Endoscopic sleeve gastroplasty

Date Updated: 09/24/2021

Overview

Endoscopic sleeve gastroplasty is a newer type of minimally invasive weight-loss procedure. In endoscopic sleeve gastroplasty, a suturing device is inserted into your throat and down to your stomach. The endoscopist then places sutures in your stomach to make it smaller. This procedure may be an option if you're significantly overweight — a body mass index of 30 or more — and diet and exercise haven't worked for you.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. And the procedure is minimally invasive, reducing the risk of operative complications and allowing quick return to daily activities.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

Why it's done

Endoscopic sleeve gastroplasty is performed to help you lose weight and potentially lower your risk of serious weight-related health problems, including:

Heart disease and stroke
High blood pressure
Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
Sleep apnea
Type 2 diabetes
Osteoarthritis (joint pain)

Endoscopic sleeve gastroplasty and other weight-loss procedures or surgeries are typically done only after you've tried to lose weight by improving your diet and exercise habits.

Who it's for

Endoscopic sleeve gastroplasty is available to people whose body mass index (BMI) is above 30, who haven't been successful in maintaining weight loss with lifestyle modification alone, and who don't qualify or wish to pursue traditional bariatric surgery.

But endoscopic sleeve gastroplasty isn't for everyone who is overweight. A screening process helps doctors see if the procedure might be beneficial for you. And you must be willing to commit to healthy lifestyle changes, regular medical follow-up and participate in behavioral therapy.

Endoscopic sleeve gastroplasty isn't appropriate for anyone who has a large hiatal hernia or a condition associated with gastrointestinal bleeding, such as gastritis or peptic ulcer disease.

Endoscopic sleeve gastroplasty is not currently covered by most health insurance.

Risks

So far, endoscopic sleeve gastroplasty has shown a favorable safety profile. Pain and nausea may occur for several days after the procedure. These symptoms are usually managed with pain and nausea medications. Most people feel better after a few days.

In addition, although it's not designed to be a temporary procedure, endoscopic sleeve gastroplasty can be converted to other bariatric surgery.

When combined with lifestyle modification, endoscopic sleeve gastroplasty results in about 15% to 20% total body weight loss at 12 to 24 months.

How you prepare

If you qualify for endoscopic sleeve gastroplasty, your health care team will give you specific instructions on how to prepare for your procedure. You may need to have various lab tests and exams before surgery. You may have restrictions on eating, drinking and which medications you can take. You may also be required to start a physical activity program.

It's helpful to plan ahead for your recovery after the procedure. For instance, arrange for a companion or someone else to help at home. Recovery from endoscopic sleeve gastroplasty generally takes only a few days.

What you can expect

During the procedure

Endoscopic sleeve gastroplasty is done in the endoscopy unit as an outpatient procedure. General anesthesia is used for the procedure, so you'll be unconscious.

The procedure is done using a flexible tube with a camera and an endoscopic suturing device attached (endoscope). The endoscope is inserted down your throat into the stomach. The tiny camera allows the doctor operating the endoscope (endoscopist) to see and operate inside your stomach without making incisions in your abdomen.

Using the endoscope, the doctor places sutures in the stomach. The sutures change the structure of your stomach, leaving it shaped like a tube. This restricts the amount of food you can eat because you feel fuller sooner.

Endoscopic sleeve gastroplasty takes about 60 to 90 minutes.

After the procedure

After the endoscopic sleeve gastroplasty, you'll awaken in a recovery room, where medical staff monitors you for any complications.

After recovering from sedation, the majority of people go home the same day. Some people might require a short admission to the hospital for one day or less for observation after the procedure.

After the procedure, you generally won't be allowed to eat for a few hours. Then, you'll be allowed to start a liquid diet, which you need to continue for at least two weeks.

Eventually, you'll move on to semisolid foods, and then to a regular healthy diet.

Results

As with any weight-loss program, commitment to nutrition, physical activity, emotional health and resiliency will play a large role in how much weight you lose. Typically, if someone completes the entire program and follows all the guidelines, he or she can expect to lose about 12% to 20% of his or her body weight in one year.

Endoscopic sleeve gastroplasty may improve conditions often related to being overweight, including:

Heart disease or stroke
High blood pressure
Severe sleep apnea
Type 2 diabetes
Gastroesophageal reflux disease (GERD)
Osteoarthritis (joint pain)

When weight-loss surgery doesn't work

It's possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don't follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.