Endoscopic Sleeve Gastroplasty (ESG)

Endoscopic bariatric procedures are performed using an endoscope and involve inserting devices or administering treatments through the gastrointestinal tract to restrict food intake, enhance feelings of fullness and promote successful weight loss. Within this category of advanced, incisionless techniques, endoscopic sleeve gastroplasty (ESG) is one of the most effective options.

 

ESG is a minimally invasive procedure that offers a nonsurgical alternative to traditional bariatric surgery, helping patients achieve meaningful, sustained weight loss with little to no downtime. The ESG procedure is FDA approved for the treatment of obesity. 

 

At Houston Methodist, ESG is part of a comprehensive, multidisciplinary approach to weight management. Patients who choose us for their ESG benefit not only from innovative expertise, but also from ongoing nutrition, lifestyle, medication and behavioral support — designed to promote lasting success and improve overall health.

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Our Approach to Endoscopic Sleeve Gastroplasty

Houston Methodist’s team of experts collaborates to build a personalized treatment plan for every patient, pairing the ESG procedure with lifestyle changes and medical weight loss options — including GLP-1 medications, when appropriate — to help optimize results. Each patient undergoes a comprehensive evaluation to determine the safest and most effective path forward based on his or her individual needs.

  • How Is Endoscopic Sleeve Gastroplasty Performed?

    During an ESG procedure, a thin, flexible endoscope equipped with a camera is passed through the mouth and into the stomach while you are under general anesthesia. A specialized suturing device allows your physician to fold and stitch the stomach inward, creating a stomach that is approximately 20-30% of its original volume.

     

    Because no tissue is cut, removed or rerouted, ESG preserves the natural anatomy of the stomach and digestive system, resulting in little scarring and a faster recovery compared to traditional bariatric surgery. A smaller stomach capacity helps you feel full sooner, eat less and achieve meaningful weight loss.

  • Who Needs an Endoscopic Sleeve Gastroplasty Procedure?

    ESG is ideal for adults who:

     

    • Are considered high risk for surgery or prefer to avoid major surgery
    • Have a BMI of 30 or higher
    • Have struggled to lose weight through diet, exercise or prior weight loss medications
    • May benefit from combining ESG with weight loss medications for greater results

     

    Alternative endoscopic bariatric procedures are also available to help individuals who previously had weight loss surgery and have regained weight. These patients often qualify for transoral outlet revision (TORe) — a related endoscopic suturing procedure that supports renewed weight loss.

  • What Are the Benefits of Endoscopic Sleeve Gastroplasty?

    ESG provides a significant, sustainable weight loss solution without the need for major surgery. As patients lose weight, many also see improvements in related health conditions such as cardiovascular disease, fatty liver disease, high blood pressure, high cholesterol and type 2 diabetes. Both physicians and patients choose ESG because it is:

     

    • An outpatient procedure, with patients going home the same day
    • Highly effective, producing an average of 15-20% total body weight loss by 12 months post-procedure
    • Minimally invasive, with no external incisions or scars, no risk of malabsorption with minimal impact on vitamin absorption compared to traditional bariatric surgeries, and a significantly low complication rate

  • What Is Recovery Like After Endoscopic Sleeve Gastroplasty?

    Most patients experience a remarkably quick recovery compared to traditional bariatric surgery. After an ESG procedure, patients typically:

     

    • Go home the same day
    • Graduate from a liquid diet to solid foods gradually, with support from our dietitians 
    • Return to work and daily activities within 1-2 days

     

    As a patient, you also benefit from long-term follow-up with our multidisciplinary team of dietitians, behavioral health specialists, exercise physiologists and medical weight loss physicians at the Houston Methodist Center for Weight Loss & Bariatric Surgery who can help support your ongoing health and weight management.

Why Choose Houston Methodist for Your ESG Procedure

Weight loss is a personal journey that requires expert guidance and compassionate support. At Houston Methodist, you benefit from a program built on leading expertise, advanced technology and a patient-centered approach that extends far beyond any procedure itself. From your first consultation through extended follow-up, our multidisciplinary team works together to deliver safe, effective and individualized care — giving you the confidence and support needed to achieve lasting results.
Leading Academic Endoscopic Weight Loss Program

Advancing the science of endoscopic weight loss through research, education and innovation

Currently, Houston Methodist has the largest academic endoscopic weight loss program in Texas. The program offers ESG and other advanced endobariatric procedures, with cutting-edge technology and strong results. Our researchers have participated in:

 

  • Multicenter ESG studies on fatty liver disease
  • National trials evaluating endoscopic therapies for metabolic conditions
  • Studies advancing future standards of obesity care

 

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Patient-Centered, Comprehensive Weight Loss Support

A full spectrum of weight loss care, coordinated for your long-term success

Houston Methodist is one of the few programs nationwide offering lifestyle, medical, endoscopic and surgical weight loss options within a single system. This breadth of services allows our experts to recommend the exact interventions, or combination of interventions, best suited to your goals and health needs. 

 

Whether you need ESG, medications, lifestyle coaching or weight loss surgery, your care remains personalized, supportive and focused on lasting results. And with all resources aligned and easily accessible, you benefit from safe, individualized and evidence-based care throughout your entire weight loss journey.

Choose an Endoscopy Sleeve Gastroplasty Specialist

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