FAQs
How does the ESG work?
The ESG procedure will shorten the length of the stomach by approximately 50% and will reduce its volume by 75%. Given this, the ESG works in several ways to help you lose weight:
The quantity of food that you can eat is significantly restricted – helping you to reduce your portion sizes
Your stomach will empty more slowly – helping you to feel fuller for longer
What does the procedure involve?
The ESG will be completed by Dr. Frey within 2 hours at an outpatient surgery center under general anesthesia.
Once asleep, the specialist inserts a camera (i.e. endoscope) through the mouth and into the stomach via a protective tube that protects the esophagus (food pipe) from injury. Following an examination to ensure it is safe to proceed, a series of stitches are made within the stomach to create a tube-shaped stomach - significantly decreasing the stomach’s capacity.
How much weight can I expect to lose with the ESG?
The more you work on making lifestyle changes with diet and exercise, the more successful your weight loss journey will be. You can expect to achieve 20% Total Body Weight Loss OR 49% of your excess body weight. Ultimately, the amount of weight you lose and maintain will depend on how closely you follow the advice of your medical and allied health care team.
Who is the ESG suitable for?
The ESG is suitable for patients who have:
a BMI of ≥30 - 50 who have not been able to keep weight off with diet and exercise alone
metabolic diseases such as type 2 diabetes, hypertension, hypertriglyceridemia, obstructive sleep apnea, polycystic ovarian syndrome (PCOS), and fatty liver disease.
Will the ESG affect my medications?
It is not expected that tablets be affected by ESG, however, medication may take longer to act if in pill form. Anti-inflammatory medications may irritate the stomach more than they typically do following the procedure.
As you lose weight, other health markers may also improve and you may find that some medications may not be necessary (such as anti-hypertensives and diabetic medications). We ask all patients to meet with our team on a regular basis to assess their requirements for medication before making any changes.
What about pregnancy with the ESG?
Any plans for a future pregnancy should be discussed with your Bariatric Specialist at your initial consultation. We advise our ESG patients to avoid pregnancy for at least 18 months following an ESG to allow time for your weight and body composition to stabilize.
It is important to note that there is no data on ESG and pregnancy as yet, which represents one of the ‘risks of the unknown’.
How long will it take to recover from the ESG procedure?
You should plan at least three days of inactivity to recover from the procedure and to allow symptoms to resolve. We advise patients to wait until they are able to tolerate suitable volumes of fluid before resuming exercise to minimize the risk of dehydration. We encourage low to moderate intensity exercise during weeks 1-2 post-ESG, with a return to higher intensity exercise possible after one month.
Most patients are able to return to work within the week. You may be able to resume normal activity sooner or later than this depending on how quickly your body adjusts to the ESG.
Will the ESG limit my activities?
During the first week of the procedure you should not plan any heavy activities. Once you are able to manage adequate amounts of fluids, you can continue your normal activities. Starting a regular exercise program is highly recommended and will improve your success.
Is there anything you cannot eat after the ESG procedure?
You will be provided with specific dietary advice, including suitable foods and portion sizes, from our expert dietitian who you will meet with regularly across the duration of your program.
You will need to follow a restricted, fluid diet prior to your ESG procedure, and will be advised to follow a diet progression of various food textures for a period of 6 weeks following your ESG. However, beyond this, you are able to enjoy most foods without concern and within the context of a healthy, balanced diet.
When can I return to a normal diet?
In order to allow the stitches to mature, it is important that the diet progresses slowly. Thankfully, appetite is strongly suppressed by this therapy and hunger is reduced. Our patients are required to maintain a liquid only diet for approximately 4 weeks before progressing to a puree diet, then soft diet. Our patients are able to return to a normal diet approximately 8 weeks after the procedure, however portion sizes are much smaller than previous, and will remain so for many months and even years.
Are there any other complications associated with the ESG?
ESGs are the safest form of weight loss procedures. They have been in use worldwide for over a decade and the risks of complications are surprisingly small. There have been no deaths documented with this procedure. To date, complications that have occurred have been able to be managed with endoscopies, medications or minor procedures.
Complications are very rare and are generally easily managed. They may include:
1% risk of major complications has been documented in the literature, with the most common complication being infection around the stomach. This is treated with antibiotics, possible drainage, and rarely requires surgery.
Trauma to the stomach or surrounding structures (such as the liver, colon, spleen, or gall bladder), which may require surgery to fix.
Bleeding
Clots in the legs
What are possible side effects from the ESG?
The side effects of the ESG procedure are usually limited to the first 5 days after it is performed, with the first 3 days being most severe. After this period, the symptoms disappear completely and will only recur (and are typically mild) when one of the “golden rules” are broken.
Our doctors have worked tirelessly to optimize the treatment of our patients. You will be provided with our highly advanced, unique and comprehensive treatment program to minimize the occurrence of side effects.
You will also be prescribed medications to assist in controlling symptoms and it is important that you fill these medications and take them as directed. If symptoms persist or worsen, you should contact the clinic immediately.
Most patients of our clinic now typically experience only mild side effects (if any), with the most common being:
Cramping
Cramping is common in the first 3-4 days after the procedure and can be treated with medications.
Overeating or drinking too much at a time can also bring on cramping.
Reflux (including heartburn and some belching)
You will be required to take acid medication for two weeks prior to the procedure and recommended during the first year following your procedure to manage any reflux. Over the counter antacid medications can also be used.
Overeating, overdrinking, eating rich (creamy/oily) foods or drinking wine will typically bring on acid reflux symptoms.
Nausea
Typically mild to moderate in the initial days after insertion.
Lethargy
Typically due to the anesthesia and medications used to manage side effects and resolves after 3 days. We recommend resting during this period to hasten your recovery.
Is the ESG permanent?
The stitches used in the procedure are permanent and do not dissolve, however, they may break over time if under too much tension, as might be seen with repeated overeating or vomiting. However scar tissue frequently replaces the stitches over time and even if the stitches fail, the ESG is only partly reversed. One study showed up to 25% of patients lost one stitch by the end of 12 months, but this was not associated with weight gain.
It’s important to keep in mind that although the anatomical change is permanent, the functional change is not.
Can I Exercise?
Yes! Exercise is an important part of losing weight and keeping it off. We encourage exercise as part of your weight loss strategy – all activities are encouraged and safe. Your Surgeon will provide you with specific recommendations for starting exercise at your post-op appointment.