospitals perform the procedure, there is no reimbursement.

WHY IS IT IMPORTANT FOR AN OBESE PATIENT TO SEEK PROFESSIONAL HELP?

According to WHO (World Health Organization), obesity is one of the most persistent epidemics of the 21st century. It has drastically increased because of poor eating habits and lack of physical exercise.

Obese people may suffer from other pathologies such as type 2 diabetes, high blood pressure, dyslipidemia, and cardiovascular diseases. They may also have psychological problems, sleep apnoea, gynecological, digestive, and liver disorders.

If you have excess weight, you are at risk of increasing the probability of uterine and colon cancer. In the long term, people who suffer from this health condition may evolve towards obesity. Therefore, its progression can affect health significantly.

Dr Patricia Gonçalves - endoscopic sleeve gastroplasty specialist