Endoscopic sleeve gastroplasty

Endoscopic sleeve gastroplasty (also called endoscopic gastric sleeve or ESG) is a minimally invasive, FDA-approved weight loss procedure that requires no incisions. If you are not interested in traditional bariatric surgery, our bariatric care team may recommend ESG as another option for achieving weight loss.

No incisions are needed for endoscopic bariatric procedures. During the procedure, a bariatric doctor passes a device through your mouth and esophagus. With the device, they “fold” your stomach to a smaller size and reduce it to 33 percent (one-third) of its original size.

Endoscopic sleeve gastroplasty is reversible. If you need future bariatric surgery to reach your health goals, you can still qualify.

ESG is one of several advanced weight loss options for obesity offered at Penn Medicine. Our specialists carefully consider your unique needs before creating a personalized treatment plan. They recommend the best surgical option to help you achieve and maintain a healthy weight.

Candidates include patients with a body mass index greater than 30 and unsuccessful attempts at weight loss through diet and exercise. You might also be a candidate if you had a previous bariatric surgery but did not reach your weight loss goals.

ESG makes your stomach up to 80 percent smaller and slows the rate at which your stomach empties. You feel full more quickly when eating and feel full for longer. As a result, you eat less, which helps you lose weight.

ESG can lead to significant weight loss. In clinical studies, patients lost an average of 13 percent of their total body weight and 49 percent of their excess body weight in one year. How much you lose depends on your commitment to changing your diet and exercise habits. Losing weight has other benefits as well, including improved sleep apnea, diabetes, and high blood pressure.

After endoscopic sleeve gastroplasty, you may experience discomfort for a few weeks. While some discomfort is normal, you should call your care team if you feel pain.

You may not feel hungry in the first week after your procedure. Your appetite should return in week two but because your stomach is now smaller, you’ll feel full after a minimal amount of food.

Follow-up care and lifestyle changes are important for long-term success after ESG. You’ll need to make permanent changes to your diet, incorporate regular exercise, and undergo weight loss counseling to maintain a healthy weight.

We recommend yearly follow-up after ESG, but our team is here for you at any time. You’ll work with our gastroenterologists, registered dietitians, and nurses who are passionate about supporting your commitment to a healthier lifestyle.

People who do not lose enough or regain weight and those who have complications after ESG may need an endoscopic revision procedure. Our team performs these corrective procedures without incisions.

We recommend bariatric revision procedures on a case-by-case basis.

The fellowship-trained bariatric surgery team at Penn Medicine has expertise in minimally invasive endoscopic procedures and laparoscopic and robotic surgery. These advanced techniques reduce your discomfort and recovery time. Our program is also accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

We have decades of experience helping people find the right weight loss option. As your partners on your journey to a healthy weight, we’re dedicated to helping you find a solution that works.