Endoscopic Sleeve Gastroplasty (ESG)

The endoscopic sleeve gastroplasty (also known as an endoscopic stomach sleeve) is a procedure similar to gastric sleeve surgery, but it is non-surgical. The entire ESG procedure is done through the mouth without requiring any incisions. Using this technique, your physician reduces the size and volume of your stomach to much less than its original capacity. Endoscopic sleeve gastroplasty offers a safe, effective alternative for patients who are not ideal candidates for surgery or who prefer a non-surgical solution.

With only a few physicians in the country performing the ESG procedure, UChicago Medicine is one of the few hospitals offering this option in the Chicago area. If you and your physician decide ESG is the right procedure to meet your weight loss goals, you can feel confident that you have partnered with experts who have the skill and experience you can trust.

While you are asleep, the physician places an endoscope into your mouth, which is advanced down the esophagus and into your stomach. A suturing device is attached to the endoscope and allows the insertion of sutures in a specific pattern to constrict the stomach, resulting in a “sleeve” shape.

This series of sutures is then tightened, constricting the overall usable volume of the stomach. Patients generally go home the same day or the following day after an overnight admission. They are instructed to follow a specific diet for a brief amount of time afterward. Once a patient's stomach volume is restricted, he or she will consume smaller portions of food. In conjunction with diet and exercise, the endoscopic sleeve can result in weight loss ranging from 40 to 60 pounds.

The endoscopic sleeve gastroplasty (ESG) procedure is designed for patients who are obese, having a BMI of greater than 30, who are not ideal candidates for, or do not desire, bariatric surgery.

The ESG is one of the most effective endoscopic procedures for primary weight loss. On average, patients lose 40 to 60 pounds, or nearly 20 percent of their body weight. Recent research has demonstrated that the weight loss achieved with the ESG procedure can last for more than two years. The sleeve also has been demonstrated to improve other medical complications brought on by excess weight, including cholesterol, diabetes and high blood pressure.

The ESG procedure should be considered internal endoscopic surgery. The rate of major complications associated with the endoscopic sleeve is very low (approximately 2 percent), but some patients might experience abdominal pain, nausea, vomiting and constipation and may need to be observed overnight in the hospital to manage symptoms.

Intragastric Balloon (IGB)

Often referred to as the “weight loss balloon,” these durable, saline-filled silicone balloons are temporarily placed in your stomach for six to eight months to promote healthy weight loss. The shape and volume of the stomach balloon (about the size of a grapefruit) takes up approximately one third of the space in your stomach and helps you adapt to smaller portion sizes. With this technology patients can experience up to three times the weight loss of diet and exercise alone.

In order to provide our patients with the most advanced care, UChicago Medicine is participating in clinical trials, including a weight loss balloon trial. Patients who are interested in pursuing weight loss balloons should talk to their physicians about qualifying for or getting more information about this clinical trial.

These balloons are placed into the stomach in a simple, nonsurgical outpatient procedure. During the procedure, a deflated gastric balloon is inserted through your mouth, down the esophagus and into your stomach. A syringe is then used to fill the balloon with a sterile saline solution to about the size of a grapefruit. The entire procedure takes only about 20 to 30 minutes, and typically patients are discharged home after two hours of recovery.

Some patients may experience abdominal discomfort, nausea or vomiting for the first one to two weeks. However, this can often be controlled with medications and typically improves after the first week.

Although the balloons were somewhat recently approved in the United States, gastric balloons have been used for more than 20 years with over 220,000 gastric balloon procedures successfully performed in more than 80 countries. Serious complications are extremely rare, and balloons can be removed at any time.

Weight loss balloons, and all endoscopic therapies, should be considered a tool to help assist with weight loss. Each patient must learn to use the tools effectively to ensure maximum results. Similar to any weight loss endeavor, the number of pounds lost varies from patient to patient, depending on his or her individual body and lifestyle changes. However, on average, patients can expect to lose approximately 20 to 40 pounds.

Aspiration Therapy with AspireAssist

Aspiration therapy with the AspireAssist is a new FDA-approved weight loss solution that reduces the calories absorbed by the body, allowing you to make progressive, healthy changes to your lifestyle. With AspireAssist, a small tube is placed in your stomach that allows you to aspirate (or evacuate) up to 30 percent of a meal after eating, preventing those calories from being absorbed into the body and resulting in weight loss.
 

After anesthesia puts you to sleep, your physician uses an endoscope to place a thin tube in your stomach that connects the inside of your stomach to a small, discrete button on the outside of your abdomen. After each meal, you connect a small handheld device to the button, which allows you to empty up to 30 percent of your meal into the toilet through this tube. This prevents those calories from being absorbed into the body. But you still retain enough food so the body receives the calories it needs to function.

After eating, patients must wait 20 to 30 minutes before beginning aspiration. Patients can expect aspiration to take between 5 to 10 minutes before the process is complete. The food being emptied from the stomach can be drained directly into the toilet, so patients can perform aspirations in private.

By the end of six months of aspiration therapy, patients lose on average 40 percent of their excess weight.

Secondary Therapies for Weight Gain After Bariatric Surgery

Although bariatric surgery is often a highly effective tool for weight loss, sometimes patients experience weight re-gain. If this occurs, endoscopic bariatric therapies, including endoscopic suturing, are available to help patients by non-surgically reducing the size of their residual stomach or surgical connection site to assist in losing weight that has been regained.
 

Some bariatric surgeries reduce the size of the stomach. This helps patients feel full more quickly and eat smaller meals. Over time, the stomach can begin to stretch, enabling the patient to eat more before feeling full and can lead to weight gain.

Endoscopic therapies, such as endoscopic suturing, are nonsurgical procedures for reducing the size of the stomach pouch or sleeve for patients who have gradually stretched the stomach after weight loss surgery. These incisionless procedures place a scope through the mouth and into the stomach once a patient is under anesthesia. Sutures are put in place internally to tightening the stomach or the surgical connection site where it has stretched. This can restore that feeling of fullness and encourage patients to eat smaller meals again

Patients who undergo endoscopic revision of bariatric surgery procedures lose 30 to 40 pounds on average. For maximum results, patients should consider therapy before a significant amount of weight is re-gained. When patients feel loss of restriction, notice an increased tolerance of larger meals, or start regaining weight, it is time to contemplate scheduling a consultation.

Meet Our Endoscopic Therapy Specialist