Endoscopic Sleeve Gastroplasty FAQ
General information and Comparison
It is important to understand that ESG is a tool to aid weight loss and is most effective when combined with a comprehensive lifestyle program delivered by your doctor and trained allied health team.
Patients lose an average of 20% Total Body Weight. Ultimately, the amount of weight you lose and maintain will depend on how closely you follow the advice of your doctor and allied health team.
Losing weight and keeping it off is a lifetime undertaking. Your body will always remember its peak weight and your metabolism will adapt to drive you back to this weight. We understand that weight regain (relapse) is part of obesity, being a chronic disease, and needs to be proactively managed.
Current research indicates that weight loss following ESG is maintained at 2 years.
The key to preventing weight regain after any intervention is proactive management. On completion of our program you will be provided with an action plan to monitor your weight with a stepwise approach to preventing its rise. We expect to continue to see you at least on an annual basis after you graduate from our program to monitor your progress and to help you avoid regaining weight.
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 stabilise.
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’.
Most patients can travel within a week, but we recommend staying in Sydney for at least 7 days. This is because the first two weeks carry a slightly higher risk of uncommon complications. Once you’re on a solid diet, you’re free to travel.
Endoscopy is an internal examination performed with a camera by a specialist doctor, and in this case it refers to the examination of the stomach. All endoscopies must be performed in accredited hospitals and by accredited doctors. Before the endoscopy begins, the patient is deeply sedated by a specialist anaesthetist. The camera (or endoscope) is then inserted through the mouth and into the stomach where an examination is performed to ensure it is safe to proceed with the procedure.
In total, the endoscopy can generally be expected to take approximately 20 minutes for balloon procedures (including insertion, adjustment or removal of the balloon). Some procedures, such as an ESG (Endoscopic Sleeve Gastroplasty) may take up to an hour or sometimes even a little longer. Once the procedure is finished, the patient is allowed to wake up and returns home the same day.
The risks relating to endoscopy are very low: typically, the risk of any complication is much less than 1%, and the risk of major complication is less than 0.1%. Your doctor will discuss endoscopy and any relevant risks specific to your health in your consultation.
Procedure and Recovery
The procedure is non-surgical and is performed by a specialist doctor using endoscopic techniques in an accredited hospital under general anaesthesia.
Once asleep, the specialist inserts a camera (ie. endoscope) through the mouth and into the stomach via a protective tube that protects the oesophagus (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 overeating. While this is not dangerous at all, this may decrease effectiveness of the procedure over the course of several years.
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.
While the procedure creates a lasting change in the stomach’s shape, maintaining long-term weight loss still depends on following healthy eating habits and lifestyle choices.
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 6 weeks after the procedure, however portion sizes are much smaller than previous, and will remain so for many months and even years.
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 minimise 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 (unless travelling from interstate, as you are required to remain in Sydney for the 7-10 days following your procedure). You may be able to resume normal activity sooner or later than this depending on how quickly your body adjusts to the ESG.
We generally recommend about 5 days off work following the procedure to ensure the symptoms have resolved. If you are travelling from interstate, you will be required to remain in Sydney for 7-10 days post-procedure, as it is during this time that you are most at risk of an uncommon complication.
Most people experience a significant reduction in appetite after the ESG procedure and feel full on very small portions (e.g., half to one cup of fluid). In the first three weeks, you will follow a liquid diet, during which your appetite will remain minimal.
As your recovery progresses, your appetite may gradually return after 1-2 weeks, but it will remain significantly reduced. Many patients report feeling full after just a few tablespoons of yoghurt. During this period, it is essential to eat slowly and cautiously to prevent discomfort caused by overeating. Signs of overeating include bloating, reflux, hiccups, or indigestion—listening to your body is key to adapting to your new portion sizes.
Over the next 6-8 weeks, your stomach will gradually adjust to slightly larger portions, but you will not return to your previous eating capacity. With guidance from your dietitian, you will learn to maintain balanced, nourishing meals in appropriate portions to support sustainable weight loss.
Clinical studies show that ESG patients typically achieve an average total body weight loss of 20-25%, meaning a person starting at 100kg can expect to lose 20-25kg. Long-term success depends on maintaining healthy eating habits and lifestyle changes, emphasizing the importance of engaging with your medical and allied health care team for optimal results.
Eligibility and Follow-up
The ESG is suitable for patients who:
- Have tried modifying their diet and exercise but have struggled to maintain weight loss.
- Are looking to lose approximately 20-25% of their total body weight (e.g., 20-25kg for a person starting at 100kg).
- Have a BMI of ≥30.
Are considering a surgical procedure such as a gastric band, gastric sleeve, or bypass but prefer a lower-risk, non-surgical alternative.
- ESG following gastric balloon: Recent research has revealed that people who’ve had a gastric balloon do less well following ESG in terms of weight loss. For this reason, we do not recommend ESG to anyone who’s has previously had a gastric balloon.
- ESG following gastric sleeve: Endoscopic revision of a gastric sleeve is possible, however the weight loss that results is only approximately 10% of the baseline weight. There are likely more effective options which you can talk through with your Bariatric Specialist.
- ESG following gastric bypass: Endoscopic suturing is possible via a procedure called TORe, Transoral Outlet Revision.
The follow-up program is critical to your weight loss success as you’ll learn new lifestyle skills. You will meet with your allied health team at least once a month, during the first six months and then monthly to bi-monthly for the remainder of your program. During this time your progress will be evaluated and you will learn valuable principles of health, nutrition and exercise that will provide you with a foundation for long-term success.
Absolutely, we work with patients from all around Australia and currently have many patients located outside of Sydney or Melbourne.
Your initial consultation can usually occur remotely via video conference (Zoom).
When it comes to the procedure itself, you will be required to remain in Sydney or Melbourne for 7-10 days post-procedure, as it is during this time that you are most at risk of an uncommon complication. We will also schedule your post-procedure review with your Specialist during this time.
To further support patients who are unable to attend their allied health consultations face-to-face, we offer video consultations to ensure you are able to access the full support of your care team and get the most out of your included allied health consultations.
Diet, Lifestyle, and Side Effects
When it comes to eating AND drinking post procedure, Dr Sartoretto recommends these three Golden Rules to minimise the risk of symptoms, optimise 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’ll change your ways!
You will be provided with specific dietary advice, including suitable foods and portion sizes, from our expert team of dietitians, whom you will meet with regularly throughout your program.
Before your ESG procedure, you will need to follow a calorie and carbohydrate-restricted diet rather than a fluid-only diet. Following the procedure, you will transition through a structured diet progression of various food textures over a 5-week period. Beyond this, you can enjoy most foods within the context of a healthy, balanced diet.
Alcohol in moderation is fine, however keep in mind that excessive or regular alcohol intake will compromise your weight loss efforts given it is high in calories.
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 Bariatric Endoscopist or Surgeon will provide you with specific recommendations for starting exercise at your post-procedure review appointment.
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.
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 optimise the treatment of our patients. You will be provided with our highly advanced, unique and comprehensive treatment program to minimise the occurrence of side effects.
You will also be prescribed medications to assist in controlling symptoms and it is important that you purchase 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 any reflux. Over the counter antacid medications can also be used.
- Overeating, overdrinking, eating rich (creamy/oily) foods or drinking alcohol 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 resolve after 3 days. We recommend resting during this period to hasten your recovery.
The ESG is not known to affect medication efficacy, 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 antihypertensives 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.
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).