Obesity rates have been rising in the United States at an alarming rate. According to the Centers for Disease Control (CDC), about 42% of the adult U.S. population had obesity between 2017 and 2020. The stress of the COVID-19 pandemic has made things worse. Obesity is not only a disease itself, but it also increases the risk of other chronic diseases such as diabetes, high blood pressure, high cholesterol, fatty liver disease, sleep apnea, heart disease and multiple cancers. A focus on healthier nutrition and physical activity is more important than ever before, but lifestyle modification alone is not successful in many situations. Bariatric surgery is well known to be the most effective and long-lasting treatment for obesity. However, only 1% of the patients that qualify for bariatric surgery get the treatment. There are various reasons for this, but patient perceptions and the invasive nature of the procedures play a role. Endoscopic sleeve gastroplasty is a minimally invasive bariatric procedure that is increasing in popularity.

What is Endoscopic Sleeve Gastroplasty? Endoscopic sleeve gastroplasty, commonly known as ESG or the “accordion procedure,” is a non-surgical weight-loss procedure. It is similar to the surgical sleeve gastrectomy in the sense that it works by reducing the size of the stomach, but it is done without incisions or surgery. ESG is performed endoscopically, meaning the doctor introduces a tube through the mouth into the stomach with a camera and an FDA-approved suturing device attached to the tube. The surgeon places four to six stitches to fold the stomach into a smaller size. No portion of the stomach is removed. In general, ESG is performed as a same-day procedure or in some cases is followed by a short period of observation in the hospital. Patients still must undergo general anesthesia, but they have a quicker recovery time due to the lack of incisions. The procedure takes about one to two hours, and some patients may return to normal activity in as little as two to three days. Patients can start consuming a clear liquid diet in a few hours. After a week or two of a liquid diet, patients move on to semisolid foods and eventually a healthy regular diet.

"A focus on healthier nutrition and physical activity is more important than ever before, but lifestyle modification alone is not successful in many situations."

Should I Consider Getting ESG? ESG is ideal for those that have a body mass index (BMI) of 30 or higher and have not had success with other non-surgical weight-loss methods. It is also beneficial when patients either don’t qualify or do not want to undergo traditional bariatric surgery. There is no upper age limit for the procedure if the person is in overall good health. Each patient needs to be evaluated in detail prior to the procedure. Those that have gastric ulcers, severe inflammation of the stomach or extensive polyps in the stomach should not undergo the procedure. ESG has shown promising results so far. A recent trial performed at multiple hospitals in the U.S. and published in 2022 in the prestigious medical journal Lancet revealed that patients, on average, lose over 49% of their excess weight and over 13% of their total body weight. Other medical studies have demonstrated an even higher average percentage of total body weight-loss, between 15% and 18% at 12 to 24 months. This of course is affected by an individual commitment to healthy nutrition and increased physical activity. The effects can be further enhanced by adding weight-loss medications afterward. In addition to weight-loss, ESG helps improve associated conditions such as diabetes, high blood pressure, sleep apnea, high cholesterol, heart disease and joint pain.

"ESG is ideal for those that have a body mass index (BMI) of 30 or higher and have not had success with other non-surgical weight-loss methods."

What Are the Risks Associated with ESG? There are risks and complications associated with every procedure. However, on average, there are less than 1-2% of adverse events with ESG. The most common side effects noted by patients are abdominal pain and nausea, which can be treated successfully with medications and improve after a few days. In some cases, patients may experience bloody vomiting, but this is rare and usually treated without any significant long-term consequences. The chances of developing post-procedure heartburn are much lower with ESG compared to surgical sleeve gastrectomy. ESG is both reversible and able to be converted to other surgical procedures if it is not effective or more weight-loss is desired. This is seen as a big advantage by those that are hesitant to pursue surgical weight-loss. Patients should maintain long-term follow-up care with their physicians and continue to work on maintaining a healthy diet with adequate physical activity. Conclusion In summary, ESG is a non-surgical weight-loss procedure for those that either don’t qualify for, or don’t want, a more invasive bariatric operation. It has promising results, especially in those with a BMI of 30 to 40, and has a low risk of complications. Each patient should establish care with a trusted doctor to hear more about possible treatments and learn whether ESG is an option.