Risks and Complications
Endoscopic Sleeve Gastroplasty (ESG)
Like all medical and surgical procedures, having endoscopic sleeve gastroplasty (ESG) carries risks and can result in unpredictable complications. The relative risks and potential benefits need to be assessed on an individual basis and depend on factors such as your medical history and personal circumstances. This will be discussed with you by your doctor in detail prior to committing to any procedure.
Some of the potential risks associated with endoscopic sleeve gastroplasty are outlined below.
Endoscopy Related Risks
- Anaesthesia: The general anaesthesia required for the procedure involves risks of complications, injury and, in rare instances, death.
- Aspiration: Regurgitation of stomach fluids or food into the lungs can occur during endoscopy. While severe aspiration is unlikely, it can cause pneumonia, respiratory failure requiring support with a breathing machine, and even death. It is important that you follow the fasting instructions provided before the procedure to minimise the risk of aspiration.
- Bleeding: Bleeding is a common complication during and after an ESG. Because the stomach has a rich blood supply, and the sutures are placed deep into or through the stomach wall, significant bleeding can be seen during the procedure. Some patients may develop symptoms and signs of bleeding later following the procedure. Symptoms include, dizziness, shortness of breath, rapid heart-beat, vomiting blood or “coffee ground” stools (passing bloody or black stools). Any of these symptoms should be immediately reported to the clinic. A blood transfusion and/or repeat endoscopy or surgery to stop bleeding may be necessary.
- Stomach or Oesophageal Injury: In order to perform the ESG the surgeon/physician needs to place a number of instruments and tubes through the oesophagus to reach the stomach. The oesophagus is thinner walled than the stomach and more easily injured by instrumentation. Injury to the stomach or oesophagus is a rare complication that can cause life-threatening complications and may require emergency surgery for treatment, a prolonged hospital stay, a long period of nothing to eat, prolonged antibiotic requirements, organ failure and even death.
- Organ Failure: In rare circumstances, organ failure may occur following ESG. This may include failure of the kidney, heart, lungs or liver.
- Admission to Hospital: Complications of the procedure or anaesthesia may require admission to hospital. In some cases, surgery may be necessary to treat a problem or complication.
- Deep Vein Thrombosis (DVT)/Pulmonary Embolism: Blood clots are a rare complication but obese patients are more prone to developing blood clots in the veins of the legs than are normal weight patients. Blood clots that form in the legs, or elsewhere, and break off and travel to the heart and lungs may cause death. To help minimise the risk, leg squeezing devices are fitted over the legs during the operation.
- Other Complications that may be common: Allergic reactions, headaches, itching, medication side-effects, damage or irritation of the vein where intravenous medications were given, heartburn/reflux, anaesthetic complications, injury to the bowel or vessels, gas bloating, aspiration of gastric contents into the lungs.
- Death: While the procedure is still new, there have been no reported deaths resulting from the ESG procedure to date. We expect the mortality rate of the ESG procedure is low, estimated at less than 1 in 10,000. Note: this does not preclude the risk of death.
Endoscopic Sleeve Gastroplasty Related Risks
- Post-Procedure Symptoms: These are common in the first few days after the procedure, and patients may experience stomach cramps, stomach pain/discomfort, nausea, vomiting, acid reflux with heartburn / indigestion, minor bleeding in the stomach or oesophagus, and a feeling of fullness or bloating. You will be prescribed medications to assist in controlling these symptoms and it is important that you purchase these medications and take them as directed. If these symptoms persist or worsen, you should contact the clinic immediately (including by the 24-hour patient support number on 1300 376 026). Rarely, patients may additionally have symptoms of diarrhoea, sore throat, excessive salivation, gas or belching, hiccups, constipation, gastrointestinal hypermotility, oesophageal dysmotility, aspiration, hyperventilation, gastritis, halitosis (bad breath), indigestion or dizziness.
- Dehydration: Some patients may become dehydrated after the procedure and need to have intravenous fluids administered.
- Gastrointestinal Injury: It is possible that the suturing device or the sutures themselves may cause bleeding or a tear (perforation) or hole. Endoscopy and/or surgery to repair of the area of bleeding or injury is likely to be required for treatment.
- Peri-gastric leak/collection: This is potentially a life-threatening complication. A small leak after ESG may allow bacteria to leak out along the full thickness suture, causing an infection in the abdomen. Symptoms of a leak/collection may include rapid heart rate, dizziness, shortness of breath, fever, worsening abdominal pain, left chest or shoulder pain or abdominal distention. Endoscopy and/or surgery to repair the leak and/or drain the collection may be required.
- Suture failure: The sutures used to perform ESG are made from polypropylene of approximately 0.3mm diameter. It is possible that these sutures may break or fray, or pull through the stomach wall allowing the stomach to distend, reducing the restrictive effect of the ESG. Patients are placed on a strict fluid diet for a number of weeks after the ESG procedure to allow the stomach time to heal and for scar tissue to form, strengthening the suture points. Not following the diet progression strictly will drastically increase the likelihood of suture failure.
- Gastric remodelling: It is possible that over time the sleeve formed by the ESG procedure may stretch or widen, increasing the volume of the stomach and reducing the restrictive effect of the ESG.
- Stenosis: It is possible that a narrowed area may form somewhere along the tapered tube of the stomach achieved by ESG. Persistent nausea and vomiting after ESG may be an indication of stenosis and a repeat endoscopy might be required to investigate or adjust/release some of the sutures to reduce the restriction of the original ESG.
- Psychiatric Complications: Although most people experience improvements in their mood, some may experience worsening states of depression, which could lead to suicide. Patients taking psychiatric medications must disclose this treatment to their physician/surgeon, and should have the dosage and effectiveness of these medications monitored carefully by their prescribing physician.
- Additional surgeries/procedures: Additional endoscopic procedures may be deemed necessary or desirable to revise the procedure. This may be for the purpose of treating complications, relieving symptoms (to improve tolerance) or to increase satiety (to improve weight loss).