In an era where “obesity” has become a chronic and increasingly complex health problem, treatment approaches have continuously evolved. One of the most popular methods today is Endoscopic Sleeve Gastroplasty (ESG), which is considered a new option for those who want to lose weight safely without major surgery and with a quick recovery.
What is Endoscopic Sleeve Gastroplasty (ESG)?
ESG stands for Endoscopic Sleeve Gastroplasty. It is a procedure to reduce the size of the stomach by “suturing” from the inside through an endoscope without open abdominal surgery. The endoscope is inserted through the mouth, and the stomach is sutured to form a tube shape similar to a banana, which reduces food intake, makes you feel full faster, and leads to effective weight loss.
Phyathai 2 Hospital would like to clarify doubts about this new weight loss technique that does not require traditional surgery. This article compiles Frequently Asked Questions (FAQ) about ESG to help you understand the treatment with greater confidence.
Q1: Will the weight come back after ESG?
A: If you do not adjust your behavior after endoscopic sleeve gastroplasty, there is a chance that the weight will return, similar to weight loss surgery where weight can also come back. ESG is a tool to help control food intake, but long-term results depend on diet control, exercise, and regular follow-up with the medical team.
Q2: Does ESG affect hunger hormones?
A: ESG does not cut the stomach, so it does not affect the hunger hormone Ghrelin as much as stomach removal surgery does. There are two main points to discuss: the effect on weight loss and the satisfaction after eating. Regarding weight loss, studies have found that ESG is not inferior to stomach surgery in reducing weight and can be combined with medical weight loss injections for enhanced results without surgery. Additionally, because ESG does not affect hunger hormones related to post-meal satisfaction, patients can still enjoy eating in the long term after weight loss.
Q3: Do I need to take time off work or rest for a long time?
A: Patients after ESG can undergo the procedure as an outpatient or may stay 1-2 days for close observation. Patients can return to office work or jobs that do not require heavy physical effort immediately after the procedure. However, for heavy labor, rest of about 2-4 weeks may be needed depending on the body’s readiness.
Q4: What kind of diet should I follow after ESG?
A: The nutrition program is usually divided into phases, starting with clear liquids, then thick liquids or pureed foods, focusing on protein during the first three weeks. After that, soft foods are gradually introduced until returning to a normal controlled portion diet within six weeks. Strict adherence to recommendations helps reduce complications and enhances weight loss effectiveness.
Q5: How much weight can ESG help lose?
A: On average, ESG patients can lose about 15–20% of their total body weight within 1 year and can lose an average of 25-35% when combined with medical weight loss injections. Results depend on post-procedure eating behavior, exercise, and continuous follow-up care. At Phyathai 2 Hospital, we emphasize care by a Multidisciplinary Team including doctors, nutritionists, and health teams to increase long-term success chances.
Q6: Can ESG be repeated?
A: ESG can be reassessed and repeated if weight returns in the future, but it must be evaluated on a case-by-case basis by a specialist, similar to stomach surgery or bypass surgery where endoscopic suturing can be done to correct weight regain.
Q7: How is ESG different from Sleeve Gastrectomy surgery?
A: ESG uses an endoscopic method to suture the stomach from the inside without surgery, no stomach is cut, and there are no external scars. In contrast, Sleeve Gastrectomy surgery permanently removes part of the stomach, leaves abdominal scars, and has a higher risk of complications, especially acid reflux, compared to ESG.
Q8: Does ESG improve comorbidities?
A: In many cases, weight loss leads to improved blood sugar, reduced blood pressure, improved blood lipids, reduced fatty liver symptoms, and better sleep apnea. However, results vary by individual and require medical follow-up.
Q9: Does ESG cause nutrient deficiencies?
A: Generally, the risk of nutrient deficiency is lower than with stomach removal surgery, and lifelong vitamin supplementation is not necessary as with bypass surgery. Patients should eat a balanced diet, take vitamins as recommended by doctors initially, and have periodic blood tests.
Q10: Can people who have had previous stomach surgery undergo ESG?
A: It must be evaluated individually. Those who have had previous stomach surgery for weight loss can undergo ESG without repeat surgery, but it requires assessment by a specialist.
Q11: Can I get pregnant after ESG in the future?
A: Pregnancy is possible, and ESG has the advantage of minimal impact on nutrient absorption for the fetus. However, it is recommended to wait until weight stabilizes (about 12 months) and consult a doctor before planning pregnancy.
Q12: How safe is ESG?
A: When performed in a standard medical facility by an experienced medical team, ESG is a highly safe procedure with a low complication rate compared to major surgery.
ESG may not be a “shortcut” for weight loss but is a “medical tool” that helps make weight control more effective and safer, especially for those who have tried many methods without success.
The key to success is not just the stomach suturing alone but lies in behavior modification, continuous care, and close collaboration with the medical team.
If you are looking for an option without major surgery, quick recovery, and systematic care by a multidisciplinary team, evaluation by a specialist will help you make a confident decision and plan the most suitable long-term weight loss strategy for your body.
Dr. Kittithat Tantithanawat
Specialist in Advanced Gastrointestinal Endoscopy
Phyathai 2 Hospital
