In an era where “obesity” is not just about appearance but the starting point of many chronic diseases such as diabetes, hypertension, high cholesterol, heart disease, stroke, and even some types of cancer, proper weight loss is not merely about aesthetics but an investment in long-term health.
For those who have tried dieting, exercising, or using medical weight loss drugs but have not achieved their target weight, experience weight regain after stopping medication, and are not yet ready for bariatric surgery, there is now a modern and safer alternative: Endoscopic Sleeve Gastroplasty (ESG), which reduces stomach size without open abdominal surgery.
At Phyathai 2 Hospital, we emphasize a holistic approach to obesity treatment under the care of a specialized team of gastroenterologists, surgeons, and multidisciplinary professionals to ensure safe and sustainable weight loss in the long term.
What is ESG?
Endoscopic Sleeve Gastroplasty (ESG) is a weight loss procedure that does not require open surgery. Doctors use an endoscope inserted through the mouth into the stomach, then use special devices to stitch and fold the stomach walls from the inside, reducing the stomach size to resemble a “sleeve” without cutting any part of the stomach or external surgical wounds. The results are:
- Feeling full faster
- Eating less
- Better control of daily energy intake
How is ESG different from traditional stomach reduction surgery?
| Comparison | ESG | Sleeve Gastrectomy Surgery |
| Surgical wound | No external wound | Abdominal surgical wound |
| Stomach cutting | No stomach removal | Partial stomach removal |
| Recovery time | 1-2 days | 3-4 days |
| Risk of complications | Low | Higher than ESG |
Therefore, ESG is suitable for those who want serious weight loss but are not ready for surgery.
Who is suitable for ESG?
International medical practice guidelines recommend ESG for individuals who have:
- Body Mass Index (BMI) ≥ 30
- BMI ≥ 27 with comorbidities such as diabetes, hypertension, or high cholesterol
- Failed to lose weight by other methods
- Want a non-surgical option
However, suitability must be assessed through physical examination and planning with a specialist doctor.
ESG Procedure Steps
Endoscopic Sleeve Gastroplasty (ESG) begins with a thorough physical evaluation by a specialist team to assess suitability and prepare for the procedure. On the treatment day, the patient receives sedation or general anesthesia under anesthesiologist supervision. The doctor then inserts an endoscope through the mouth into the stomach without any external surgical wounds and uses special stitching devices to fold the stomach walls from the inside, reducing the stomach size to resemble a sleeve. The entire procedure takes about 90–120 minutes. Afterward, the patient is observed and can start sipping water as per the doctor’s care plan. Generally, recovery is short, and patients can go home within 1–2 days. Post-procedure, dietary behavior must be adjusted, and continuous follow-up with the medical team is necessary to ensure safe and sustainable weight loss.
Advantages of Endoscopic Sleeve Gastroplasty (ESG)
- No external surgical wounds, reducing infection risk
- Quick recovery, allowing a fast return to daily life
- No stomach removal, preserving body structure
- Helps reduce weight by an average of 15–20% within 1 year
- Reduces risks of diabetes, hypertension, cholesterol, and heart disease
- Reduces pressure on knees and back, increasing mobility
- Supports physical health and long-term confidence
Results after ESG
On average, patients can lose approximately 15–20% of their body weight within the first 12 months and up to 25-35% when combined with medical weight loss drugs, following strict nutritional and behavioral guidelines. Results depend on:
- Discipline in diet control
- Exercise
- Adherence to post-procedure care programs
At Phyathai 2 Hospital, we emphasize Multidisciplinary Care with nutritionists and health behavior care teams providing continuous follow-up.
Possible Complications
Although ESG is a highly safe procedure, side effects may include:
- Nausea and vomiting
- Initial abdominal pain and tightness
- Acid reflux
- Upper gastrointestinal bleeding
Endoscopic Sleeve Gastroplasty (ESG) is a modern weight loss technology that reduces risks associated with major surgery by using a non-incisional technique without stomach removal, minimizing bodily injury. This results in a lower overall complication rate and shorter recovery time, allowing patients to return to work and daily life quickly. It suits the lifestyle of modern individuals who do not want to pause their lives for long.
At Phyathai 2 Hospital, ESG is performed under the care of a specialized gastrointestinal and obesity treatment team, along with anesthesiologists and multidisciplinary professionals who closely monitor every step—from pre-procedure evaluation, nutritional planning, to long-term follow-up—to ensure weight loss is not just a “number on the scale” but a reduction in chronic disease risk and an improvement in quality of life safely and sustainably.
Therefore, ESG is not just a medical procedure but a lifestyle-changing option that prioritizes safety, results, and the patient experience in every aspect.
Dr. Kittithat Tantithanawat
Specialist in Endoscopic Stomach Reduction for Weight Loss
Phyathai 2 Hospital
