ESG Stomach Tightening

Endoscopic sleeve gastroplasty — ESG, or stomach tightening — is a procedure that makes the stomach smaller and slower without surgery. A flexible endoscope is passed through the mouth, and a suturing device mounted on it places a series of stitches through the stomach wall, drawing it inward along its length. Nothing is cut, nothing is removed, and there are no incisions on the outside of the body.C-IV-05

The idea came from bariatric surgery. Sleeve gastrectomy achieves durable weight loss by reducing the stomach's capacity, but it does so by removing most of the organ. ESG asks whether the same principle — a smaller, slower stomach — can be reached from the inside instead, and reversed if it needs to be.

The FDA granted De Novo marketing authorisation for the endoscopic suturing device used in ESG in July 2022, for adults with a BMI between 30 and 50. Dr. Thompson performed the world's first-in-human cases with the current technique in 2012C-BIO-01, and the procedure is now performed internationally. He co-founded Everself, where he continues to perform it.

The procedure is done under general anaesthesia and takes about 45 minutes. There is no external incision, so there is no wound to heal and no scar. Most people go home the same day.

An endoscope carrying a suturing device is passed down the oesophagus into the stomach. Working from inside, the operator places a running pattern of full-thickness sutures along the greater curvature — the long outer wall of the stomach. Tightening those sutures folds the wall in on itself, so the stomach takes on a narrow, tubular shape and holds considerably less.

The sutures are the whole procedure: how many, where they are placed, and in what pattern determine the result. That is also why ESG has kept improving since 2012 without the underlying idea changing — the technique has been refined through successive multicentre studies rather than replaced.

Two things change, and neither is willpower. The stomach holds less, so a smaller meal produces the stretch that signals fullness. And it empties more slowly, so that signal lasts. Both effects are measurable, and both are still present a year afterward.C-IV-05

Patients lose about 18% of their total body weight. The full science page walks through the individual trials, including the ones that found less, and is the place to read before drawing conclusions from any single figure.