Weight problems are one of the most important health problems of our age. Many people try diets, exercises or different surgical methods to reach their ideal weight. However, in some cases, classical methods may not be enough. At this point, a less invasive procedure that has become increasingly popular in recent years comes to the fore: Endoscopic Sleeve Gastroplasty (ESG). This method stands out by offering patients both a faster recovery process and a chance of success in the long term.
Endoscopic Sleeve Gastroplasty, also known as "ESG", is an oral (endoscopic) weight loss method that aims to significantly reduce the volume of the stomach. It is possible to roughly define this procedure as "narrowing part of the stomach with stitches". However, it is important to note that there are no classical surgical interventions such as "cutting out" or "making an incision from the outside".
To use an analogy, the sides of the stomach, which is normally a wide piece of fabric, are folded at the appropriate points with stitches and turned into a narrower tube. It's like a wide t-shirt being narrowed at the waist. Thus, the stomach volume is reduced by almost half and the feeling of being full with less food begins to occur.
The most striking feature of this method is that the procedure is endoscopic. In other words, it is not necessary to make large incisions in the abdomen, it is an intervention performed from inside the body (through the mouth). This increases the comfort of the patients and shortens the recovery time.
Endoscopic Sleeve Gastroplasty consists of several basic stages. Many people wonder, "What awaits me after I enter the operating room?" Since it is less traumatic compared to conventional surgery, the recovery time after the procedure is also relatively short. So, how does it work step by step?
Preparation and Anesthesia
ESG is usually performed in a hospital under anesthesia. General anesthesia is applied at this stage, meaning that the patient is put to sleep. The patient is not allowed to move because the stomach must be sutured meticulously. At the beginning, the anesthesiologist checks the general health of the patient and the necessary medications are given.
Endoscopic Intervention
During the procedure, the doctor inserts an endoscope (a thin, flexible tube with a camera and a special suturing device at the end) through the mouth. The points in the stomach to be treated are seen through the camera. You can think of it like checking the inside of your house with a camera: The inner walls of the stomach, where the sutures will be placed and which areas will be folded are specially planned.
Suturing (suturing)
Full-thickness sutures are placed at regular intervals along the large edge of the stomach (usually the so-called greater curvature). These sutures are positioned so that they also grasp the inner surface of the stomach from the outside. Each time a suture is placed, the stomach wall folds up and begins to transform into a narrower tube shape. And this is the trick: There is no incision from the outside, but from the inside there is a "narrowing" procedure that changes the shape of the stomach.
Control and Completion
Once the desired narrowing is achieved, the endoscope is withdrawn and the patient is woken up. In some cases, the doctor will perform a second round of checks before the procedure is finished, i.e. looking at the final folded stomach again through the endoscope to assess whether there are any leaks or problems.
Short Observation Period
Patients are usually kept under observation for a few hours (sometimes overnight). If there are no problems, they are soon discharged. This is one of the biggest advantages of ESG: It does not require long hospitalization periods like traditional surgery.
After completing these basic stages, the patient feels full with less food as there is a significant volume reduction in the stomach. In the first days after the operation, the process of transition to liquid nutrition and soft foods begins.
Many people wonder, "Is my weight suitable for this procedure? Under what conditions can ESG be performed?" The degree of obesity is usually assessed on the basis of body mass index (BMI or BMI). The most common range for this method is when BMI is between 30 and 50 kg/m².
BMI (30-40 kg/m²) or (40-50 kg/m²) range: ESG can often be preferred in people who cannot lose weight or achieve permanent weight loss with diet and exercise.
People at high surgical risk: For patients for whom traditional bariatric surgery (such as Sleeve Gastrectomy) may be risky or who are unable to tolerate major surgery under general anesthesia, ESG offers an alternative.
Those who are averse to surgery: For people who fear surgery or do not want incision scars, it promises a less invasive and easier recovery.
However, ESG may not be suitable for everyone. In particular, those with active stomach ulcers or severe gastritis, a large hiatal hernia (stomach hernia), dysphagia or esophageal diseases should be treated first. In addition, psychological evaluation, which is also valid for surgical operations, is also important for ESG. In cases of eating disorders, alcohol addiction or serious psychiatric illness, ESG is not recommended until these problems are under control.
In ESG, patients usually have a fast recovery period after the operation. This can be likened to going on a short trip: You don't travel very far, just a short distance, so your body is less shaken. But there are still some rules of the road that you should pay attention to.
Diet
Liquid foods for the first few days: Water, soup, liquid protein supplements.
Then pureed and soft foods: Bananas, pureed vegetables, yogurt, etc.
Transition to solid feeding after about 2-4 weeks: However, portion sizes are kept small and slow chewing is recommended.
Fluid intake
Since there is a severe contraction in the stomach, solid foods can give a feeling of satiety quickly. Since this can trigger fluid loss, it is important to drink plenty of water. However, water should also be drunk in sips; large sips may cause discomfort due to stomach constriction.
Physical Activity
After a week or ten days of rest, light walking is usually recommended. In about 4-6 weeks, brisk walking, swimming or light resistance exercises can be started. It is important to get a doctor's approval for heavy exercise.
Medicines and supplements
In contrast to traditional bariatric surgery, malabsorption (impaired absorption of nutrients) is not common in ESG, so vitamin deficiencies are not common. Nevertheless, multivitamin, iron or vitamin D supplements may be required in the postoperative period. It is important to plan appropriate supplementation under the supervision of a doctor.
Psychological and Dietitian Support
ESG only reduces the physical capacity of the stomach; it does not completely eliminate eating habits and emotional eating behaviors alone. Therefore, dietitian and psychological counseling support is recommended for long-term success. So it is always useful to have guidance for the rest of the journey.
The aim of Endoscopic Sleeve Gastroplasty is to achieve a healthy weight in the long term and to improve obesity-related diseases (diabetes, high blood pressure, sleep apnea, etc.). Most patients experience significant weight loss in the first 6 months. Some studies have shown that patients lose an average of 13-20% of their body weight within 1 year after the procedure.
To explain this with a simple example: A person weighing 100 kg can see a weight loss of 13-20 kg in a period of 6-12 months. Of course, every patient is different and personal lifestyle changes and regular doctor visits have a great impact on this process.
Diabetes and Insulin Resistance: With weight loss, insulin resistance and diabetics may experience noticeable improvements.
Blood Pressure and Cholesterol: With the reduction of excess weight, blood pressure values are close to normal; bad cholesterol (LDL) levels also decrease.
Joint Pains: The excess load caused by obesity causes pressure on joints such as the knees and lower back. After weight loss, an increase in mobility and a decrease in pain can be seen.
Sleep Apnea: As weight is lost, the reduction of fatty tissue in the throat area relaxes the airways. It becomes possible to achieve better quality sleep.
The important point here is not to think that "I became ESG and everything is over" in order to fully benefit from these advantages. Because a successful outcome is only possible with a serious lifestyle change.
Reducing the volume of the stomach refers only to a physical change. If eating behaviors, exercise habits and mental attitudes remain the same, the expected effect may be limited. Life after ESG is therefore transformed in several ways:
Portion Control: A smaller stomach means smaller portion sizes. Since it is no longer possible to eat as much as before, overeating can lead to nausea or pain.
Meal Frequency: It may be necessary to eat more frequently but in smaller portions. Planning 5-6 small meals during the day instead of 3 large meals ensures adequate nutrient intake without tiring the stomach.
Tackling Emotional Eating: Emotions such as boredom, sadness, stress or happiness can sometimes lead to overeating. ESG alone will not solve this behavior. Therefore, self-awareness and, if necessary, psychological support are important.
Regular Follow-up: Periodic consultations with a dietitian and doctor are valuable for the healthy progress of the weight loss process and early detection of possible problems that may occur.
Motivation and Patience: The weight loss process sometimes does not progress as fast as we would like. However, with regular follow-up and the right habits, permanent results can be achieved in the long term.
As with any medical procedure, ESG has certain risks and potential complications. Although these are rare, they are important for patients to be aware of.
Minor Ailments:
Nausea and vomiting: This may be considered normal in the first few days after the procedure; it usually passes within a few days.
Abdominal pain or cramps: During the transition to liquid or semi-solid foods, there may be occasional pain until the stomach gets used to it.
More Serious Complications (Rarely):
Bleeding: Endoscopically placed sutures can sometimes cause mild bleeding. It can usually be controlled with endoscopic intervention.
Perforation or leakage: A weakness in the stomach wall and leakage from this area can be serious. If treated early, permanent damage can be avoided.
Infections: Fluid accumulation around the stomach or inflammation of the suture lines may rarely occur.
Possible Long Term Problems:
Reflux (GERD): Reduced stomach volume can sometimes cause acid to back up into the esophagus.
Nutritional Deficiencies: Although less common compared to classical bariatric surgery, iron, vitamin B12 and vitamin D deficiencies may occur in case of malnutrition.
When it comes to obesity treatment, it is possible to hear many methods such as "gastric bypass, sleeve gastrectomy, gastric balloon". ESG has the following differences compared to these methods:
No Surgical Incision: Since it is an endoscopic method, there are no large incisions in the abdominal wall. This means less pain and faster recovery.
Stomach Tissue is not removed: While a large part of the stomach is cut out in Sleeve Gastrectomy, in ESG, the stomach tissue remains in place and is only narrowed with sutures. This preserves the anatomical integrity of the stomach.
Short Recovery Time: ESG usually allows for same-day or next-day discharge. Hospitalization time is much shorter than with conventional surgery.
Less malabsorption: In methods such as gastric bypass, deficiency of vitamins and minerals is common because absorption in the small intestine is altered. Since the main mechanism in ESG is "restriction", malabsorption develops more rarely.
Reversibility: ESG is theoretically considered to be reversible because there are no surgical incisions. This means that when the sutures are removed, the stomach can return to its former state. Of course, this is not always practical, but it can be considered as a flexible option.
ESG alone does not work miracles. Lasting success is directly related to the patient's attitude and lifestyle change. A few key points stand out for long-term success:
Regular Doctor Follow-up
It is important that patients go for check-ups more frequently in the first few months after the procedure and at least once a year in the following period. Any changes in body chemistry or stomach structure can be easily prevented if recognized early.
Dietitian Support
Adopting healthy eating habits after ESG is critical for weight loss to be sustainable. Dietitians can create nutrition plans based on patients' individual needs. This helps to better understand "how, how much and when" to eat.
Exercise and Physical Activity
Quality weight loss refers to burning fat while preserving muscle mass. Regular exercise (walking, swimming, light weight training) boosts metabolism, protects cardiovascular health and provides psychological support. It is not necessary to sweat in the gym; brisk walking a few days a week, even resistance exercises at home can make a big difference.
Psychological Support
Eating habits are often influenced by emotional factors. Many people tend to snack extra in situations such as stress, boredom or loneliness. Psychological support in the post-ESG period makes it easier to recognize these triggers and develop healthy coping methods.
Motivation and Patience
Weight loss is not always steady and fast. Some weeks there may be a big drop in weight, while other weeks there may be a very limited change. It should be remembered that this up and down process is normal and the goal is long-term health gains.
Endoscopic Sleeve Gastroplasty is a minimally invasive option for the treatment of obesity. It offers a smaller stomach capacity, a quicker feeling of fullness and the potential for healthy weight loss in the long term. Although it has some advantages over surgical options, people should not see this method as a "magic wand". Because the success achieved depends significantly on the change in daily habits and the active participation of the person in the process.
Healthy weight loss does not only mean an improvement in appearance. It has positive effects on many parameters such as blood sugar, blood pressure, joint health and cardiovascular risks. The important thing is to sustain this "regained opportunity" for a long time and to change habits permanently.
Viewed as a journey, ESG is the first big step at the starting point. The next steps are shaped by regular nutrition, exercise, mental balance and medical follow-up. In other words, as long as there are guides, maps and the right equipment (dietician, psychologist, exercise plan) on this journey, it becomes much more possible to reach the goal.
For a healthy future, ESG can open a door. But it is important to remember that it is up to the individual's effort and determination to walk through the door and keep walking. This is only the first scene of a full-length movie. After that, with the right script and good acting, a happy ending is quite possible.
