ESG: A New Weight-Loss Procedure Without Surgery

Dr Melvin Look
General Surgeon (Upper Gastrointestinal)
Director
PanAsia Surgery

Published in Prime Magazine, December 2023

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ESG: A New Weight-Loss Procedure Without Surgery

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Obesity is a global public health concern as our modern diet and lifestyles have caused the incidence of obesity to triple worldwide in the last 50 years. The World Health Organization (WHO) indicates that there are over 1.9 billion overweight adults in 2014 alone. There are approximately 2.8 million obesity-related deaths each year.This is a large burden on our healthcare system as obesity is linked with metabolic problems such as diabetes, high blood pressure, high blood lipids, and heart disease.

Obesity is usually defined by your Body Mass Index (BMI). Simply put, it is the detrimental and excessive accumulation of body fat far beyond your body’s needs.

Fat cells are important specialized tissues in our body that store surplus energy for future use during periods of starvation or energy deficit. There are physiological controls that help to restrict this fat storage to a certain range and obesity happens when there is a breakdown in the energy balance mechanisms.

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LOSING WEIGHT

Losing excess weight seems simple enough. Caloric restriction through dieting and increased energy expenditure by exercise would lead to fat burn to draw on these energy reserves. Unfortunately, we all know that it can be an enormous challenge for most people to sustain these changes in their lifestyle habits using willpower alone.

New prescription weight-loss drugs, such as the hugely popular GLP-1 agonist Ozempic, have been very popular recently, but they can be costly and associated with side effects if they are taken on a long-term basis.

On the other hand, surgery has been, for many years, the gold standard for obesity management. Procedures such as the Gastric Bypass and the Sleeve Gastrectomy produces effective and sustainable weight loss results together with reversal of metabolic problems such as diabetes. These surgical procedures are usually done by Laparoscopic keyhole surgery. Although recovery is fast there is still a downtime of a few weeks for full recovery. There are also inherent risks that come with any surgery, and for that reason, we are very strict about offering these procedures only to patients with a BMI above 32 to 37 kg/m².

As such, there are many patients who are overweight but do not reach the criteria for surgery (BMI between 27 and 32 kg/m²). There are also those who do but are simply afraid of or resistant to an operation which is potentially irreversible.

Just like any weight loss procedure, ESG must be done in conjunction with a comprehensive weight management program that enables healthy food choices, exercise and lifestyle modification. Although this is a new procedure in Singapore, it is already an FDA approved procedure in the USA and thousands of cases have been done worldwide with an excellent safety profile. Clinical trials have reported about 15% to 20% total body weight loss 1 to 2 years after the procedure (this would be equivalent to about 50% excess weight loss). We are delighted that we can now offer ESG as part of the many options available in our weight management program.

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ENDOSCOPIC SLEEVE GASTROPLASTY

Fortunately, there are now Endoscopic therapies which can mimic the effect of surgery by using an endoscope. This is a flexible telescope which is inserted through the mouth. These procedures are done under general anaesthesia, but they are non-surgical and do not leave any scars.

For example, in Laparoscopic Sleeve Gastrectomy (LSG), keyhole instruments are inserted into the abdominal cavity to staple and remove about 80% of the stomach, leaving a tube-shaped stomach that is the size and shape of a banana. On the other hand, Endoscopic Sleeve Gastroplasty (ESG) uses an endoscopic stitching device inserted through the mouth to insert multiple rows of stiches within the stomach. When these stitches are tightened, they help to shorten, fold and reshape the stomach.  The stomach’s volume is reduced by about 70% to 80%, and it holds food in the stomach longer so that you will feel full longer after a small meal.

The procedure takes about an hour and there are minimal side effects. A small number of patients may experience mild pain, nausea or vomiting, but the majority recover very quickly and can be discharged after an overnight stay. A liquid diet is required immediately after the procedure, and this can be slowly progressed to small meals over the course of a few weeks. You will feel full with a small meal, and feel full for a longer time. This perception of satiety or fullness is the key to ending the constant hunger that comes with most diet plans.

Compared to LSG which has a downtime of a few weeks, you can return to work and normal activities within a few days of your ESG procedure. The effect of ESG lasts for a few years and is repeatable if needed. It can also be reversed by cutting the stitches with an endoscope.