22 May, 2023

ESG Vs LSG: Which One Is Best For You?

If you have been struggling with obesity for years and relying solely on lifestyle modifications did not work, a weight loss procedure with a high rate of effectiveness can be a great choice for you. Nowadays there are a variety of surgical and non-surgical bariatric treatments that can solve your problem. However, it is important to keep in mind that they come with a certain level of risks, pros, and cons. To choose the best option for you, it is essential to have a comprehensive understanding of all the available choices. In this article, we will tell you in detail about the two common bariatric procedures as endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy.

What Is The Difference Between Gastric Sleeve And Endoscopic Sleeve Gastroplasty?

Doctors at Reveal Weight Loss often get asked if ESG and a gastric sleeve are the same thing. The short answer is no. In fact, they are totally different approaches to the same issue of obesity. Laparoscopic sleeve gastrectomy (LSG) which is also referred to as vertical sleeve gastrectomy (VSG) is a traditional bariatric surgery that has been performed for the first time more than two decades ago and since then has been widely used to fight obesity.

On the other hand, endoscopic sleeve gastroplasty (ESG) is one of the latest advancements in the field of bariatric medicine that was created for those who want a high level of results and fewer risks. ESG is an innovative non-surgical endoscopic weight loss procedure that has rapidly gained popularity among those who cannot or do not want to undergo surgery. It is a minimally invasive procedure that poses much fewer risks compared to surgical alternatives such as LSG.

Endoscopic sleeve gastroplasty

ESG Vs LSG: How Different Are The Techniques?

In terms of the methods and techniques, the main difference between the two approaches is that with ESG your stomach will be stitched together whereas with LSG some part of your stomach will be removed permanently. Both procedures induce weight loss by reducing gastric volume but do it differently.

During the minimally invasive ESG, the patient is asleep under general anesthesia and doctors use an endoscope with a little camera and a suturing device attached to it to make stitches in the stomach walls and fold them together; this shrinks the volume of the stomach. The reduced stomach will fill up quickly and prompt the patient to eat less. Also, the gastric emptying will be delayed and the patient will stay full longer. All of these induce weight loss. Since the necessary equipment enters through the mouth, ESG does not involve incisions and thus there will be no unnecessary scars.

For the LSG procedure, the surgeon will put you to sleep under general anesthesia and make 4-5 small incisions on your abdomen. Then he will take a special thin scope with a small camera attached to it and push them through the incisions. Around 75-80% of the stomach, the fundus, will be taken out with the help of these tools, and the rest of the stomach will be closed by the surgeon and resemble the sleeve of the shirt. This decreases the volume of the stomach and the amount of food the patient can eat which helps get rid of extra body fat.

Key Differences Between ESG and LSG
ESG LSG (VSG)
Method And Description Non-surgical, incision-less, endoscopic reduction of stomach size by 70% Surgical reduction of the stomach by 75% that involves small abdominal incisions
Will there be scars? No Yes
Good Candidates Obese people who have a BMI of 30 or higher
  • People with BMI 35+ and associated comorbidities
  • Morbidly obese people with a BMI of 40 or more
Required Time At Hospital Outpatient. Can go home several hours after the procedure At least 1-2 days
Recovery Length 1-2 days About 2-3 weeks
Average Excessive Weight Loss at 12 months 60% 65%
Risk level Less than 1% 2-6% (0.11% mortality)
How Painful Is the Procedure? Little to no pain during the procedure; possible mild discomfort after the procedure Patients can experience a pain level of 7 (out of 10) a couple of days after the surgery
After The Procedure Up to 4 weeks of liquid and soft food diet 8 weeks of liquid, puree, and soft diet

Endoscopic Sleeve Vs Surgical Sleeve: Which One Is More Effective?

Both procedures have proven to show significant results. According to research, within 12 months following the ESG procedure patients lose about 55-65% of their excess weight while LSG patients can expect to get rid of around 65-70% of the extra body mass. These are only average expected results. The individual results may vary and the patients can lose much more or much less weight than expected. In fact, there are many cases when ESG patients lost much more than expected and set a new record.

ESG vs LSG: Results of Total Weight Loss (TWL, %)
ESG LSG
Total Weight Loss at 1 month 8.7 %
Total Weight Loss at 6 months 15.3 %
Total Weight Loss at 12 months 17.1 % 30.5 %
ESG vs LSG: Results Excessive Weight Loss (EWL,%)
ESG LSG
Excessive Weight Loss at 1 month 31.7 %
Excessive Weight Loss at 6 months 59.4 %
Excessive Weight Loss at 12 months 63 % 69.3 %
ESG vs LSG: Results Body Mass Index (BMI)
ESG LSG
BMI at 1 month 32.6
BMI at 6 months 30.4
BMI at 12 months 30 29.3

ESG Is A Safer Choice Than LSG

Both weight loss interventions have a certain level of risks and possible complications. However, studies found that ESG treatment carries significantly fewer risks than LSG. The major complications rate for ESG is between 1-2% whereas for LSG this number increases up to 8%.

What Is the Timeline of the Procedures?

LSG surgery takes about 2 hours to perform and 2 days of staying at the hospital after the surgery. ESG procedure will last for about 30-45 minutes and since it is an outpatient procedure several hours after the procedure the patient goes home to recover. Regarding the recovery time, ESG patients can return to work in 1-2 days following the procedure whereas for VSG procedure it takes about 1-2 weeks.

Choosing Between Gastroplasty and Gastrectomy

Some of the clear advantages of ESG over LSG procedure are that ESG is:

  • Safer choice
  • Fewer risks and complications
  • No scars and incisions
  • Shorter recovery and procedure time
  • Effectiveness

Although LSG has a slightly higher rate of weight loss, the risks associated with it might outweigh the benefits. Therefore, ESG is a golden middle solution because it brings results while keeping you away from the many risks associated with surgical procedures such as LSG.

Are You A Good Candidate For ESG Or VSG?

Generally, ESG is suitable for obese patients with a BMI of 30 or more. However, recent studies showed that ESG also could be an effective treatment for class III obesity (formally known as morbid obesity) as well. Especially, it can be helpful in case for some reason morbidly obese patients are not qualified for LSG surgery. On the other hand, LSG can be advised for patients with a BMI of 40+ or a BMI of 35 and associated co-morbidities.

Reveal Weight Loss Will Help You Choose Between ESG And LSG

Being informed about the variety of ways to approach weight loss is definitely a good idea, but to choose the right procedure for your specific situation you will need to consult with experienced medical professionals in the field of endoscopic bariatric procedures such as Dr. Sarkar and Dr. Shahid at Reveal Weight Loss. Only a doctor can determine the best way for you to lose weight after a thorough examination of your medical history and lab tests. Make an appointment now to lose weight safely and effectively.

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