Endoscopic Sleeve Gastroplasty (ESG)

An endoscopic weight loss procedure is a non-surgical approach that uses an endoscope for your weight loss treatment, instead of the incisions (cuts) that are used in traditional surgery. An endoscope is a thin, flexible tube that helps a doctor view your digestive system.  Endoscopic procedures are considered very safe and less risky than surgery.

We offer a full range of endoscopic treatment options and perform more endoscopic suturing (stitching) weight loss procedures than any other hospital. This includes endoscopic sleeve gastroplasty (ESG).

What is endoscopic sleeve gastroplasty (ESG)?

Endoscopic sleeve gastroplasty (ESG), also known as the accordion procedure, involves using an endoscope with an attached suturing device to place sutures in the stomach. ESG is a minimally invasive procedure that doesn’t require any incisions on the outside of your body and you won’t have any external scars. The recovery time is also much faster than traditional surgery.

How is ESG performed?

While you are sedated, your doctor puts an endoscope through your mouth and into your stomach. The endoscope has a suturing device attached to it. The suturing device is used to suture small accordion-like folds into the stomach to make it smaller and decrease its length. When these folds are stitched into your stomach tissue, there’s less room in your stomach to hold food. With a smaller stomach, you feel full faster and tend to eat less as a result.

What is the expected amount of weight loss from ESG?

Patients who have the ESG weight loss procedure typically lose 15 to 20 percent of their starting total body weight.

What is recovery like after ESG?

Patients usually go home the same day as the procedure. You first follow a full liquid meal plan, which includes protein shakes and similar products. You then transition to a soft food plan (including easy-to-eat foods, like oatmeal, bananas and soft-cooked rice). Finally, you can return to regular eating. People usually take 1 to 2 days off work. You should avoid lifting heavy objects after the procedure. ESG is reversible in most patients. 

Are there any additional health benefits, besides weight loss?

You may experience better health, like improvements in weight-related health conditions. These can include sleep apnea, high blood pressure, type 2 diabetes, fatty liver, and dyslipidemia. Dyslipidemia is when you have abnormal amounts of lipids (fats) in your blood.  In some case, these conditions may even resolve completely.

Am I a candidate for ESG?

Your doctor can work with you to determine if ESG is right for you. To qualify for ESG, you need a body mass index (BMI) of at least 30. Healthcare professionals use BMI to determine your health risk for weight-related diseases. It’s based on a formula that considers your current weight and height. While it’s not a perfect method, BMI can be a useful health indicator for many people. To find out your BMI, you can use our BMI calculator.

How can I improve my health before ESG and prepare for the procedure? You can meet with your doctor to ask any questions you may have about ESG. You also can work with our dietitians and nutritionists before and after the procedure to adopt a healthy lifestyle.

Do you offer long-term weight management support?

Yes. We provide weight management support after the procedure. We take a collaborative approach to treatment that combines the expertise of many different specialists, including the expertise of dieticians. Our team-based approach helps us offer a very high quality of care.

Which doctors offer treatment with ESG?

Christopher Thompson, MD, MSc, AGAF, FASGE, FACG
Co-director of Center for Weight Management and Wellness
Director of Endoscopy
Director of Bariatric Endoscopy

Pichamol Jirapinyo, MD, MPH, ABOM
Associate Director of Bariatric Endoscopy
Director of Bariatric Endoscopy Fellowship

How do I schedule an appointment to learn more about ESG?

If you would like more information or would like to schedule an appointment with a Brigham doctor, you can call us at 617-525-3597 or fill out our appointment request form.

I’m a physician. How do I refer a patient for treatment?

Physicians who are looking to refer a patient can call 617-525-3597 or email us at brighamweightloss@bwh.harvard.edu.