31 January, 2023

Advantages Of Endoscopic Sleeve Gastroplasty vs Laparoscopic Sleeve Gastrectomy

Many people struggle with their weight and have tried several ways to lose weight but have been unsuccessful. Different factors can play a part in the success of an individual’s ability to lose a significant amount of weight and sustain that weight loss long-term. Research has proven that many of these patients will not be successful in losing enough weight to lower their BMI without medical intervention.

Today, we are going to consider and compare two types of medical intervention that can be used to help these patients: surgical laparoscopic sleeve gastrectomy (LSG) and non-surgical endoscopic sleeve gastroplasty (ESG).

Surgical vs Non-Surgical Weight Loss Procedures

One option available to these patients is bariatric surgery, which is effective in assisting patients with weight loss. However, there are risks and possible side effects associated with any surgical procedure.

Patients that do consider bariatric surgery most often look at less invasive surgical procedures such as a vertical sleeve gastrectomy (VSG) which is also known as laparoscopic gastric sleeve (LSG) or gastric sleeve for short. LSG surgery has a proven track record and has been performed for years so the expected results, associated risks, and complications are well-known and understood.

Some individuals may not be candidates for bariatric surgery for different reasons including their current health situation or the associated recovery time. The good news is that now there is a new procedure that rivals that of the laparoscopic gastric sleeve (LSG) but does not require surgery. When comparing non-surgical endoscopic sleeve gastroplasty vs LSG, we think you will agree that the ESG comes out a winner.

Comparing Endoscopic Sleeve Gastroplasty vs Laparoscopic Sleeve Gastrectomy

Quick Overview Of LSG

Gastric sleeve surgery is performed laparoscopically through a series of 3 to 5 abdominal incisions. A laparoscope is a thin surgical tool that has a camera on the end so the surgeon can visualize what they are doing as they perform the procedure. The laparoscope is inserted into one of the abdominal incisions and other surgical tools used to complete the procedure are inserted through the other incisions as needed.

During the procedure, the surgeon cuts and removes about 70-75% of the patient’s stomach and the sides are stapled together to heal. Reducing the stomach capacity through this procedure helps the patient lose weight because they cannot eat as much in one sitting. The smaller stomach empties slower and patients stay full longer.

Also, the portion of the stomach that is removed is responsible for the production of a hormone called ghrelin. Since the production of ghrelin is significantly reduced, patients do not experience chronic hunger pangs.

Quick Overview Of ESG

Endoscopic sleeve gastroplasty is a procedure that also reduces the size of the stomach but does not involve incisions or cutting and removing any portion of the stomach.

The stomach is accessed through the patient’s throat using a special surgical tool called an endoscope. The endoscope is a flexible hollow tube-like hose that has a camera and a light mounted on it. The endoscope is gently lowered down the patient’s throat as the tiny camera guides the surgeon’s movements. The endoscope’s hollow design also creates a pathway that allows the doctor to insert a special suturing device and other surgical tools that will be used during the procedure.

The doctor folds and reshapes the patient’s stomach into a small sleeve-like pouch shape and then places sutures to hold it in place. The tools and endoscope are removed and the procedure is complete. Patients will be observed and then can return home the same day to recover. Most patients recover in just a few days.

This side-by-side comparison chart of ESG vs laparoscopic sleeve gastrectomy demonstrates that ESG is a comparable alternative for weight loss as opposed to gastric sleeve surgery for many patients.

ESG vs LSG Comparison Chart

Gastric Sleeve (VSG or LSG) Endoscopic Sleeve Gastroplasty (ESG)
Type Of The Procedure
Surgical Procedure Non-surgical Procedure
Description Of The Procedure
3-5 small incisions are made in the abdominal area and the patient’s stomach is reduced to about 25% of its original size. The excess stomach is excised and removed using laparoscopic tools. The remaining stomach edges are surgically stapled together to form a smaller stomach sleeve. The incisions are sutured and closed with surgical tape. The patient’s stomach capacity is reduced by about 70% by reshaping it into a banana-shaped pouch and then suturing it into place from the inside. The procedure is completed endoscopically (via the patient’s mouth) so there are no incisions.
Duration of Hospital Stay
One to three nights No overnight hospital stay is required; ESG is an outpatient procedure
Who Is A Good Candidate For Gastric Sleeve Vs ESG?
Patients that have a BMI of 35 or higher and suffer from one or more weight-related conditions (i.e. Type 2 diabetes) or individuals with a BMI of 40 or higher. Patients who are in good enough health to safely undergo surgery Patients with a BMI of 27 or more that are willing to follow a healthy lifestyle to promote and maintain weight loss
Length of Procedure
2-2.5 hours 45-60 mins
Alterations To The Stomach
Part of the stomach is cut off and removed to reduce it by around 75%. These surgical alterations are permanent The capacity of the stomach is made approximately 70 -75% smaller using sutures. No portion of the stomach is cut or removed. The procedure can be reversed or revised
ESG vs LSG Recovery Timeline
Incisions heal in about two weeks but 6-8 weeks for the staple line to fully heal About a week for the patient to return to their normal routine
3-5 Small abdominal scars No Scars
Activity Restrictions After Procedure
Patients will have activity restrictions specific to their surgery but generally have lifting restrictions for about 6 weeks and 4 weeks before they can do light exercises Most doctors caution patients to refrain from heavy lifting for a few weeks but overall, there are no physical restrictions.

Patients can participate in activities they are comfortable doing

Weight Loss at 2 Years
Approximately 60% excess weight at the 2-year point Approximately 60-65% of excess body weight at the 2-year mark
Long-Term Results
Proven for a longer time with results of approximately 61% EWL at the 5-year mark; well-established long-term results and side effects ESG is a fairly new procedure with results of approximately 59-61% EWL at 5 years; long-term results not yet established
Covered By Insurance
Generally, but check with your specific plan Not currently, but since FDA approval was granted recently, it is anticipated that most insurance companies will cover ESG in the future
Overall Risk Profile
11.8% 2.9%

How Do ESG vs Laparoscopic Sleeve Gastrectomy Costs Compare?

When considering the average cost for LSG vs ESG, there are a few things to keep in mind. Currently, ESG is not covered on most health insurance plans so it is a self-pay procedure. Most doctors offer financing options to help break up the cost into smaller monthly payments. LSG is covered by many insurance carriers so the patient’s financial responsibility will be dependent on the stipulations of the insurance carrier. (deductible, in or out of network additional costs, etc)

The average cost of gastric sleeve surgery in the United States ranges from $9,000 to $27,000.

Benefits of ESG vs LSG

Overall, when looking at ESG (Endoscopic Sleeve Gastroplasty) vs LSG, ESG has many advantages such as the following:

  • It does not require surgery or incisions;
  • The recovery is faster;
  • Patients can get back to their lives quicker;
  • The procedure can be reversed if necessary;
  • Clinically significant weight loss;
  • More patients qualify for ESG;
  • The procedure time is shorter.

If you have been struggling with your weight and have a BMI of over 27, ESG may be the perfect solution for you. Contact Simmons Advanced Weight Loss Solutions to learn about the non-surgical weight loss options we offer and how they can help you lose weight and keep it off.

We invite you to speak with one of our knowledgeable professionals to find out how we can help you reach your weight loss goals. To learn more about non-surgical endoscopic sleeve gastroplasty, book your consultation today!

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