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Endoscopic sleeve gastroplasty

Endoscopic sleeve gastroplasty, also known as the accordian procedure, is a weight loss procedure that uses an endoscopic suturing device to reduce the size of your stomach. The procedure recreates what would occur at a surgical sleeve gastrectomy though without the need for surgery.

This procedure is ideal for those with a body mass index of 30 or more and for those where diet and exercise alone have not worked. Because the procedure is minimally invasive, there is a reduced risk of complications.

Like other weight loss programs, however, a commitment to a healthier lifestyle will help to ensure long-term success and permanent weight loss.

In addition to weight loss, endoscopic sleeve gastroplasty can also lower your blood sugar and potentially address other serious weight-related problems.

ESG reduces gastric volume by using an endoscopic suturing system inserted in the throat to place pleated sutures in the stomach that cause it to constrict like an accordion.

 Lead study author Reem Z. Sharaiha, MD, MSc, assistant professor of medicine at Weill Cornell Medicine and attending physician at New York-Presbyterian/Weill Cornell Medical Center, described it as “a day procedure done in the endoscopy suite” that leaves “no scars from the outside and no cuts.”


Unlike traditional bariatric surgery, which requires cutting through skin and tissue to alter or remove parts of the anatomy, no incisions are made during endoscopic sleeve gastroplasty.

During this procedure, a flexible tube called an endoscope fitted with a mechanical suturing device is inserted through the mouth and threaded down the esophagus to the stomach, as seen above left.

Once in the stomach, the suturing device sews three rows of stitches, as seen above right.

The stitches are then pulled, constricting the pouch-like stomach into the shape of a sleeve. Above left, a normal stomach is shown; above right is a stomach after endoscopic sleeve gastroplasty.


Like vertical sleeve gastrectomy, endoscopic sleeve gastroplasty leads to significant weight loss by reducing the size of the stomach from a football to that of a banana.

The smaller stomach size limits how much you can eat, giving you the experience of feeling full sooner and for a longer period of time.

Vertical sleeve gastrectomy achieves the smaller stomach size by surgically removing approximately 85 percent of the stomach.

With endoscopic sleeve gastroplasty, however, the stomach size is reduced by placing sutures within the stomach and then pulling them tight to gather portions of the stomach together.

Because the procedure is minimally invasive, both the risk of surgical complications and the recovery time are reduced.

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.


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.