Endoscopic Sleeve Gastrectomy in Birmingham, AL

Non-Surgical Weight Loss

We are uniquely positioned to offer you ‘one-stop-shop’ access to all the products, services and support you require to successfully achieve your health goals.

The Endoscopic Sleeve Gastroplasty (ESG) involves the placement of internal stitches inside the stomach to lessen the volume and change the shape of the stomach, forming a tube. 

The ESG procedure was pioneered by the famous Mayo Clinic in the US in 2012,  and has since grown in popularity due to its minimally invasive nature which reduces patient recovery times, rates of complication and side effects.

FAQs:

How does the ESG work?

The ESG procedure will shorten the length of the stomach by approximately 50% and will reduce its volume by 75%.  Given this, the ESG works in several ways to help you lose weight:

• The quantity of food that you can eat is significantly restricted – helping you to reduce your portion sizes
• Your stomach will empty more slowly – helping you to feel fuller for longer
• The number of calories your stomach can absorb is reduced

What does the procedure involve?

The ESG will be completed by your Bariatric Endoscopist within 50 minutes in an outpatient surgery center, under general anesthesia.

The procedure is endoscopic, which means no incisions are required. Instead, a flexible tube with a camera (endoscope) is inserted into the your stomach via your mouth. Several rows of stitches are then made within the stomach using a special tool, making it very narrow.

How can I enhance my weight loss?

The ESG is a tool to aid weight loss, giving you a kick-start by allowing you to control portions as you develop healthy and sustainable habits. We know the ESG is most effective when accompanied by a lifestyle change. Our Dietitian will assist your with making the correct dietary changes for ongoing success.

How much weight can I expect to lose with the ESG?

The more you work on making lifestyle changes with diet and exercise, the more successful your weight loss journey will be. You can expect to achieve 20-25% TBWL (Total Body Weight Loss, however ultimately, the amount of weight you lose and maintain will depend on how closely you follow the advice of your medical and allied health care team.

Who is the ESG suitable for?

The ESG is suitable for patients who:

• have tried modifying their diet and exercise, however have not been able to keep the weight off
• have around 55 pounds or more to lose
• have a BMI of ≥30

How do I prevent portion creeps?

Portion creep can compromise your weight loss efforts, as it leads to a greater number of calories being consumed. Regular contact with your Dietitian and Bariatric Physician provides a valuable point of accountability to ensure you are maintaining small portion sizes and not experiencing symptoms after eating (symptoms of reflux, bloating and cramping can suggest your portions are too large).

Will the ESG affect my medications?

It is not expected that tablets be affected by ESG, however medication may take longer to act if in pill form. Anti-inflammatory medications may irritate the stomach more than they typically do following the procedure.

As you lose weight, other health markers may also improve and you may find that some medications may not be necessary (such as anti-hypertensives and diabetic medications). We ask all patients to meet with our Bariatric Physicians on a regular basis to assess their requirements for medication, before making any changes.

What about pregnancy with the ESG?

Any plans for a future pregnancy should be discussed with your Bariatric Specialist at your initial consultation. We advise our ESG patients to avoid pregnancy for at least 18 months following an ESG, to allow time for your weight and body composition to stabilize.

It is important to note that there is no data on ESG and pregnancy as yet, which represents one of the ‘risks of the unknown’.

How is the ESG performed?

The procedure is non-surgical and is performed by a specialist doctor using endoscopic techniques in an accredited hospital under general anesthesia.

Once asleep, the specialist inserts a camera (i.e. endoscope) through the mouth and into the stomach via a protective tube that protects the esophagus (food pipe) from injury.  Following an examination to ensure it is safe to proceed, a series of stitches are made within the stomach to create a tube-shaped stomach which significantly decreases the stomach’s capacity. The procedure takes approximately 60 minutes to perform and the patient is able to be discharged from hospital on the same day.

While the stitches are not dissolvable, over several years the stitches may loosen or come undone – this may happen with vomiting or over-eating.  While this is not dangerous at all, this may decrease effectiveness of the procedure over the course of several years.

How long will it take to recover from the ESG procedure?

You should plan at least three days of inactivity to recover from the procedure and to allow symptoms to resolve. We advise patients to wait until they are able to tolerate suitable volumes of fluid before resuming exercise to minimize the risk of dehydration. We encourage low to moderate intensity exercise during weeks 1-2 post-ESG, with a return to higher intensity exercise possible after one month.

Most patients are able to return to work within the week. You may be able to resume normal activity sooner or later than this depending on how quickly your body adjusts to the ESG.

Will the ESG limit my activities?

During the first week of the procedure you should not plan any heavy activities. Once you are able to manage adequate amounts of fluids, you can continue your normal activities. Starting a regular exercise program is highly recommended and will improve your success.

Is there anything you cannot eat after the ESG procedure?

You will be provided with specific dietary advice, including suitable foods and portion sizes, from our expert dietitian who you will meet with regularly across the duration of your program.

You will need to follow a restricted, fluid diet prior to your ESG procedure, and will be advised to follow a diet progression of various food textures for a period of 5 weeks following your ESG. However, beyond this, you are able to enjoy most foods without concern and within the context of a healthy, balanced diet.

When can I return to a normal diet?

In order to allow the stitches to mature, it is important that the diet progresses slowly.  Thankfully, appetite is strongly suppressed by this therapy and hunger is not an issue. Our patients are required to maintain a liquid only diet for approximately 3 weeks before progressing to a puree diet, then soft diet.  Our patients are able to return to a normal diet approximately 5 weeks after the procedure, however portion sizes are much smaller than previous, and will remain so for many months and even years.

Are there any other complications associated with the ESG?

ESGs have been in use by our practice and worldwide for over a decade, and the risks of complications are surprisingly small.  There have been no deaths documented with this procedure with well over 2,000 cases having been performed worldwide. To date, complications that have occurred have been able to be managed with endoscopies, medications or minor procedures.  No complication has yet required surgery to resolve, however there is a very small risk that this may be required.

Complications are very rare and are generally easily managed. They may include:

• 1% risk of major complications has been documented in the literature, with the most common complication being infection around the stomach. This is treated with antibiotics and rarely requires surgery.
• Trauma to the stomach or surrounding structures (such as the liver or gall bladder), which may rarely require surgery to fix.
• Bleeding
• Clots in the legs

What are the Golden Rules?

When it comes to eating AND drinking post procedure, we recommend these three Golden Rules to minimize the risk of symptoms, optimize the chances of weight loss and improve the odds of keeping the weight off

• Small, single portions
  • When eating, use a small plate (eg a bread plate or a child’s plate) and serve a portion only the size of the palm of your hand.
  • Use a small cup – no large tumblers.
  • Do not set your table with food; instead, serve your portion (and anyone else’s) and pack the leftovers away before you eat.
  • It is OK to leave some leftover food on your plate – pack it away for lunch tomorrow.
• Go slow!
  • Your meal should take no less than 20 minutes to finish – this ensures you chew your food thoroughly and prevents you feeling unwell after you eat.
  • Sip on your cup of liquid slowly – drinking too quickly will make you feel bloated and uncomfortable.
• Wait 30 minutes before you go back for seconds
  • The brain’s connection with the stomach is delayed – eating too soon after a meal increases the chances of overeating and the chances of developing discomfort.

These rules prevent you from overeating and allow you to get back in touch with your feeling of fullness. If you break them, you are likely to suffer some reflux or cramping, so sooner or later you will change your ways!

What are possible side effects from the ESG?

The side effects of the ESG procedure are usually limited to the first 5 days after it is performed, with the first 3 days being most severe. After this period, the symptoms disappear completely and will only recur (and are typically mild) when one of the “golden rules” are broken.

Our doctors have worked tirelessly to optimize the treatment of our patients. You will be provided with our highly advanced, unique and comprehensive treatment program to minimize the occurrence of side effects.

You will also be prescribed medications to assist in controlling symptoms and it is important that you fill these medications and take them as directed. If symptoms persist or worsen, you should contact the clinic immediately.

Most patients of our clinic now typically experience only mild side effects (if any), with the most common being:

• Cramping
  • Cramping is common in the first 3-4 days after the procedure and can be treated with medications.
  • Overeating or drinking too much at a time can also bring on cramping.
• Reflux (including heartburn and some belching)
  • You will be required to take acid medication for the first week following your procedure to manage anyreflux. Over the counter antacid medications can also be used.
  • Overeating, overdrinking, eating rich (creamy/oily) foods or drinking wine will typically bring on acid reflux symptoms.
• Nausea
  • Typically mild to moderate in the initial days after insertion.
• Lethargy
  • Typically due to the medications used to manage side effects and resolves after 3 days. We recommend resting during this period to hasten your recovery.

Is the ESG permanent?

The stitches used in the procedure are permanent and do not dissolve, however, they may break over time if under too much tension, as might be seen with repeated overeating. However scar tissue frequently replaces the stitches over time and even if the stitches fail, the ESG is only partly reversed. One study showed up to 25% of patients lost one stitch by the end of 12 months, but this was not associated with weight gain.

It’s important to keep in mind that although the anatomical change is permanent, the functional change is not.

Can I Exercise?

Yes! Exercise is an important part of losing weight and keeping it off. We encourage exercise as part of your weight loss strategy – all activities are encouraged and safe. Your Surgeon will provide you with specific recommendations for starting exercise at your post-op appointment.