What is endoscopic sleeve gastroplasty?

endoscopic sleeve gastroplasty ESG

Endoscopic sleeve gastroplasty, or ESG, is a new non-surgical weight loss procedure in the UK performed at Centre for Surgery in London. ESG involves a specialised stitching device being inserted into the stomach via your mouth. The doctor will carefully place stitches in the stomach to reduce its size. The procedure may be ideal for significantly overweight or obese patients who have tried diet and exercise programs with no success. Patients should have a body mass index of 30 or more to be suitable for treatment.

Being significantly overweight or obese is linked with several weight-related conditions, including type two diabetes, high blood pressure and raised cholesterol. These obesity-related conditions continue to rise in prevalence in the UK. Currently, the most effective treatment for morbid obesity is weight loss surgery, also known as bariatric surgery and is more effective than a diet, exercise or prescription weight loss medication. A sleeve gastrectomy involves partial stomach removal to reduce its size by up to 80%. Sleeve gastrectomy surgery is associated with a significant rate of weight loss, although less than one percent of people who are eligible for weight loss surgery actually have the procedure due to the significant risk of complications and the high cost of the procedure.

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Recently a non-invasive endoscopic approach has been developed as an alternative treatment for obesity which is more financially affordable with a lower risk of complications as it does not involve incisions or scars. The most popular type of endoscopic weight loss treatment is currently the gastric balloon procedure involving the insertion of a deflated balloon in the stomach followed by its inflation with saline. The balloon works by filling most of the stomach volume and is known as a restrictive type of weight loss procedure as portion sizes are significantly reduced following a gastric balloon fitting. Restrictive type white gloss procedures have been proven to be the most effective form of weight loss when patients are followed up over a 12-month period.

Endoscopic sleeve gastroplasty, or ESG for short, is a new non-surgical weight loss procedure in the UK that involves reducing the stomach size with the application of a specialised endoscopic stitching device, also known as OverStitch^TM.

ESG involves stitching the front and back walls of the stomach together to achieve a tubular shape which is similar to the shape of the stomach achieved after gastric sleeve surgery. Endoscopic sleeve gastroplasty can result in significant weight loss. The procedure works by limiting how much a person can eat, leading to weight loss. ESG is a non-surgical procedure; most patients can return to their normal daily activities 2 to 3 days later.

As with any type of weight loss procedure, patients should be committed to living a healthier lifestyle with a more nutritious diet and regular physical exercise to ensure the benefits of endoscopic sleeve gastroplasty are maintained for the long term.

What are the benefits of ESG?

Endoscopic sleeve gastroplasty is designed to help mild and moderate Lee obese people lose weight without the need for invasive surgery. The procedure can help to reduce the risk of several weight related medical conditions including:

Heart disease
Stroke
High blood pressure
Type two diabetes
Obstructive sleep apnoea
Osteoarthritis
Fatty liver disease

Patients who have tried eating a healthy diet and exercising regularly but have been unable to lose weight may be suitable for an ESG procedure.

Am I suitable?

Endoscopic sleeve gastroplasty is designed for people who have a body mass index (BMI) over 30 and have been unable to achieve significant weight loss with lifestyle modifications alone. Patients may not be on the idea of invasive bariatric surgery or may not be suitable due to significant medical conditions that may affect their suitability for weight loss surgery.

The best way to determine suitability is to have a face-to-face consultation with an experienced specialist at Centre for Surgery. The specialist will carry out a detailed medical assessment, including taking a medical history to learn about the previous weight loss treatments you may have tried as well as any current medicines you may be taking. A physical examination will help to confirm your suitability. It’s important to bear in mind that you must be willing to commit to making several lifestyle modifications, and you must make sure you participate in the post-procedure after-care program, which is designed to reinforce healthy lifestyle habits.

If you have a large hiatus hernia measuring over 5 cm, severe acid reflux, peptic ulcer or gastritis, you may not be suitable for the procedure. Endoscopic sleeve gastroplasty is not currently covered by most private medical insurance policies and is not routinely available on the NHS.

How to prepare for ESG

Once your doctor has assessed you and determined you are a suitable candidate for the procedure, our preoperative nursing team will conduct a clinical assessment to ensure you are medically fit. You will be given detailed instructions on how to prepare for endoscopic sleeve gastroplasty. You may be required to have certain blood tests before the day of the procedure. You may be required to modify your dietary intake in the days leading up to the procedure. You will be advised on which medications you must stop before the procedure to reduce the risk of bleeding. You must also commit to a realistic program of physical activity after the procedure.

You should arrange to have a responsible adult escort collect you what’s the procedure is complete and look after you for the first 24 hours after your procedure.

What does endoscopic sleeve gastroplasty involve?

ESG is performed at our state-of-the-art Baker Street clinic in Marylebone as an outpatient procedure which means you’ll be able to go home later the same day once you have recovered from the anaesthetic effects. ESG is carried out under a general anaesthetic, meaning you’ll be unconscious throughout the procedure. Once you have been placed under anaesthesia, the doctor will insert an endoscope camera into your stomach via your mouth to firstly inspect the health of the oesophagus and stomach. The doctor will then insert a specialised endoscopic stitching device attached to the endoscope. The doctor can directly visualise the internal structure of the stomach through the endoscope by viewing a screen in the procedure room. The procedure does not require making any incisions through the abdomen. Once the correct areas have been marked, the doctor will place endoscopic stitches in the stomach to join the front and back walls of the stomach together. The goal is to create a tubular-shaped stomach similar to a gastric sleeve which will help to restrict the amount of food that can be eaten. You will therefore feel fuller much quicker after eating small portion sizes. ESG takes approximately 60 to 90 minutes to perform.

Recovery after ESG

Once the procedure is complete, your anaesthetist will wake you up. You will be transferred to our dedicated recovery suite staffed by specialist nurses, where the effects of anaesthesia will gradually wear off. During this period, you’ll be closely monitored to ensure any complications that occur are promptly managed. Once you have fully recovered from the effects of anaesthesia, you will be seen by your doctor, who will give you detailed post-procedure instructions. You will not be allowed to eat for 3 to 4 hours after the procedure. A liquid diet can then be commenced, which must be continued for a minimum of two weeks. After this time, you may then transition to a semi-solid diet for a further two weeks before converting to a healthy diet with all the recommended food groups.

When will I see results from endoscopic sleeve gastroplasty?

Following a sensible program of healthy eating and regular physical exercise is important after the procedure. This will play a significant role in how much weight is eventually lost. If you adhere to all aspects of the post-procedure care instructions, you can generally expect to lose between 15% and 20% of your body weight within 12 months.

The procedure can help to reduce the impact of certain obesity related medical conditions including:

Type two diabetes
High blood pressure
Heart disease or stroke
Osteoarthritis
Obstructive sleep apnoea

What happens if I do not see results after the procedure?

As with any type of weight loss procedure, including bariatric surgery, it may be possible to lose insufficient amounts of weight or to gain weight after the procedure. This may occur even if the procedure was carried out correctly. Weight gain is more likely to occur if you fail to follow the

How much does endoscopic sleeve gastroplasty cost?

The cost of an ESG will vary depending on the extent of correction required and your state of health. The price of endoscopic sleeve gastroplasty includes your endoscopist’s fees, anaesthetist fees and facility charges.

What are the finance options for ESG?

Centre for Surgery partners with Chrysalis Finance, the leading medical finance provider in the UK, for specialist procedures. We offer a range of flexible payment options, including 0% finance for eligible applicants. Please call us on 020 7993 4849 to learn more about the finance options available for your procedure.

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What are the risks of endoscopic sleeve gastroplasty

After the endoscopic sleeve gastroplasty procedure, certain side effects may be experienced, including mild abdominal discomfort, nausea and vomiting. All of the symptoms will improve over the first few days after the procedure as your doctor will prescribe appropriate pain relief medication to control symptoms.

FAQs

Can I get endoscopic sleeve gastroplasty on the NHS?

ESG is not routinely available on the NHS other than in a few specialist centres in the UK, and the acceptance criteria are known to be particularly strict. Waiting lists for most types of weight loss surgery have also been affected by the Covid 19 pandemic. Many patients now have to face waits of over two years before treatment.

We would advise having prompt treatment at a specialist private clinic such as Centre for Surgery in London.
Will my private medical insurance cover endoscopic sleeve gastroplasty?

Private medical insurance does not yet cover the cost of a non-surgical sleeve procedure.
Is endoscopic sleeve gastroplasty painful?

ESG is not painful. The procedure is performed under a general anaesthetic, which means you will be unconscious throughout the procedure. You may experience mild discomfort when you wake up after the procedure.

Painkillers will be prescribed to help you feel comfortable during the early recovery period. Once you have arrived at home, any pain or discomfort can be managed with over-the-counter painkillers. As part of your treatment journey with the Centre for Surgery, you have access to our nursing team via a dedicated helpline for any questions or concerns you may have.
How shit my diet change following an endoscopic gastroplasty procedure?

Once you have recovered from the ESG procedure, it is important to follow the diet plan given to you by your specialist. The size of your stomach will have been reduced, and your portion sizes need to be reduced accordingly. Most foods can be eaten as long as they don't cause you significant discomfort or acid reflux. Your overall food intake will begin to diminish, so it is important to eat a variety of food groups to prevent malnutrition. You should focus on eating foods high in protein and low in sugar, salt or fat. Good foods include fresh fruit, vegetables, whole grains, fish and lean meat. Most people find they eat small amounts more often after endoscopic sleeve gastroplasty. Alcohol intake should be minimised because alcohol contains a lot of calories.

There is a rare possibility of a condition called dumping syndrome developing after the procedure.

This occurs when high energy or sugary foods passed too quickly through the stomach and enter the small intestine rapidly, which may result in nausea, bloating, blood pressure drops or diarrhoea.

Dumping syndrome is a rare side-effect of endoscopic sleeve gastroplasty.

What To Expect

Consultation

We would invite patients considering an endoscopic sleeve gastroplasty to have a consultation with an expert specialist at our Baker Street clinic. At the consultation, you can discuss with your surgeon what you hope to achieve from an ESG. The doctor will assess whether your expectations for treatment are considered realistic. The doctor will explain the risks and complications associated with the procedure, including what the procedure involves and how long the recovery period takes. A note will be made of any previous treatments you have had and what medications you are taking. If you are determined to be a suitable candidate for endoscopic sleep gastroplasty, our patient coordinator team will be in touch to offer you suitable dates for the procedure and discuss potential finance options if you would like to spread the cost of your procedure.

Before your procedure

Once you have decided to proceed with an ESG, our nursing team will be in touch to conduct a medical assessment to ensure you are fit for the procedure. We recommend you stop smoking before the procedure, as smokers have a higher risk of complications.

You should also avoid taking any medicine containing aspirin to reduce the risk of bleeding during the procedure. The procedure is carried out under a general anaesthetic, and you will be required to fast for the procedure. Food is allowed up to 6 hours before the procedure, and clear fluids are allowed up to 2 hours before the procedure.

Procedure day

Endoscopic sleeve gastroplasty is carried out under a general anaesthetic and involves an endoscope being passed into the stomach via your mouth. Once you are under anaesthesia, the doctor will insert the endoscope and stitching device into the stomach. The doctor will stitch marked stomach areas together to create a tubular segment. Once the desired shape has been achieved, the anaesthetist will wake you up. The procedure takes between 60 to 90 minutes to perform from start to finish. You will recover in our dedicated recovery suite, where the effects of the anaesthetic will be allowed to wear off.

Endoscopic sleeve gastroplasty is an outpatient procedure which means you will be able to go home later the same day accompanied by a friend or family member.

After your procedure

After the ESG procedure, it will be at least four weeks before you can eat a normal solid diet. For the first few days after the procedure, he will need to eat a liquid diet, such as soup, without added solids. You may then move on to pureed foods for the next two weeks.

Most patients can commence a normal healthy diet approximately four weeks after the procedure. Most people can return to work 2 to 3 days after the procedure. You will need to attend regular post-operative follow-up visits after your endoscopic sleep gastroplasty. You may be required to take vitamin supplements to reduce the risk of developing malnutrition. Our nursing helpline is available to you whenever you require further assistance throughout recovery. It is normal to experience rapid weight loss during the first 3 to 6 months following an ESG procedure.

You may develop certain symptoms, including a loss of energy, changes in mood, hair thinning or hair loss and a feeling of cold. The symptoms will resolve once your weight begins to stabilise.

Julie Dyson

11:05 23 Jun 22

Everyone at the Centre for Surgery has exceeded my expectations by miles! From the moment I made contact and enquired about the procedures offered, all the way through to my post-operative aftercare, I have been blown away by the levels of customer service and empathy shown to me on my journey.At 62 years of age, some might question whether I was a bit old for a “mummy makeover” wanting both a bi-lateral breast reduction and an abdominoplasty. However, I was treated so kindly and with such respect that these thoughts were soon left behind. Lidia the Patient Coordinator allocated to me was great – she sent me loads of information to read and arranged a consultation with Mr Ertan Erel, the surgeon.When I met Mr Erel, he immediately made me feel at ease. We discussed performing the procedures in a staged format, to allow my body to recover in between surgeries. He also encouraged me to lose a few kilos before my surgery saying it would be of benefit health-wise and give better results. He walked me through both of the procedures, what to expect and likely outcomes. We agreed that I would have the breast reduction first, followed by the tummy-tuck 4 to 6 months after that. I was offered a follow-up consultation, but didn’t need one, I was so happy with the first.Lidia then helped me choose a date for the first op based on my personal commitment to lose the weight. The encouragement helped tremendously and in January 2022, I had my first surgery. On the day, the whole team were amazing, from the receptionist who greeted me, the entire theatre team – Mr Erel, the anaesthetist and all the theatre nurses couldn’t have looked after me any better. What was truly wonderful for me – I was able to go home the same day once Mr Erel and the nurses were happy for me to leave, no stay in hospital where you can’t sleep etc. – absolute bliss.The support team telephoned me the next day to ensure all was well and organised an appointment to see a perioperative nurse to check my wounds and re-dress. How lucky am I – Sophie Ship is just the best! Knowing that support team was always available together with regular check-ups in Sophie's very capable hands I was very soon on the mend.AT 6 weeks post-op, I had a review with both Mr Erel and Sophie. We were all delighted with the results and my recovery, it was agreed that the second operation could take place in May/June.Lidia, then sent me loads more information about the procedure, answering all my questions swiftly and booked the date. To ensure I was fit for surgery, Mr Erel saw me again two weeks before my surgery. All was agreed and the abdominoplasty performed on 25th May. Once again, everything went like clockwork and every member of the team were outstanding.I’m now 4 weeks post-op 2 and already delighted with the results. Mr Erel is a genius! I feel so privileged to have had both my surgeries performed by him. The swelling is already going down and I can’t wait to see how I look in a couple of months.I have given Centre for Surgery and Mr Erel permission to show my photographs to anyone considering the procedure(s) and am more than happy to provide more details/chat to anyone about any concerns they have. Please just ask Centre for Surgery/Mr Erel to arrange.

Jose Sasam

14:44 28 May 22

Absolutely fantastic! Highly recommended!

Rita W. Eversole

10:18 28 May 22

Highly recommend this clinic for anyone wanting a friendly, welcoming, professional and non judgmental approach to all your surgical and non surgical needs. I wouldn’t consider going anywhere else.

Jemes Rodreges

05:59 28 May 22

Staff are very helpful and friendly, nothing has ever been to much trouble. Definitely put me at ease before I had my surgery and gave great aftercare after my surgery

Colly Hazel

20:08 02 May 22

I made an enquiry with the Centre for Surgery after reading everyone's reviews on Google - and I am elated that I chose CfS.The website was easy to navigate and provided me with sufficient information and understanding of the consultation I wanted to have. Booking the appointment and paying the small consultation deposit was incredibly simple. The availability of appointments on offer was really good too.I received quick confirmation of my booking, and also an email reminder of my appointment one day prior which was really nice.The clinic, both interior and exterior, was well kept and clean.The consultant was Dr Alok Misra. I was really nervous but his bubbly and kind character quickly put me at ease. First he clarified the purpose of my visit (which shows that Dr Misra and the team are observant) and discussed my concerns. Dr Misra was honest and open. He carefully listened to everything I had to say, repeated what we discussed to ensure there was no misunderstanding (I really appreciated this), and then gave advice and guidance which neither me nor self Google-searches, would have ever considered.At the end of the consultation, his team brought me to a private office to discuss what was said and to ask how I'd like to proceed. I think this is an example of exemplar customer service.

Endoscopic Sleeve Gastroplasty (ESG)