Laparoscopic Sleeve Gastrectomy (LSG) vs Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic sleeve gastroplasty (ESG) reduces the gastric lumen to a size comparable with that of laparoscopic sleeve gastrectomy (LSG). However, there is a paucity of research comparing outcomes between the 2 procedures. Major study compared the 6-month weight loss outcomes and adverse events of ESG with LSG in a case-matched cohort.
Until recently, the most common surgical procedure used to achieve this goal was the minimally invasive Laparoscopic Sleeve Gastrectomy (LSG). However, a recent alternative called an Endoscopic Sleeve Gastroplasty (ESG) provides a less invasive option that can achieve virtually the same effect.
Looking at the two options in detail to compare them can help a patient have a useful discussion with a doctor about which procedure can give them control over their appetite once and for all.
What is a Laparoscopic Sleeve Gastrectomy (LSG)?
An LSG procedure is an effective means to reduce the storage capacity of a patient’s stomach. This allows the patient to feel full after consuming a much smaller portion of food than before the weight loss surgery, thereby controlling their appetite and eating habits.
Essentially, the doctor makes five small incisions and stitches the stomach to a narrower size in order to reduce its storage capacity. It is much less invasive than open surgery, and allows a patient to return to normal life after just a few weeks.
The patient is put under general anesthesia and then undergoes the 20 to 40 minute laparoscopic procedure. After an overnight stay to recover, the patient can return to work in a week or two, while abstaining from strenuous activity or heavy lifting for an additional three weeks after that.
The result of the procedure is that the patient will eat less, feel full after less food, and experience less hunger overall. The result is healthy weight loss that will help control or eliminate medical issues due to obesity.
What is the Endoscopic Sleeve Gastroplasty?
The Endoscopic Sleeve Gastroplasty (ESG) is a weight loss procedure that uses an endoscopic camera with a suturing device to reduce the size of your stomach.
An internal suture pattern is used to collapse 70–80% of your stomach, but no portion of the stomach is removed and there are no incisions and no scars. The procedure is permanent but reversible if necessary.
ESG patients have had good weight loss results, losing 30–60% of excess weight and usually have improvement or remission of diseases like type 2 diabetes, hypertension and other obesity related comorbidity diseases. The ESG is also known as the Endosleeve or the Accordion procedure.
How is the Endoscopic Sleeve Gastroplasty different from the Laparoscopic Sleeve Gastrectomy?
The ESG is performed with a suturing device on the end of an endoscope to collapse the majority of the stomach from the inside. There are no incisions and nothing is removed.
The Laparoscopic Sleeve Gastrectomy is performed with a camera and long instruments through small incisions in the abdominal wall. The majority of the stomach is detached and completely removed from the body through one of the incisions.
Endoscopic Sleeve Gastroplasty Works
In the course of this two-hour procedure, the patient is put under general anesthesia. An endoscopist advances the endoscope through the mouth into the stomach, where sutures are inserted in a specific pattern from the bottom (antrum) portion of the stomach up to the top (fundus).
The series of sutures is then tightened in a fashion that resembles an accordion, constricting the overall usable volume of the stomach. Patients generally follow a liquid diet for a brief amount of time after the procedure, and often can go home that same day.
Both our bariatric surgery program and our gastroenterologists who perform the ESG work closely with a team of doctors including an endocrinologist and nutritionist to monitor one’s food intake and metabolic health before and after the procedure.
Diet and exercise remain an integral part of a patient’s health regimen before and after the procedure, but constricting the stomach to reduce the amount of food one can eat helps turn the corner toward weight loss.
Preparing for ESG
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
Is the ESG permanent? Is the ESG reversible?
Yes, the Endoscopic Sleeve Gastroplasty is permanent, but, it is also reversible. We use permanent sutures that do not dissolve and 5 year data has demonstrated that the procedure is durable.
The ESG suture could be removed endoscopically if necessary to reverse the ESG procedure. It is very rare that this is needed, and is best to be done by an endoscopist who is experienced with performing the ESG.
Conclusions:
ESG, a minimally invasive same-day procedure, achieved less weight loss at 6 months than LSG, with the caveat that LSG caused more adverse events and new-onset GERD than ESG.
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.
If you want to cure your problem consult with our team here
