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Endoscopic Sleeve Gastroplasty (ESG)
➤ Procedure: Endoscopic suturing of the stomach creating a full-
thickness plication of stomach tissue
➤ Indication: BMI 30–50 kg/m
2
➤ Efficacy: 16% total body weight loss and 60% excess weight loss
for up to 1–2 years
• Improvement of at least 1 weight-related chronic disease in 80% of
individuals
➤ Safety: Stitch failure, upper GI bleeding, peri-gastric leak/infection,
perforation
• No deaths observed in published ESG literature
Physiologic Mechanisms of Weight Loss with ESG
➤ Restriction of gastric expansion induces early satiation during
meals.
➤ Delayed emptying of the stomach promoting a prolonged
sensation of satiety after meals.
➤ Fundus is left intact, and ESG does not appear to affect ghrelin
secretion the way VSG/laparoscopic sleeve gastrectomy (LSG)
does.
Stomach
before ESG
Stomach
after ESG
Suturing device
inserted through
the mouth
Procedure performed
without scars
