Endoscopic Sleeve Gastroplasty (ESG)

Posted on Healthcare By Dr. Wael Dahhan- FACG , M.D. - Published on 2018-01-08


Once asleep, the specialist inserts a camera (i.e. endoscope) through the mouth and into the stomach via a protective tube, that protects the oesophagus from injury.  Following an examination to confirm it is safe to proceed, a series of stitches are made within the stomach to create a tube which significantly decreases the stomach’s capacity by using FDA approved device (overstitch).

The procedure takes approximately 60 – 90 minutes to perform and the patient is able to be discharged from hospital on the next day.

While the stitches are not dissolvable, over several years the stitches may loosen or come undone- this can happen with vomiting or over-eating.  While this is not dangerous at all, this may decrease effectiveness of the procedure over the course of several years. However adding more stitches in the future could be possible if required.

How Does it Work?

The procedure not only forms a tubular-shaped stomach which is significantly more narrow, but also shortens the length of the stomach by approximately 50%.  It is thought that the volume reduction of the stomach following ESG is approximately 70%.

In addition, the ESG slows the ability of the stomach to empty, which further enhances the appetite suppression and allows the patient to feel full for longer period of time.

How effective is it and how long does it last?

Studies show the procedure, when combined with a comprehensive dietary and lifestyle program, leads to an average of approximately 20-25% TBWL over 18 months (Total Body Weight Loss; ie a 100 kg person would lose 20 kg on average).  One study has indicated that for people whose BMI is between 30 – 40, this procedure performs as well as a surgical sleeve in terms of weight loss over 18 months.

The procedure is designed to be permanent, however the stitches can be removed in early weeks (returning the stomach to full volume) should your doctor decide it is necessary in the future.

The procedure is relatively new, having been developed in 2012, however data show persistent weight loss out to 3 years.  It is expected that there may be some weight regain as the stitches loosen or break, however this can be prevented by avoidance of overeating and vomiting.

What are the side effects and risks?

Side effects after the procedure may include abdominal pain, nausea, cramping and vomiting, proper diet and certain medications after the procedures would minimize the risk of these side effects, particularly nausea and vomiting.  These side effects last 2-3 days and then typically disappear.

The risks of complications are surprisingly small.  There have been no deaths documented with this procedure with well over 3000 cases having been performed worldwide.  There are risks of bleeding and infection, however the total risk is less than 1%.

To date, complications that have occurred have been able to be managed with endoscopies, medications or minor procedures.  No complication has yet required surgery to resolve, however there is a very small risk that this may be required.

Maximizing your results

Studies demonstrate that a critical component of successful weight loss procedures is engaging with your team of doctors, dietitians, psychologists and support staff.  Research confirms that the more often you contact our team, the more successful your weight loss journey will be.

As part of the ESG program, you will be expected to see or be contacted by our dietitian as well as our psychological / psychiatrist therapist 6 – 8 times for 12 months.  You will also be required to see your specialist 3 – 4 times over the course of the year.  After your first year, it is recommended you see your team every 6-12 months, to guard against the risk of weight regain.


About Author

Dr. Wael Dahhan- FACG , M.D.

Dr. Wael Dahhan is an American Board Certified gastroenterologist with great work experience gained from practicing in the USA and UAE. After completing his gastroenterology fellowship from Yale University in New Haven, Connecticut, he trained in advanced and interventional endoscopy at BIDMC, Harvard University, Boston, Massachusetts, USA. Prior to moving to Dubai, Dr. Dahhan worked as a consultant gastroenterologist and hepatologist in one of the largest gastroenterology groups in South East Michigan and has built an excellent professional reputation over the past decade in the UAE. Dr. Dahhan's scope of work encompasses simple digestive diseases, routine procedures to more complex gastrointestinal cases, utilizing his remarkable skills in advanced endoscopy. He also offers colonoscopy for colon cancer screening and early detection. Dr. Dahhan provides upper endoscopy, colonoscopy, ERCP, capsule endoscopy, esophageal PH, motility studies, enteroscopy and liver biopsy. Dr. Dahhan has a keen interest in the field of non-surgical procedures for weight loss management and treatment of gastro-esophageal reflux disease

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