What is Endoscopic Sleeve Gastroplasty?

Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive, non-surgical weight-loss procedure that reduces the size of your stomach. Unlike traditional bariatric surgery, ESG doesn't involve any incisions. Instead, a specialized endoscope (a flexible tube with a camera and tools) is inserted through the mouth and guided into the stomach. The doctor then uses sutures to reshape the stomach, creating a smaller, sleeve-like pouch. This reduces the amount of food you can eat, leading to weight loss.

ESG is a relatively new procedure, but it's gaining popularity as a safer and less invasive alternative to surgery for individuals struggling with obesity. It's particularly attractive for those who may not be suitable candidates for more complex surgical interventions or who prefer a less risky option. The reduced stomach capacity helps you feel fuller sooner, promoting smaller portion sizes and ultimately, weight loss.

Key Facts:

• Minimally Invasive: No surgical cuts are required.
• Endoscopic Procedure: Performed using a flexible endoscope.
• Stomach Reduction: Reduces stomach volume by approximately 70%.
• Non-Surgical: No removal of any part of the stomach.
• Reversible: Though not easily, the sutures can potentially be removed in the future.
• BMI Target: Typically suitable for individuals with a BMI of 30 or more, or over 27 with comorbidities.

Why is Endoscopic Sleeve Gastroplasty Performed?

ESG is primarily performed to help individuals achieve significant and sustainable weight loss, leading to improved overall health.

Main Conditions/Indications:

• Obesity: Individuals with a Body Mass Index (BMI) of 30 or higher.
• Overweight with Comorbidities: Individuals with a BMI of 27 or higher who also have weight-related health conditions.
• Failed Weight Loss Attempts: Those who have struggled to lose weight through diet and exercise alone.
• Alternative to Surgery: Patients who are not candidates for or prefer to avoid more invasive bariatric surgeries.

When Doctors Recommend It:

Doctors often recommend ESG when:

• A patient's BMI indicates they are obese or overweight with related health problems.
• Traditional weight loss methods (diet and exercise) have been unsuccessful.
• The patient is motivated to make significant lifestyle changes.
• The patient is seeking a less invasive alternative to bariatric surgery.
• The patient is medically fit to undergo the procedure. This will be determined through a thorough medical evaluation.
• The patient understands the risks and benefits of the procedure and has realistic expectations.

ESG can help alleviate or improve the following health conditions related to obesity:

• Type 2 Diabetes
• High Blood Pressure (Hypertension)
• Sleep Apnea
• Fatty Liver Disease
• Heart Disease
• Joint Pain

Preparation for Endoscopic Sleeve Gastroplasty

Proper preparation is crucial for a successful ESG procedure and a smooth recovery. Here's what you need to do:

Essential Preparation Steps:

• Medical Evaluation: Undergo a complete medical evaluation, including blood tests, physical examination, and potentially imaging studies (like an ultrasound) to assess your overall health. This is to identify any underlying health conditions that might affect the procedure.
• Consultations: Meet with a gastroenterologist, a dietitian, and possibly a psychologist. These consultations will help you understand the procedure, prepare for dietary changes, and address any emotional or psychological factors related to your weight.
• Lifestyle Changes: Start adopting healthier habits before the procedure. This includes:
  • Diet: Begin practicing portion control and focusing on a balanced diet rich in fruits, vegetables, and lean protein.
  • Exercise: Incorporate regular physical activity into your routine. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
  • Smoking and Alcohol: Quit smoking and limit or eliminate alcohol consumption.
• Medication Review: Inform your doctor about all medications, vitamins, and supplements you are taking. They will advise you on which ones to stop or adjust before the procedure. Specifically mention if you are on:
  • Blood thinners (anticoagulants)
  • Diabetes medication
  • Antihypertensives (for high blood pressure)
  • Seizure medication
• Pre-Procedure Diet: Follow the specific dietary instructions provided by your doctor. This typically involves a clear liquid diet 1-2 days before the procedure.
• Fasting: Do not eat or drink anything after midnight the night before the procedure.

India-Specific Tips:

• Fasting: Follow the fasting instructions diligently. Inform the medical staff about any religious fasting you observe regularly so they can tailor the pre-operative care accordingly.
• Documents: Carry all relevant medical records, including previous test results, consultation notes, and a list of medications. Also, ensure you have your Aadhar card and any insurance documents.
• PCPNDT (Pre-Conception and Pre-Natal Diagnostic Techniques Act): While not directly related to ESG, be aware of the regulations regarding sex determination if you are planning a family in the future. Discuss any concerns with your doctor.
• Language: If you are not comfortable communicating in English or Hindi, bring a family member or friend who can translate.

What to Expect:

• You will receive detailed instructions from your medical team regarding the preparation process.
• You may feel anxious or nervous before the procedure. Talk to your doctor or a counselor about your concerns.
• You will need to arrange for someone to drive you home after the procedure, as you will be under sedation.
• Plan to take some time off work or other responsibilities to recover.

The Endoscopic Sleeve Gastroplasty Procedure

Here's a simplified overview of the ESG procedure:

Step-by-Step:

1. Anesthesia: You will be placed under sedation or general anesthesia to ensure your comfort during the procedure.
2. Endoscope Insertion: The gastroenterologist will gently insert a flexible endoscope (a thin tube with a camera and light) through your mouth and into your stomach.
3. Visualization: The camera on the endoscope allows the doctor to view the inside of your stomach on a monitor.
4. Suturing: Using specialized tools passed through the endoscope, the doctor will strategically place sutures (stitches) within your stomach. These sutures are used to create a sleeve-like shape, effectively reducing the stomach's volume. The sutures are typically placed along the greater curvature of the stomach.
5. Stomach Reduction: The sutures cinch the stomach wall, creating a smaller pouch that restricts the amount of food you can eat.
6. Endoscope Removal: Once the suturing is complete, the endoscope is carefully removed.

Duration, Comfort Level:

• The procedure typically takes 60-90 minutes.
• You will be under sedation or anesthesia, so you will not feel any pain during the procedure.

What Happens During the Test:

• You will be lying down on a procedure table.
• Your vital signs (heart rate, blood pressure, oxygen saturation) will be monitored throughout the procedure.
• The medical team will ensure your comfort and safety at all times.
• After the procedure, you will be monitored in a recovery area until you are fully awake and stable.

Understanding Results

ESG results are focused on weight loss and improvement in related health conditions.

Normal vs. Abnormal Ranges (if applicable):

There aren't "normal" or "abnormal" ranges in the traditional sense. The success of the procedure is measured by the percentage of weight loss achieved.

• Significant Weight Loss: Studies show an average total body weight loss of 15% to 20% within the first year, and some studies have even shown up to 30% weight loss within 6 months.
• Long-Term Maintenance: A study in India showed that at 4 years, the mean percentage of total body weight loss was 18.19%, and 70% of patients maintained an excess weight loss of 25% or greater.

What Results Mean:

• Successful Weight Loss: Achieving a significant percentage of weight loss indicates a successful procedure and adherence to lifestyle changes.
• Improved Health Conditions: Improvements in blood sugar levels, blood pressure, sleep apnea, and other weight-related conditions are positive indicators of the procedure's effectiveness.
• Weight Regain: If you are not following the recommended diet and exercise plan, you may experience weight regain.

Next Steps:

• Follow-Up Appointments: Attend all scheduled follow-up appointments with your gastroenterologist, dietitian, and other members of your medical team.
• Dietary Adherence: Strictly adhere to the dietary guidelines provided by your dietitian. This typically involves a gradual transition from liquids to pureed foods to solid foods.
• Regular Exercise: Continue to incorporate regular physical activity into your routine.
• Lifestyle Modifications: Make long-term lifestyle changes to maintain your weight loss and improve your overall health.
• Monitoring: Undergo regular monitoring to assess your weight loss progress and identify any potential complications.

Costs in India

The cost of ESG in India can vary significantly depending on several factors.

Price Range in ₹ (Tier-1, Tier-2 Cities):

• Tier-1 Cities (e.g., Mumbai, Delhi, Bangalore, Chennai): ₹3,75,000 to ₹6,00,000
• Tier-2 Cities (e.g., Hyderabad, Pune, Ahmedabad): ₹3,00,000 to ₹5,25,000

Government vs. Private:

• Government Hospitals: ESG is less commonly performed in government hospitals in India. If available, it may be more affordable, but waiting lists can be long.
• Private Hospitals: ESG is more readily available in private hospitals, but the cost is typically higher. Super-specialty hospitals tend to charge more.

Insurance Tips:

• Check Coverage: Contact your insurance provider to determine if ESG is covered under your policy. Some insurance companies may cover a portion of the cost if it is deemed medically necessary.
• Pre-Authorization: Obtain pre-authorization from your insurance company before undergoing the procedure.
• Documentation: Gather all necessary documentation, including your doctor's recommendation, medical records, and insurance policy details.
• Financing Options: Some hospitals offer financing options, such as no-cost EMI plans, to help patients manage the cost of ESG.
• Compare Plans: If you are considering purchasing a new health insurance policy, compare different plans to find one that offers the best coverage for bariatric procedures like ESG.

Factors Affecting Cost:

• Hospital Choice: Super-specialty hospitals typically charge more than smaller hospitals.
• Surgeon's Experience: More experienced surgeons may charge higher fees.
• Diagnostic Tests: The cost of pre-operative diagnostic tests (blood work, imaging studies) can add to the overall expense.
• Patient's Health: Patients with underlying health conditions may require more extensive monitoring and care, which can increase the cost.
• Room Selection: The type of room you choose (private, semi-private, general ward) can affect the cost.
• Post-operative Programs: Some hospitals offer comprehensive post-operative programs, including dietitian consultations and support groups, which may be included in the overall cost or charged separately.

How Ayu Helps

Ayu helps you manage your health records efficiently.

• Store Results Digitally: Securely store your ESG results and other medical records on the Ayu app.
• Track Over Time, Share via QR: Monitor your weight loss progress over time, share your records with doctors via QR code, and have quick access to your health information whenever you need it.

FAQ

Q: Is ESG a permanent solution for weight loss?

A: ESG is a tool to help you lose weight. Long-term success depends on your commitment to lifestyle changes, including diet and exercise.

Q: How much weight can I expect to lose with ESG?

A: On average, patients lose 15% to 20% of their total body weight within the first year. Some individuals may experience even greater weight loss.

Q: What are the potential side effects of ESG?

A: Common side effects include temporary nausea, pain, and bloating. Serious complications are rare but can include bleeding, infection, or injury to the stomach or surrounding organs.

Q: How long does it take to recover from ESG?

A: Most patients can return to work and normal activities within a few days. However, it's important to follow your doctor's instructions regarding diet and exercise.

Q: Is ESG covered by insurance in India?

A: Coverage varies depending on your insurance policy. It's best to check with your insurance provider to determine if ESG is covered.

Q: Who is a good candidate for ESG?

A: Good candidates are individuals with a BMI of 30 or higher, or over 27 with comorbidities, who have struggled to lose weight through diet and exercise and are committed to making lifestyle changes.

Q: What happens if I don't follow the diet and exercise plan after ESG?

A: You are likely to regain weight if you do not adhere to the recommended diet and exercise plan.

Q: Where can I find a qualified gastroenterologist to perform ESG in India?

A: You can search online directories, ask your primary care physician for a referral, or contact reputable hospitals that offer bariatric services. Make sure the doctor has experience performing ESG.