Digestive; Nutrition; Prevention

Bariatric endoscopy offers nonsurgical option for prime weight loss

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive alternative to weight loss surgery and many patients can resume their normal activities within a few days.

Each year, more than 200,000 people in the U.S. choose bariatric surgery to achieve a healthier weight when diet, exercise, and other lifestyle interventions don’t work.

However, a growing number of patients do not meet surgical requirements for bariatric surgery or do not want a surgical weight loss option. For these patients, UT Southwestern’s Endobariatric Program offers a minimally invasive procedure known endoscopic sleeve gastroplasty (ESG), which is an incisionless approach to clinically meaningful weight loss.

The procedure is performed on an outpatient basis and has a low complication rate – many patients resume their normal activities within a few days.

Similar to a laparoscopic sleeve gastrectomy, which is the most common weight loss surgery performed in the U.S., ESG uses sutures inside the stomach to make it smaller. The procedure is performed using a thin, flexible tube that is guided down to the stomach. Using an endoscopic suturing device, we can decrease the size of the stomach by up to 70%, which results in weight loss and can also lead to reductions in high blood pressure, insulin resistance, and fat deposition in the liver.

The UT Southwestern Endobariatric Program is one of the few programs in North Texas that offers a unique, multidisciplinary program that seeks to individualize and tailor weight loss therapy for each patient.

Frequently asked questions (FAQs) about ESG

Who qualifies for the procedure?

Endoscopic sleeve gastroplasty is ideal for patients with a body mass index (BMI) of 30-35 kg/m2, or for those who do not want to undergo a traditional weight loss surgery, such as a sleeve gastrectomy or a bypass. ESG is also a great option as a bridge therapy for patients who require weight loss before being considered for other surgeries, such as a knee or hip replacement or organ transplant.

It’s important to note that ESG is not currently covered by insurance. However, UT Southwestern offers some of the most competitive prices in North Texas. Here, the procedure costs approximately $8,500 to $9,000.

What are the differences between ESG, sleeve gastrectomy, and gastric bypass?

Endoscopic sleeve gastroplasty leads to weight loss by reducing the size of the stomach using a flexible thin scope to place sutures inside the stomach. We do not surgically remove any part of the stomach and instead suture the stomach together to make it smaller. The procedure takes about two hours to perform. Patients go home the same day and are typically back to their normal activities within a few days.

A sleeve gastrectomy and gastric bypass are bariatric surgical procedures performed in the operating room at UT Southwestern. These procedures typically involve small incisions to surgically remove part of the stomach or create a small gastric pouch, respectively. Both procedures take about two to three hours to perform and require a short hospital stay.

How do patients prepare for ESG?

All patients who choose to undergo endoscopic sleeve gastroplasty visit UTSW’s Weight Wellness Clinic to consult with a doctor who specializes in obesity medicine, as well as a registered dietitian and a behavioral psychologist. This type of multidisciplinary integrated care program is unique and ensures our patients have all the necessary resources and support to be successful after their procedure.

Pre-operative blood work and an upper endoscopy are performed prior to the endoscopic sleeve gastroplasty. Patients do not need to be on a special diet before the procedure and most patients can schedule their endoscopic sleeve gastroplasty within 6-8 weeks of choosing this option.

What are the risks of the procedure?

An endoscopic sleeve gastroplasty is a very safe procedure and the risk of adverse events is very uncommon, about 1 %, and those can include bleeding and infection. The most common side effects after ESG are sore throat, nausea, and mild abdominal pain. They usually last about 3-4 days.

Related reading: New anti-obesity drugs are closing gap between dieting and bariatric surgery

Life after endoscopic sleeve gastroplasty

How long is recovery and how will I feel?

We typically schedule ESGs for Thursdays or Fridays, so if you have weekends off you can take fewer days off work. After one week, you should be able to resume your normal physical activities.

After ESG, most patients can expect to lose 15-20% of their total body weight over 6-12 months.

What will my diet be like after ESG?

Each patient’s diet is personalized based on their metabolic and physical needs. Patients meet with a registered dietitian in the Weight Wellness Clinic before and after the procedure. Generally, patients do at least one week of a liquid diet and one week of a soft diet. By week three, most are back to eating solid foods.

How much weight can I expect to lose?

Weight loss procedures are a pathway toward a healthier future. Whichever option you choose, success will depend, in part, on your dedication to physical and emotional wellness going forward. With proper support after ESG, patients can expect to lose 15-20% of their total body weight over 6-12 months, and most patients maintain that weight loss after one year.

What if I had a previous bariatric surgery and I’m still unhappy with my weight?

We perform revisions of surgical sleeve gastrectomy and gastric bypass with a flexible tube and suturing device. You can expect to lose 15-20 pounds after a revision of a gastric bypass (outlet reduction) and up to 10-15% total body weight after a revision of a surgical sleeve gastrectomy. We are happy to discuss these options with you in our endobariatric clinic to determine if you are a candidate.

Is ESG right for you?

The goal of the UT Southwestern Endobariatric Program is to offer personalized weight loss therapy for each patient. We work closely with the Weight Wellness Clinic and our bariatric surgeons to individualize and tailor weight loss therapy for each patient. We reserve time in our endobariatric clinic specifically for patients interested in learning whether an endoscopic sleeve gastroplasty or revision of their prior bariatric surgery is the right option for them.

UT Southwestern also plans to open a state-of-the-art, interdisciplinary obesity management center at Texas Health Dallas, where patients can see endobariatric experts, obesity medicine specialists, bariatric surgeons, and plastic surgeons in a single location.

Improving the future of obesity treatment

Our endobariatric team is always working toward the next innovation in weight wellness. We are conducting several research projects, such as:

  • Developing a registry to track patients’ progress after they have an endoscopic bariatric procedure.
  • Planning a survey to distribute to doctors nationwide to understand how they implement endoscopic bariatric procedures such as ESG.
  • Piloting an ESG-based weight management program for breast cancer survivors, since having excess body weight increases the risk of cancer recurrence

Losing weight is difficult, and we are eager to offer more patients ESG as a supportive, minimally invasive option. No matter which method you choose, the multidisciplinary team at UT Southwestern is here to support you before, during, and after your procedure.

To learn more about endoscopic sleeve gastroplasty, call 214-645-2800 to schedule a consultation, or request an appointment online.