Endoscopic Sleeve Gastroplasty (ESG)
Is a non-surgical procedure the best option for you?
At Healthier Weight we are the first UK clinic to offer the traditional surgical sleeve and a new non-surgical alternative, the Endoscopic Sleeve Gastroplasty (ESG).
The ESG is an exciting development in obesity treatment that offers people a safe and effective alternative to the established weight loss options. Its main attraction is that it is non-surgical so people benefit from a lower risk profile and faster recovery time.
The technique we use for ESG was developed by Mr Jamie Kelly, Bariatric Surgeon, at our centre of excellence in Southampton. Mr Kelly is a world leader in ESG and sits on the manufacturer’s European Advisory Board. Mr Kelly has developed an ESG technique known as Longitudinal Compression and it’s with this technique that ESG patients can benefit from more sutures than with the traditional technique. Therefore, Mr Kelly’s approach is now shown to deliver better weight loss outcomes and with very low complication rates.
What is the ESG?
How does the ESG work?
The ESG works in two ways:
- Restriction – The capacity of the stomach is restricted so it holds less, and
- It slows gastric emptying. This means the food you eat stays in the stomach a little longer.
The ESG involves suturing the stomach from the inside to significantly reduce its capacity by up to 80%. After the procedure, the stomach remains intact but has been sutured from top to bottom to leave a smaller banana shaped stomach through which the food you eat passes.
The operation itself
The ESG procedure is done using a device called an Overstitch; a device that is placed into the stomach through the mouth that enables us to place a number of sutures (stitches) inside the stomach to significantly reduce its capacity by up to 80%.
As the procedure requires about an hour to complete we do it under general anaesthetic for your comfort. However, unlike surgery, we do not need to make any incisions to access the abdominal cavity thus reducing the risk to you and enabling a faster recovery. Click here for a comparison of ESG and surgical sleeve.,
Weight loss with the ESG
The weight loss results with ESG are excellent. Initially we were seeing weight loss similar to that for gastric band at 50-60% excess weight loss after 2 years, however the latest results are more encouraging. The Longitudinal Compression technique used is now delivering over 50% excess loss in the first 6 months which is comparable to surgical sleeve and gastric bypass.
We always stress to patients that we need to wait to see long term results, 5 years plus, to be satisfied with the long-term benefits of the procedure but the fact we are seeing over 50% at 6 months and generally 60% at 2 years is very positive. It is too early to tell but we expect that the technique used will encourage enduring weight loss as well as good results for the short term.
As with all weight loss procedures there is a small proportion (about 10-20%) for whom the procedure is unsuccessful and for whom it is best to consider a surgical procedure.
The evidence we have suggests people can expect to lose about 15-18% of their starting weight (generally half of their excess weight) over a 12-18 month period*. At this stage, because this is still a new procedure, longer term weight loss results are not available.
The weight loss results in the chart below are the published results from a study of 248 ESG patients. They show average total body weight loss (TBWL) as a percentage of the starting weight. Also, we’ve shown how much weight this equates to assuming different starting weights.
In summary, based on the published data you can expect to lose just over half of your excess weight after 24 months. This is similar to the weight loss with a gastric band but as we said above, the latest results with the new technique are comparable to surgical sleeve and bypass.
|% of starting weight||Start weight 16st||Start weight 20st|
|At 6 months||15.2%*||34lbs||43lbs|
|At 18 months||18.6%*||42lbs||52lbs|
Based on a group of 248 patients with a mean starting BMI of 37.8
Here is a summary of published weight loss data:
|Participants||Avg weight loss at 2 years|
|Alqahtani et al||1600||15-20%|
|Lopez-Nava et al||248||18.6%|
|Sharaiha et al||91||20.9%|
In the Lopez Nava study we saw that nearly all of the weight loss was achieved in the first 6 months
Other benefits of the ESG
The major benefit of the ESG is that it is performed endoscopically with a stitching device placed into the stomach through the mouth. This means that unlike surgery, there is no cutting or stapling, no scarring and no wounds. Therefore patients benefit from a faster recovery time and lower post-operative risks, both incidence rate and severity.
Studies also show that the rate of complications with ESG is low too. One study showed the post-operative complication rate to be as low as 2.4% (AlQuatani et al December 2018).
Health benefits of the ESG
Through losing weight ESG patients will enjoy the same benefits that accrue from weight loss with any procedure, including improvements in:
Like the gastric band, health improvements will come steadily over time as you lose weight. The sleeve and bypass procedures are a little different because they offer immediate health improvements by changing the anatomy of the stomach. So if you are managing existing health issues associated with your weight, the sleeve or bypass are options you should consider as well as the ESG.
How much is the ESG?
The price for an ESG may vary depending on location and medical history but the price is very similar to that for the surgical sleeve. This reflects the fact that hospital, surgeon and anaesthetist costs are the same.
Finance options for ESG
There are two finance plans available to help you fund your procedure**. There is a plan that enables you to borrow most of the price and repay over a period of up to 4 years, and a short-term plan that enables you to borrow a smaller amount and repay over 12 months. The longer-term plan is interest bearing at a representative APR of 9.9%. The short-term plan however is completely free of interest and fees. See more details of these finance plans below.
Interest FREE optionDefer £2k of your procedure fee
- Defer £2,000 of your fee
- Pay back over 12 months
- No credit check, UK residents only
- 0% interest
This plan is aimed at people who want to finance just a small part of their gastric sleeve fee. You can defer up to £2000 of the fee with this plan and repay over 12 months in equal instalments†, free of interest and charges. To be eligible you need to be working and be living in the UK.
Full finance optionSpread the full cost of your procedure
- Min £1000 deposit required
- Spread full cost over 4 years
- Manageable instalments
- Representative 9.9% APR
Under this plan you can borrow up to the full amount of your procedure*. You can apply to borrow over a term of up to 4 years and you’ll pay interest at a representative APR of 9.9%. The loan would be made by our lending partner AfforditNOW.
Whichever weight loss procedure you have, long term success requires that you learn to work with your procedure and adapt your diet and eating. In this way you can achieve and then sustain your weight loss for the long term.
Anyone who has had a weight loss procedure will tell you that the importance of aftercare and support can never be overestimated.
Our package has been developed based on our experience of supporting weight loss patients for over 15 years. It’s comprehensive and ensures that you receive the specialist input needed to develop the skills that will enable you to get the best possible results.
Healthier Weight ESG patients enjoy a package that includes all of the following:
- Lifetime support in our clinics with our team of specialist nurses
- Free clinic visits whenever you require them for a period of 2 years after your procedure
- Surgeon review post-operatively when clinically indicated
- Scheduled support calls for a period of two years from our support team
- Protection against complications arising directly from your ESG for a period of 2 years
- Multi-disciplinary support and supervision from our team of weight loss specialists – before and after your ESG procedure
Extended stay. Investigations. Treatment of Leak, bleed, stricture - where safe to do so outside of NHS Unit
|6 months||36 months|
Blood tests by HW
Conducted by HW not GP. Carried out at operating hospital and analysed by Bariatric expects
|6 months||6 and 12-18 months|
One to one review with a surgeon, only where clinically indicated.
|1 where required||1 where required|
Extended review with nurse
30-40 minute consultation with a focus on well being, weight loss and maintenance.
|12 months||12, 24 and 36 months|
Long term follow up calls
Scheduled calls at 3 days, 3 weeks, 7 weeks, 3m, 6m, 9m, 12m, 18m, 24m as standard. 30m and 36m with upgrade package. Any clinic reviews where necessary.
|24 months||36 months|
Access to Healthier Weight
Scheduled contact stops at 2 years but access to team via phone or clinic for lifetime
Pre and post op food included
Soups, shakes and meals to guide you through the pre and post op nutrition requirements.
Endoscopic Sleeve Gastroplasty (ESG) FAQs
Here is a rather detailed description of the ESG procedure. Please call if you have any questions about it.
The ESG is an endoluminal procedure that is performed under general anaesthesia. It is intended to mimic the sleeve gastrectomy, reducing the gastric lumen (stomach capacity) by 80% using a series of stitch plications along the length of the stomach from the incisura up to and including a portion of the fundus. The procedure involves placement of full thickness stitches using a Helix device.
The suture is carried across from the posterior wall back to the anterior wall and the stitch pattern is repeated, gathered, then ‘cinched’ (stitched). Stitches on the anterior and posterior gastric walls are commonly placed at approximately mid-wall and 6-8 plications in total are usually made. The stitching approach may vary slightly from surgeon to surgeon. Your operating surgeon can provide more detail on this at your consultation. At the completion of the procedure the “sleeve” lumen is usually 1-1.5 cm in diameter.
We only offer the ESG at Southampton at the moment with Mr Kelly. We were the first centre in the UK to offer this procedure. In time, we expect the procedure to be rolled out to other Healthier Weight centres. Mr Kelly is happy to offer consultations over the telephone or by Skype but patients would have to travel to Southampton for pre-operative assessment and for their procedure.
The procedure was developed in the United States some years ago and trials have been conducted in the US, South America and Europe. The procedure was launched in the UK in January 2016.
It’s impossible to predict accurately because weight loss results vary by patients. The studies we have available show patients, on average, achieving about 50% excess weight loss. Of course, there are some patients who lose nearly all of their excess and others who lose little. This is true of all the weight loss procedures. For optimal results you will need to make changes to your diet and eating behaviours, and the procedure will support you to make these changes. We would say exactly the same to patients having a gastric band, sleeve or bypass procedure.
The procedure fee will depend on location and surgeon. The price is similar to the surgical sleeve because the hospital stay, the time in theatre and the instrument costs are broadly the same.
We do not offer an in house finance plan for this procedure but as approved credit brokers we would be happy to introduce you to the lender, afforditNOW, to whom we make referrals. Please ask for details when you call or email us your enquiry.
The surgeon is Mr Jamie Kelly. Mr Kelly is a consultant surgeon at Southampton NHS Trust and has his NHS practice at Southampton General Hospital. HE is a very experienced bariatric (weight loss) surgeon. He does his private ESG procedures at the local Spire Hospital. Mr Kelly was selected to be the first surgeon for ESG in the UK because of his skill and experience with invasive endoscopic surgery, a field in which he specialises.
What is right for you will depend on your personal circumstances. We will be pleased to talk you through the pros and cons of each procedure in order that you can decide on the option that is best for you. Also, when you come in for consultation we can answer your questions and make sure you are clear on the route that is best for your personally.
All Weight loss procedures carry an element of risk and ESG is no exception. Early complications of ESG include haemorrhage, anaesthetic reaction, pneumoperitoneum, pneumo thorax, fever, peritonitis and abdominal pain. Beyond 4 days they include pneumoperitoneum and pulmonary embolus/deep vein thrombophlebitis and ‘later’ complications might include pulmonary embolus, abscess and seroma. It’s important to remember that all hospital procedures carry an element of unpredictability, also that over time the complications associated with a procedure, especially a new procedure such as the ESG, may change.
Ask your question here
* Monthly Deferred Instalments will be collected via Direct Debit or Credit/Debit cards. Terms and conditions relating to these recurring payments are included within the credit agreement and procedure terms and conditions supplied at the time of booking.
** The full finance quote “£201.77 per month” assumes a gastric sleeve package of £9,990 with a deposit of £2,000 plus 48 monthly instalments of £201.77. Total amount payable £9,684.96 (APR 9.9%) EXCLUDING deposit. Minimum deposit is £1,000. Finance subject to individual status and UK residence. Terms and conditions apply. Healthier Weight is a trading name of Weight to Go Limited (WTG) which is a registered credit broker and not a lender. Finance examples assume a 4-year repayment period.