There are many ways to treat obesity so that patients achieve their weight loss goals. At one end of the treatment spectrum are lifestyle modifications and weight loss medication. At the other, is bariatric surgery.
Atlantic Health is one of few health care providers in the state of New Jersey to offer a “middle option” called endoscopic sleeve gastroplasty (ESG), currently performed at Morristown and Overlook medical centers.
“What’s exciting about ESG is it offers patients another avenue to achieve their weight loss goals,” says Sanjay Salgado, MD, an interventional gastroenterologist with Atlantic Health. “By offering ESG, we’re adding to our arsenal of options through which patients can combat obesity.”
What is endoscopic sleeve gastroplasty?
Endoscopic sleeve gastroplasty (ESG) is not a surgery. Rather, it’s a minimally invasive weight loss procedure that uses endoscopic suturing to reduce the stomach’s size by 50%–70%. As a result, patients tend to require less food to feel full and lose weight over time.
This procedure is a nonsurgical alternative to gastric sleeve surgery and similar bariatric surgery procedures. Patients recover more quickly and go home on the same day.
How does ESG compare to bariatric surgery?
Typically, bariatric weight loss surgery is best for patients who want to lose the maximum amount of weight possible — often over 20% of their body weight. In comparison, those who receive the ESG procedure lose 15% of their body weight. But not everyone can or wants to undergo surgery.
When surgeons perform bariatric surgery with bariatric laparoscopic sleeves, they make a series of small incisions in the abdomen. Then, they remove part of the stomach. With an endoscopic approach, an interventional gastroenterologist inserts a flexible tube with a camera into the mouth and esophagus and brings the folds of the stomach together like an accordion.
“We don’t cut you open in any way,” explains Dr. Salgado. “We reduce the size of the stomach, but instead of cutting anything out, we suture or sew the stomach together from the inside.”
Benefits of ESG
An endoscopic weight loss procedure can be the best approach to treatment — especially for patients who can’t take weight loss medication or undergo surgery. Benefits include:
- Faster recovery time compared to traditional bariatric surgery. Patients who get the procedure go home the same day, without limitations on lifting or physical activity.
- Option to reverse. At any time, an interventional gastroenterologist can go in and cut the sutures from the ESG, so the stomach returns to its initial size within 24–48 hours.
- Fewer risks and complications. ESG minimizes some of the risks associated with surgery, such as infection, and often results in less pain.
- No weekly injections. Weight loss medications, such as Wegovy or Zepbound, often require lifelong adherence to maintain weight. They’re also not recommended for patients who are pregnant or breastfeeding.
- Approval as a trusted weight loss approach. ESG is fully endorsed by the American College of Medicine and American Society for Metabolic and Bariatric Surgery. It’s also covered by Medicare and a growing number of commercial insurance providers.
ESG recovery and long-term outcomes
Unlike traditional weight loss surgery, ESG has no physical recovery. Most patients go back to work or regular activity in a day or two. After the 60–90-minute procedure, you return home.
Overall, long-term outcomes from ESG have been positive. On average, after the the one-day procedure, patients maintain approximately 15% weight loss after five years, making this treatment option appealing to many patients with obesity.
“There aren’t many places in the country that do this procedure,” says Dr. Salgado. “It puts Atlantic Health in a unique position to be able to offer patients this type of treatment, in addition to the standard medical and surgical options.”
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