Most people who need to lose 65 or more pounds have tried multiple times to lose the weight on their own. While they may have some success at first, less than five percent of people keep the weight off for five years or more. 

– Philip Schauer, MD, bariatric surgeon and Director of Cleveland Clinic’s Bariatric and Metabolic Institute

Endoscopic sleeve gastroplasty is a non-surgical alternative to vertical sleeve gastrectomy. This minimally invasive weight-loss procedure reduces your stomach to the size and shape of a banana just like sleeve gastrectomy, but uses staples to reduce the size of the stomach instead of relying on tissue removal.

Endoscopic sleeve gastroplasty is ideal for those who have a BMI between 30 and 35 and who want to experience significant weight loss without surgery.

What happens during an endoscopic sleeve gastroplasty?

sleeve gastroplasty

Endoscopic sleeve gastroplasty is performed as an outpatient procedure, which means you can go home the same day you have surgery. General anesthesia is used so you can remain unconscious during the procedure without feeling any pain. This weight-loss procedure usually takes roughly 45 minutes to perform, after which you will wake up in a recovery room where medical staff will check your vitals and monitor you for complications.

Your bariatric surgeon begins by inserting an endoscope into your stomach via the esophagus. The endoscope is a long, thin, flexible tube with a camera and suturing device attached. The doctor will use the endoscope to see the inside of your stomach, and to make approximately 12 sutures inside the stomach. Because the procedure is performed with an endoscope, your surgeon will not need to make incisions on your abdomen.

After your doctor has sutured your stomach, the stitches will be pulled tight to constrict the stomach and turn it into a smaller pouch roughly 30 percent of its normal size.

Endoscopic sleeve gastroplasty can help you achieve weight-loss results similar to those produced by sleeve gastrectomy, but is far less invasive in that it doesn’t involve the permanent removal of stomach tissue. This significantly reduces the risk of complications associated with bariatric surgery and shortens recovery time.

What are the advantages of endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty is a safe, effective alternative to permanent, non-reversible weight-loss surgeries such as vertical sleeve gastrectomy and gastric bypass surgery. Patients who have had endoscopic sleeve gastroplasty report that the procedure has allowed them to benefit from improved quality of life and long-term weight loss.

Advantages associated with endoscopic sleeve gastroplasty include:

Simple and minimally invasive

This weight-loss procedure is minimally invasive and eliminates the need for incisions — meaning there will be no visible scarring. Endoscopic sleeve gastroplasty is ideal for those who want to undergo an effective weight-loss procedure that offers minimal pain and downtime, and that can be reversed at any time later down the road.

Proven weight loss

The smaller stomach pouch that results from endoscopic sleeve gastroplasty allows you to consume smaller portion sizes at each sitting. Lower caloric intake can help you lose weight — especially when you’re also eating healthy foods and staying physically active. This relatively new weight-loss procedure has been shown to help people lose more than 18 percent of their total body weight after one year.

Safe and effective

Unlike surgical weight-loss procedures that come with potential risks of infection and blood clots, data on endoscopic sleeve gastroplasty show high patient survival rates and low rates of adverse events. Endoscopic sleeve gastroplasty is safer than many conventional bariatric surgeries, yet equally as effective, with weight-loss results comparable to many surgical solutions and the gastric balloon.

Lowered risk of health problems

Obesity can increase your risk of serious medical conditions including gallbladder disease, cancer, heart disease, and stroke. Endoscopic sleeve gastroplasty can help you lose weight and lower your risk of these and other obesity-related health problems — including common comorbidities such as reflux, sleep apnea, and type 2 diabetes.

Less costly weight-loss procedure

Endoscopic sleeve gastroplasty is less costly than most other surgical weight-loss options at around $12,000. This surgery is ideal for those who don’t want to spend a high amount of money on more complex, involved procedures that require longer hospitalization, such as gastric bypass surgery, which tend to cost more than $25,000.

What are the risks and disadvantages of endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty comes with risks and disadvantages just like any other weight-loss or medical procedure. Staying physically active, eating small portions of healthy foods, and adhering closely to your doctor’s instructions are the best ways to avoid adverse or unfavorable outcomes with this procedure.

Risks and disadvantages associated with endoscopic sleeve gastroplasty include:

Weight regain

Having a smaller stomach means you’ll be limited to smaller portions at each sitting, but eating foods that are sugary, processed, and/or high in fat can lead to weight regain, even if you’re eating these foods in small amounts. Being sedentary and not exercising regularly can also lead to weight regain after endoscopic sleeve gastroplasty. To maintain long-term weight loss following this procedure, you must consistently eat healthy foods and stay active.

Mandatory lifestyle changes

Endoscopic sleeve gastroplasty must be combined with a healthy diet and exercise to achieve the best possible weight-loss results. Since you’ll be consuming far fewer calories after this procedure, you must eat healthier foods that deliver adequate vitamins and nutrients. Satisfying foods like high-quality protein and vegetables can keep your energy levels high while driving weight loss.

Potential complications

With endoscopic sleeve gastroplasty, there is a risk of the stomach pouch opening partially to expand the stomach size. This can lead to your needing additional procedures to resuture part of the stomach pouch. Some people may also experience mild pain and nausea for the first two days after the procedure, which tend to go away on their own.

How do I prepare for my endoscopic sleeve gastroplasty?

Your bariatric surgeon will provide you with specific instructions on how to prepare for your procedure, such as when to stop consuming food and drinks in the hours before your appointment. You may also undergo a series of lab tests and exams to determine whether this procedure could put you at risk of any adverse events.

Adhere closely to your doctor’s instructions surrounding preparation to improve your chances of the best possible outcome. Making healthy changes to your diet and lifestyle before the procedure can also help you prepare for life after endoscopic sleeve gastroplasty. Remove all unhealthy snacks and foods from your kitchen before your appointment, and stock up on nutritious, approved foods that facilitate weight loss. For the first week or two after the procedure, you must consume liquids only, before transitioning to soft pureed foods. Your doctor will tell you when it’s okay and safe to transition from pureed foods to solid foods.

Make a comfortable space in your home where you can relax and recover following your procedure. Recovery from endoscopic sleeve gastroplasty usually takes between one and two days. Also, make arrangements for childcare if necessary, and for transportation since the effects of anesthesia will interfere with your ability to drive home safely.

What can I expect after having endoscopic sleeve gastroplasty?

Eating will be off-limits for the first eight hours following your procedure. After that, you’ll be restricted to a liquid diet to prevent nausea and vomiting, and to allow your body to adjust to its new stomach size. The liquid food phase may last one to two weeks. After the liquid phase, you can move on to eating soft, pureed foods such as mashed vegetables and applesauce. When you’ve fully recovered from endoscopic sleeve gastroplasty, you can eat solid foods just like you did prior to your procedure.

The amount of food you’ll be able to consume in one sitting will be significantly reduced after having endoscopic sleeve gastroplasty. This will lead to the absorption of fewer calories, along with weight loss.

People who undergo endoscopic sleeve gastroplasty are shown to experience an average weight loss of 18.7 percent of body weight one year following the procedure. Evidence also shows that people who have this procedure and who have a starting body mass index (BMI) of 38 can experience an average weight loss of 39 pounds after six months, and 42 pounds after 12 months. For those with a BMI of 45, weight loss is roughly 73 pounds during a six-month period.

Am I an ideal candidate for an endoscopic sleeve gastroplasty?

This stomach reduction procedure is most ideal for people who want to lose excess weight and who have a BMI greater than 30, but cannot or do not want to have weight-loss surgery. If you have a BMI of 30 or higher, are at least 18 years of age, and haven’t experienced weight-loss success with diet and exercise, then endoscopic sleeve gastroplasty may be right for you.

Having endoscopic sleeve gastroplasty requires you to participate in a medically supervised weight-loss program. This program comes with nutrition education and planning, along with a personalized weight-loss and fitness plan. You must be willing to attend regular appointments to stay on track with weight loss after having this procedure.

Endoscopic sleeve gastroplasty is not ideal for those who have a hiatal hernia that is larger than three centimeters, those who have already had stomach surgery, or those who have gastrointestinal bleeding. If you are not an ideal candidate for this procedure, talk to your doctor about alternate weight-loss options that won’t pose serious risks for your health conditions.

Use our directory to find an experienced bariatric surgeon in your area who is qualified to perform endoscopic sleeve gastroplasty. A bariatric surgeon will discuss your available options for safe, evidence-based weight-loss procedures designed to help you reach and maintain your goal weight.

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