Endoscopic Sleeve Gastroplasty
Provocative Plastic Surgery
Endoscopic Sleeve Gastroplasty (ESG) is an innovative, minimally invasive endoluminal procedure designed to achieve substantial weight loss without the need for incisions or permanent alterations to your gastrointestinal anatomy. By reducing the stomach’s functional volume and reshaping its tubular configuration through endoscopic suturing, ESG promotes early satiety and decreases caloric intake, helping patients achieve significant, sustainable weight reduction. At Provocative Plastic Surgery, our multidisciplinary team offers ESG as part of a comprehensive obesity-management program that integrates advanced endoscopic techniques, personalized nutrition counseling, and behavioral support.
From your initial consultation through each follow-up appointment, you will receive expert endoscopic care, structured dietary guidance, and ongoing coaching to maximize both the procedure’s immediate effect and your long-term success. Our goal is to provide a safe, effective alternative for patients who seek a non-surgical solution to obesity or who may not qualify for traditional bariatric surgery, empowering you to transform your health and quality of life.
Understanding Endoscopic Sleeve Gastroplasty
Endoscopic Sleeve Gastroplasty employs an endoscope—an ultrathin, flexible tube equipped with a high-definition camera and a suturing device—to place a series of full-thickness sutures along the greater curvature of the stomach. These sutures plicate the gastric wall, creating a narrow, tubular sleeve that:
-
Reduces Functional Stomach Volume
By decreasing the stomach’s capacity by approximately 70-80%, ESG induces early fullness with smaller meal volumes.
-
Preserves Gastric Anatomy
Unlike surgical sleeve gastrectomy, ESG avoids resection of stomach tissue, preserving native anatomy and potentially reducing procedure-related morbidity.
-
Minimizes Invasiveness
Performed entirely through the mouth without external incisions, ESG offers reduced pain, faster recovery, and lower risk of wound-related complications.
-
Facilitates Repeat Endoscopic Interventions
Should further volume reduction or revision be needed, the endoscopic approach allows for additional endoluminal suturing sessions.
Clinical studies demonstrate that ESG yields weight-loss outcomes averaging 15-20% total body weight at one year, with improvements in obesity-related comorbidities such as type 2 diabetes, hypertension, and dyslipidemia.
%20copy.png)
Ideal Candidates for Endoscopic Sleeve Gastroplasty in Miami
Ideal candidates for Endoscopic Sleeve Gastroplasty typically meet the following criteria:
-
Body Mass Index (BMI) Range
A BMI of 30–40 kg/m², or BMI ≥ 27 kg/m² in the presence of obesity-related conditions (type 2 diabetes, sleep apnea, hypertension).
-
Prior Weight-Loss Efforts
Documented attempts at medically supervised diet, exercise, and behavioral therapy without long-term success.
-
Desire for Non-Surgical Option
Patients who prefer to avoid the risks and permanence of surgical bariatric procedures, or who are not candidates for surgery due to medical or personal factors.
-
Commitment to Lifestyle Change
Willingness to engage in comprehensive nutritional counseling, physical activity guidelines, and regular follow-up visits.
-
Absence of Contraindications
No active peptic ulcer disease, Severe gastroesophageal reflux disease, large hiatal hernia, or coagulopathy.
During your evaluation, we perform a detailed medical review, laboratory testing, and upper endoscopy to confirm safety and exclude contraindications.
The Consultation Process: What to Expect
1. Medical & Lifestyle Assessment
-
A thorough review of your health history, medications, previous endoscopic or surgical procedures, and dietary/exercise habits.
2. Physical Examination
-
Height, weight, BMI, waist circumference, and laboratory evaluation (complete blood count, metabolic panel, liver function, thyroid studies). Upper-GI endoscopy to assess mucosal health and rule out contraindications.
3. Aesthetic Goal Setting
-
Discussion of realistic weight-loss targets (15-20% total body weight over 12 months), expected timeline, and potential challenges. Detailed overview of the ESG technique, post-procedure diet progression, and follow-up schedule.
4. Behavioral & Nutritional Counseling
-
Introduction to our multidisciplinary support team, including dietitians and behavioral therapists, who will guide meal planning, portion control, mindful eating, and stress-management strategies.
5. Customized Treatment Plan
-
Selection of suture pattern, number of plications (typically 6-8 sutures), and scheduling of the ESG procedure. Coordination of pre-procedure preparations, including fasting and medication adjustments.
6. Financial & Scheduling Planning
-
Transparent review of procedure fees, financing options, and potential insurance coverage for obesity-related interventions. Scheduling flexibility to align with your personal and professional commitments.
Procedure Technique
Endoscopic Access
-
After induction of sedation, the endoscope is introduced through the mouth into the stomach. Carbon dioxide insufflation optimizes visibility and minimizes post-procedural discomfort.
Suturing Pattern
-
Using a specialized, tissue-grasping endoscopic suturing device, a series of full-thickness sutures are placed along the greater curvature from the gastric fundus to the antrum. Sutures are placed in a triangular or “accordion” configuration to create durable plications.
Volume Reduction Assessment
-
Real-time endoscopic visualization confirms adequate sleeve formation, ensuring that the reduced gastric lumen achieves the targeted 70-80% volume reduction.
Procedure Duration
-
The entire ESG procedure typically lasts 45–60 minutes, followed by a brief recovery period before discharge.
Adjunctive Endoscopic Tools
-
In selected cases, endoscopic ultrasound may guide suture placement, and argon plasma coagulation can be used for ablation of residual fundic mucosa to enhance durability.
Procedure Options
Suture Configuration
-
Triangular, U-shaped, or Z-pattern suturing techniques tailored to your gastric anatomy and volume-reduction goals.
Number of Plications
-
Typically between six and eight plications; additional sutures may be placed in revision sessions to further reduce volume or correct sleeve dilation.
Sedation Level
-
General anesthesia versus deep propofol sedation, selected based on patient comfort, comorbidities, and procedural complexity.
Adjunct Therapies
-
Combined ablation of fundic mucosa or placement of endoscopic clips in selected high-risk areas to reinforce sutures.
The Surgical Day: What to Expect
Arrival & Preoperative Preparation
-
Check-in at our accredited endoscopy suite; verification of fasting status and consent forms; placement of IV for sedation and hydration. Sequential compression devices are applied to your legs for DVT prophylaxis.
Anesthesia & Monitoring
-
Administration of general anesthesia or deep propofol sedation by board-certified anesthesiologists. Continuous monitoring of heart rate, blood pressure, oxygen saturation, and respiratory parameters.
Endoscopic Sleeve Creation
-
Under endoscopic guidance, successive full-thickness sutures create the sleeve. Careful inspection ensures hemostasis and adequate lumen constriction.
Immediate Recovery
-
Transfer to a monitored recovery area for one to two hours. Observation for nausea, abdominal discomfort, or sedation-related effects.
Discharge Instructions
-
Detailed diet progression protocol, anti-nausea and acid-suppression medications, activity guidelines, and scheduling of follow-up visits at one week, one month, and quarterly thereafter.
Recovery and Aftercare
Dietary Progression
-
Days 1–3: Clear liquids
Days 4–7: Full liquids
Weeks 2–4: Pureed and soft foods
Week 5 onward: Gradual reintroduction of solid foods with emphasis on protein-rich, nutrient-dense meals
Medications
-
Daily proton-pump inhibitors or H₂ blockers to protect the gastric mucosa; anti-nausea agents as needed.
Activity
-
Light walking immediately post-procedure; gradual increase to moderate exercise (e.g., stationary bike, elliptical) by week two; avoidance of heavy lifting for four weeks.
Behavioral Support
-
Weekly dietitian check-ins for the first month, then biweekly until six months; behavioral therapy sessions to address emotional triggers and reinforce mindful eating techniques.
Follow-Up Visits
-
One-week tolerance and symptom assessment; one-month evaluation of weight loss and dietary adherence; quarterly assessments for the first year to monitor weight-loss trajectory, metabolic markers, and gastric sleeve integrity.
Achieving Natural, Long-Lasting Results
Structured Nutrition
A high-protein, moderate-carbohydrate, low-sugar diet tailored to caloric needs supports muscle mass retention and metabolic health.
Behavioral Modification
Cognitive-behavioral strategies to address emotional eating, stress triggers, and establish mindful eating habits.
Physical Activity Integration
Progressive exercise regimen beginning with low-impact cardio and advancing to strength training for metabolic enhancement.
Long-Term Support
Access to monthly maintenance visits for up to two years, group workshops, and remote coaching via our digital platform.
Outcome Tracking
Regular measurement of weight, body composition, and metabolic parameters ensures accountability and enables early intervention if weight regain occurs.
By combining the anatomical effect of ESG with comprehensive lifestyle support, we facilitate not only initial weight loss but also enduring health improvements.
Potential Risks and Safety Considerations
Nausea & Vomiting
-
initially managed with anti-nausea medications.
Abdominal Discomfort
-
treated with analgesics and antispasmodics.
Gastric Injury
-
Rare mucosal tears or bleeding, minimized by experienced endoscopists and immediate endoscopic management.
Suture Dehiscence
-
Partial release of plications, possibly requiring endoscopic revision in a small percentage of cases.
Reflux
-
managed with dietary modifications and medications.
Intolerance
-
in a small percentage leading to early removal.
Why Choose Provocative Plastic Surgery for Endoscopic Sleeve Gastroplasty (ESG) in Miami?
When it comes to a Endoscopic Sleeve Gastroplasty (ESG), selecting the right surgeon is crucial. Here’s why Miami women and men trust Provocative Plastic Surgery:
-
Multidisciplinary Expertise
Our team includes board-certified plastic surgeons, gastroenterologists, dietitians, and behavioral therapists—providing seamless, integrated care. -
Advanced Endoscopy Facilities
Accredited outpatient endoscopy suites with CO₂ insufflation and state-of-the-art monitoring equipment ensure your comfort and safety. -
Patient-Centered Approach
Unhurried consultations, transparent education on risks and benefits, and empathetic support throughout your weight-loss journey. -
Comprehensive Aftercare
Personalized nutrition and exercise programs, behavioral counseling, and long-term follow-up designed to sustain your results. -
Proven Efficacy
Published data supporting 15-20% total body-weight loss at one year, with significant improvements in diabetes, hypertension, and quality of life measures.
Choosing Provocative Plastic Surgery for your ESG ensures you partner with a committed team dedicated to your transformation.
Get a Free Consultation
Up
to
$2500 off
Online
