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ESG or Gastric Sleeve

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Whether to have the ESG or the gastric sleeve is a choice that patients have to make in ever-growing numbers.

Take up of the ESG has been very slow in the UK compared to other countries but that is likely to change in the future as more surgeons become proficient in ESG.

For now, it is only available in a few centres. If you are thinking about the sleeve, you should also consider the non-surgical version.  Beware that those centres who don’t offer it may be tempted to talk you out of it even though it’s a reasonable option. The surgical sleeve is the more widely established procedure.

It’s the major weight loss procedure around the world and in the UK. It delivers great weight loss results and health improvements. The only downside of the sleeve is that the complications that can arise from it are hard to treat. When patients develop a late-presenting leak from their sleeve or the stomach becomes obstructed (stricture), it can be very difficult to treat. In these situations, you’d need to plan for an extended stay in an NHS hospital.

The incidence rate is low, about 1 in 100 patients, but it’s a factor that you need to consider.With the ESG or non-surgical sleeve, it’s a non-surgical procedure. It’s certainly lower risk but it’s still done under general anaesthetic. The attraction is that you don’t have the risk of staple line leakage or stricture in the same way as you do with gastric sleeve.

In fact, leakage doesn’t apply at all and if your stomach becomes obstructed we can easily cut the sutures in the stomach to release it. So, it’s a safer option. Complications can arise but they are generally much easier to treat.

The downside of ESG is that it’s new and we don’t know how good or how sustainable the weight loss results are going to be. The gastric sleeve helps people reduce their weight by changing their appetite. It does this by changing the gut hormone GLP1.

The ESG doesn’t have this benefit. The ESG works by reducing stomach capacity and by slowing gastric emptying (the speed with which food passes through the stomach and into the bowel.

On balance, if you are prepared to accept the risks of complication associated with the sleeve, it’s the better weight loss and health solution.If you simply do not want surgery but still want a procedure that can deliver good and enduring weight loss, albeit probably a little lower than the sleeve, then ESG is a great option.

It’s also a far better option than the other non-surgical options.If you don’t want surgery at all then consider a gastric balloon or a medically supervised weight loss programme as alternatives.Ask your provider about both sleeve and ESG. If they don’t know about the ESG, try a provider who does.

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Rishi Singhal

Rishi is an expert bariatric surgeon based in the West Midlands and also Medical Director at Healthier Weight

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