ESG (Endoscopic Sleeve Gastroplasty)

ESG Explained

ESG, Endoscopic Sleeve Gastroplasty, is a type of surgery done by a gastroenterologist. It is non-invasive and does not have any incisions. With sedation, you can go home soon after the procedure. The patient will return to their normal routine a few days of at-home recovery.

Who is it For?

ESG is good for people who have been unsuccessful with diet and exercise and whose BMI is at least 30. ESG may be a solution for those who don’t want to have gastric bypass surgery or those who are not physically able. You need to be committed to this program and follow the instructions for the period of time that has been prescribed. ESG is good for people looking for a long-term weight loss solution.

How The Procedure Works

The process of ESG, or endoscopic sleeve Gastroplasty, is a quick and painless surgery that takes just 45-90 minutes. Your physician will insert an upper endoscope into your stomach from the mouth while you are under anesthesia and the stomach will be reduced in size by placing plicating sutures using a suturing device. By plicating the stomach it is reduced to 70-80% smaller than before – which means less food before feeling full and fewer calories absorbed during digestion.

How Much Weight Will I Lose?

ESG is a type of non-surgical weight loss procedure. It helps people lose weight and they usually lose 20% of their body weight at 1 year. In addition to weight loss, people will also have lower blood pressure numbers, better blood sugar control and improvement of fatty liver and sleep apnea will improve.

Why Choose Us for ESG?

Endoscopic Mastery

The complicated nature of endoscopic procedures demand a great amount of skill. Dr. Veera is a gastroenterologist with an expertise in weight loss and endoscopies. He travels all over to learn the lastest cutting edge procedures so that he can bring most advanced care to Upsate South Carolina.

Bariatric Prestige

Dr. Veera is a renowned gastroenterologist who performs endoscopic procedures at Anmed Hospital. AnMed Health Weight Loss Surgery was certified in 2016 by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a nationally accredited program that meets the highest standards for patient safety and quality of care. The MBSAQIP standards ensure that weight loss surgery patients receive a multidisciplinary program, not just surgery, which improves long-term success.

Physician Commitment

If you live in South Carolina, or are traveling from another state, we promise to provide the highest level of concierge care with direct access to your physician. We remain committed for your success throughout this weight loss journey because our goal is not just about losing pounds but also regaining health and happiness.

Pricing Plans (Cash Pay Only)


  • Initial Physician Consultation
  • Pre-Surgery Comprehensive Bariatric Nutrition Consultation
  • Pre-Surgery Psychiatry/Psychologist Evaluation
  • ESG Procedures (inclusive of all Anmed facility, anesthesia, and physician fees)
  • Physician Post Procedure Follow Up Visits
  • 24/7 Medical Staff On-Call Access

Insurance does not currently provide coverage for non-surgical weight loss procedures


What is Endoscopic Sleeve Gastroplasty?

ESG, or endoscopic sleeve gastrectomy is the new gold standard for non-surgical weight loss. It performs with an incisionless technique that reduces stomach size through internal suturing and by folding it like a surgical sleeve to reduce its original volume of 70%.

How is ESG Different Than a Surgical Sleeve Gastrectomy?

ESG is a non-surgical procedure that uses an endoscopic suturing system to reduce the size of your stomach. The surgery can be done on a same day, outpatient basis and does not involve any removal from the stomach like with other procedures such as gastric sleeve surgeries.

How Many Sutures are Placed in the Stomach?

An average of 5-7 sutures are placed along the greater curve of the stomach. The exact number will vary based on the size and shape of the stomach.

Are the Sutures Permanent or Dissolvable?

The sutures are made out of a durable material called Prolene, which is not dissolvable and considered permanent. However, it does not prevent someone from undergoing any surgical procedures on the stomach later if necessary.

What Happens to the Sutures After I Heal?

Following the ESG procedure, your stomach will be held in its new sleeve shape with internal sutures. These stitches are permanent and there is no need to worry about them afterwards! The role of these external threads becomes less important over time as you body “fibroses” or stiffens from having a reduced volume for long periods of time. You would never know that they exist because the medical professionals take meticulous care when performing this operation on patients like yourself

How Long Does the Procedure Take?

The procedure takes approximately 30-40 minutes. In order to have it done, you must be put under general anesthesia at Anmed where you’ll stay for 1-2 hours after the surgery has been performed and then discharged home afterwards.

When Can I Get Back to Normal Life?

We recommend taking three days off after the procedure to rest and recover, before going back into your normal routine.

How Much Weight Can I Lose with ESG?

The average person will lose up to 60% of their excess weight by following our dieting recommendations. This process may take 6-12 months, or more, but the end result is worth it!

Is the Procedure Permanent?

Once the stomach heals, it should remain in a smaller size and shape long-term. U.S studies tell us that weight loss after ESG is maintained for up to 5 years with key factors such as adhering to an approved diet and maintaining regular exercise routines being essential ingredients of success; overeating can lead to increased risk of failing or regaining lost pounds over time just like any other type of surgical procedure.

Can the Sutures Come Loose?

The ESG should remain in place and suture failure is rare (less than 1%). However, If needed, re-suturing can be performed to further tighten the ESG.

What Does the "Restriction" Feel Like After ESG?

When you first start eating, it may feel like your stomach is full, or “restriction”. The feeling of being full will vary from person to person and typically change over time. For the first few days or weeks after surgery, most people can only consume very small amounts of liquids at a time before they are satisfied; eventually soft foods may also be consumed in large quantities with little discomfort (though some use describe indigestion). After many months into recovery, even though feelings of hunger have decreased significantly since the initial post-operative period following surgery – around four to six months out – there still exists that sensation when one has eaten enough food for their body’s caloric needs: “fullness.”

What Happens To The Part Of The Stomach That Is Sutured?

During plication, the greater curve of a stomach is stitched together to create a “thicker” wall in that area. The blood supply remains completely intact and there are no known long-term risks associated with this procedure. The stomach looks ordinary from the outside but much smaller from inside.

Are there Risks Of Serious Side Effects?

The effects of ESG are often not as drastic or inhibitory to a person’s lifestyle, but there is still some risk. Keep in mind that the risks related to it are far less than those associated with bariatric surgery. There is only about a 0.5% – 1% chance for serious adverse events like bleeding or infection.

Am I an Ideal candidate For This Procedure?

Anyone who is obese and has not achieved their desired weight loss with diet or exercise can be a candidate for this procedure. There is no minimum BMI requirement, but the benefits of the surgery are seen in people that have BMIs between 40-50 as well.

Can I Exercise Or Lift Weights After ESG?

It is best to start off slowly after your surgery, with light walking and gentle exercise. As soon as you are meeting protein goals on a consistent basis, it will be safe for you to resume more intense forms of aerobic activity or strength training. The first month following the date of ESG may present some limitations that can prevent vigorous physical activity; however this should not limit any other form of fitness workout once these restrictions have been lifted!

Non-Surgical Endoscopic Procedure Comparisons





LSG (Do Not Offer)

Type of Procedure

Non Surgical (Endoscopic)

Non Surgical (Endoscopic)

Non Surgical (Endoscopic)


Is Hospitalization Required




Yes; 1-3 days

Return to work

2-3 days

2-3 days

2 days

1-2 weeks

Average Excess Weight Loss

50 %

30-40 %

50-60 %

60-70 %

Average Total Body Weight Loss

20 %

15 - 20 %

25 %


Major Complications

Rare <1%

Rare <1%

Rare <1%

2-6 % (0.11% mortality)






Covered by insurance




Yes (if eligible)