Endoscopic Sleeve Gastroplasty

Endoscopic sleeve gastroplasty is a minimally invasive weight loss procedure that involves inserting a suturing device into the patient’s esophagus and down to their stomach. The endoscopist then places sutures in the stomach to make it smaller.

The procedure may be an option for significantly overweight patients who have a body mass index of 30 or more and who haven’t experienced results with diet and exercise.

Endoscopic sleeve gastroplasty is an effective weight loss treatment, helping patients lose weight by limiting how much they can eat. Because the procedure is minimally invasive, the risk of operative complications is minimal and patients are able to return to daily activities relatively quickly.


To see results, patients must commit to living a healthy lifestyle. They’ll need to make permanent changes to their diet and exercise regularly to ensure long-term weight loss after endoscopic sleeve gastroplasty.

Goals of Endoscopic Sleeve Gastroplasty

Though the procedure is performed to help patients lose weight, other benefits include potentially lowering the risk of serious weight-related health problems, such as:

  • Sleep apnea
  • Type 2 diabetes
  • High blood pressure
  • Osteoarthritis (joint pain)
  • Heart disease and stroke
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)

Endoscopic sleeve gastroplasty and other weight-loss procedures are typically done only after conservative efforts, such as diet and exercise, have failed to produce results.


Who is a Candidate?

Endoscopic sleeve gastroplasty is an option for patients whose body mass index (BMI) is above 30, who haven’t been able to maintain weight loss with diet and exercise alone, and who don’t qualify for or wish to undergo traditional bariatric surgery.

However, endoscopic sleeve gastroplasty isn’t for all patients struggling with being overweight. Each patient will need to undergo a screening process to see if the procedure might be beneficial for them. The patient must also be willing to commit to living a healthy lifestyle, attend regular medical follow-up, and undergo behavioral therapy.

Endoscopic sleeve gastroplasty isn’t recommended for patients with a large hiatal hernia or a condition associated with gastrointestinal bleeding, such as peptic ulcer disease or gastritis.

What to Expect During The Procedure

The patient will be placed under general anesthesia and the physician will begin by inserting an endoscope down the patient’s throat and into their stomach. The tiny camera at the end of the endoscope will allow the physician to visualize the patient’s stomach and place sutures without making any incisions in the abdomen.

The sutures will alter the structure of the stomach, forming a tube shape that restricts the amount of food the patient can eat and aiding weight loss. The entire procedure will take between 60 and 90 minutes.

The Recovery Process

After the surgery, the patient will awaken in a recovery room, where they will be monitored for signs of complications.


Most patients are able to go home once they’ve recovered from the sedation. Some patients, however, might need to stay in the hospital for one day for observation.

After the procedure, patients will need to avoid eating for a few hours. They will then begin a liquid diet and continue the diet for at least two weeks.

Eventually, the patient will be able to consume semisolid foods, and then a regular healthy diet.

FAQs About Endoscopic Sleeve Gastroplasty & The Apollo ESG System

ESG is an endoscopic, incisionless weight loss procedure performed by a doctor, who sutures the stomach with a specialized device called the Apollo ESG™ System to make your stomach smaller.

While you are asleep, a specially-trained doctor passes a suturing device and camera through your mouth. After they reach the inside of your stomach, the doctor sews it into a smaller shape.

The procedure makes the stomach 70-80% smaller. You eat less food so your system absorbs fewer calories. Food stays in the stomach longer, and you feel full longer.

ESG is performed endoscopically, meaning there are no incisions or scars, and most patients can go home the same day.

The most common side effects are gastrointestinal symptoms such as nausea, abdominal pain, vomiting, constipation, burping, or diarrhea. These symptoms typically resolve within 30-60 days. All procedures have risk. Patients should talk with their doctor and understand all risks before having any procedure.

Apollo ESG™ is for adults with obesity (defined as having a Body Mass Index (BMI) between 30-50 kg/m2) who have not been able to lose weight or maintain weight loss through diet and exercise alone.

Patients who are unable to have an upper endoscopy, are pregnant, are using certain types of blood-thinning medications or have malignant tissue, large hiatal hernia, potentially bleeding gastric lesions, or eating disorders are not eligible for the procedure. Talk to your doctor about whether you are a candidate for ESG.

Patients typically return to work in 2-3 days.

According to a large, randomized clinical study, patients lose an average of 14% of their body weight 12 months after undergoing the ESG procedure. Results will vary by person.

The sutures are made of a durable, permanent material that does not dissolve. However, the sutures can break. In the event the sutures break, you may not feel as full after eating as you did immediately after the procedure. If this happens, another procedure can be done to replace the broken sutures and restore the sleeve.

Over time, scarring and bridging tissue forms to maintain the smaller stomach size and sleeve-like shape. As with weight loss surgeries, the sleeve can stretch over time. In the event the sleeve stretches, you may not feel as full after eating as you did after the procedure. If this happens, a retightening procedure can be performed to place new sutures and restore the sleeve.

In the event that you cannot tolerate the sleeve, your doctor may consider reversal. Reversal soon after the procedure can typically be done by cutting and removing the sutures in your stomach. If more time has passed and scarring has formed, the sleeve could be reversed by a procedure to cut the bridging tissue and removing the sutures, if recommended by your doctor. Like with any procedure, reversal of ESG is associated with risks and should be discussed with your doctor before proceeding.

Healthcare providers work with patients one-on-one to determine payer coverage and financing options.

No, you are typically not required to take nutritional supplements or vitamins following an ESG. Follow your doctor’s instructions on any specialized diet plans during recovery and to maintain a healthy lifestyle

ESG has not been specifically tested or FDA approved for the treatment of weight related health issues like diabetes or hypertension. However, in a clinical study that included some patients with diabetes and hypertension, most of the patients with those conditions lost weight. With the weight loss, they tended to show clinical improvement in those pre-existing conditions