A Guide to Endoscopic Sleeve Gastroplasty (ESG)

Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN

Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.

The landscape of bariatric surgery is witnessing significant evolution with the introduction of Endoscopic Sleeve Gastroplasty (ESG). This procedure represents a less invasive alternative to conventional surgical methods for weight loss. In this discussion, we shall elucidate the nature of ESG, differentiate it from the traditional Gastric Sleeve (VSG), identify the likely candidates for this procedure, outline the criteria for eligibility, and consider its growing prominence in the realm of bariatric options.

1) An overview of Endoscopic Sleeve Gastroplasty (ESG). ESG is a minimally invasive bariatric procedure that reduces stomach volume without external incisions. It is performed using an endoscope equipped with a suturing device inserted through the mouth. The procedure involves the placement of sutures in the stomach, altering its structure to a sleeve-like shape. This reduction in gastric volume is intended to produce an early fullness effect, which causes weight loss. Patients can typically expect a reduction of 15-20% of their total body weight following ESG.

2) Comparing ESG & Gastric Sleeve (VSG). ESG is often compared with the VSG, yet several distinctive features separate the two:

  • Surgical nature: ESG is an endoscopic procedure performed through the mouth, while VSG is a surgical intervention requiring abdominal incisions.
  • Invasiveness: ESG is a less invasive procedure with no external incisions, compared to VSG which involves the removal of a portion of the stomach.
  • Recovery timeframe: ESG patients generally experience a swifter recovery, often resuming normal activities within days, whereas VSG may require a more extended recovery period.
  • Weight loss projection: ESG offers a more moderate weight loss expectation (15-20% of total body weight compared to VSG 60% excess body weight loss). So, patients must consider when evaluating their weight loss goals and options.

3) The ideal ESG candidate. ESG is particularly suited for individuals who:

  • Present a Body Mass Index (BMI) in the range of 30 to 40.
  • Have attempted traditional weight loss methods without enduring success.
  • Seek a less invasive option, potentially due to pre-existing health conditions.
  • Are prepared to adopt a comprehensive lifestyle alteration for sustained weight loss.

4) Criteria for ESG eligibility. Prospective ESG candidates must meet the following criteria to qualify for the procedure:

  • BMI requirement: Typically, a BMI between 30 and 40 is considered ideal, although certain clinical considerations may allow for flexibility.
  • Weight management history: Documented evidence of engaging with conventional weight loss efforts.
  • Medical assessment: A thorough evaluation to ensure suitability and safety for undergoing ESG.
  • Psychological preparedness: A demonstrated understanding of the procedure, associated risks, and a commitment to lifelong dietary and lifestyle modifications.

5) Cost & regulation of ESG. It is important to acknowledge that, as of writing this blog, insurance plans generally do not cover ESG, which means patients bear the cost out-of-pocket. Nevertheless, ESG's demand has continued to rise, partly due to the FDA (Food and Drug Administration) approval it garnered in July 2022, solidifying its status as a credible and approved weight loss procedure.

6) The increasing popularity of ESG. Despite the lack of insurance coverage and the out-of-pocket expenses, the popularity of ESG is on the rise. The less invasive nature of the procedure, coupled with a rapid recovery period and the moderate but significant expected weight loss, means ESG is an attractive option for many individuals. The FDA approval further contributes to its credibility and may potentially influence future insurance coverage policies. As with any medical intervention, a detailed consultation with a bariatric specialist is imperative to ascertain whether ESG aligns with one's individual health profile and weight loss goals.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.

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