• Same weight loss benefits without surgery or scars.
  • Safer, lower risk procedure leaving anatomy intact.

At IHU Strasbourg we are the among first to offer traditional obesity surgical treatments and the new non-surgical alternative, the endoscopic sleeve gastroplasty (ESG).



The endoscopic sleeve gastroplasty is a new procedure for those who want the benefits of weight loss surgery but from a less invasive, non-surgical procedure.

Traditional bariatric surgeries such as sleeve gastrectomy and roux en-y-gastric by-pass are more invasive procedures with a generally higher risk profile, particularly that of staple line leakage, but with excellent weight loss results.

Which is the better option for you, bariatric surgery or ESG, will depend on your personal view of the risks and benefits and on your surgical and medical history.

This procedure is an option if you’re significantly overweight — a body mass index of 35 or more — and diet and exercise haven’t worked for you.

The ESG procedure is less invasive with faster recovery times but as a new procedure, there is little data available on long term outcomes. This is true of all new procedures.

Last but not least, although it’s not designed to be a temporary procedure, endoscopic sleeve gastroplasty can be reversed and converted to bariatric surgery should the weight loss achieved not be satisfactory. In addition to being reversible, the endoscopic sleeve can be redone if the patient needs their stomach to be resized again.

Who it's for?

The procedure is available to people whose body mass index (BMI) is over 30 or higher (Calculate your BMI here) who haven’t been successful maintaining weight loss with other methods.

Endoscopic sleeve gastroplasty is often an option for people who are unable to have a surgical procedure such as those who have large amounts of abdominal scarring from injuries or previous procedures, or patients who would prefer not to have surgery to treat obesity.

Endoscopic sleeve gastroplasty isn’t for everyone who is overweight. A screening process helps doctors see if the procedure might be beneficial for you as for any bariatric interventions.

To benefit from this procedure you must be willing to commit to healthy lifestyle changes, regular medical follow-up and participate in behavioral therapy in a medically supervised weight loss program.

To qualify for the endoscopic sleeve gastroplasty procedure, you should:

  • Be 18 or older
  • Have a body mass index (BMI) of 30 or higher
  • Be willing to participate in a medically supervised weight loss program.

Endoscopic sleeve gastroplasty isn’t for everybody. ESG is not appropriate for anyone who has gastrointestinal bleeding, a hiatal hernia larger than 3 centimeters or who’s had prior major esophageal or stomach surgery.


ESG involves shrinking and shortening the stomach from the inside to significantly reduce its capacity.

The procedure is done under general anesthesia using an endoscope, a flexible tube with a camera and an endoscopic suturing device attached.

The endoscope is inserted thought the mouth into the stomach. Using the endoscope, the doctor places sutures in the stomach in a specific pattern from the bottom of the stomach to the top. The series of sutures is then tightened in a fashion that resembles an accordion.

After the procedure, the stomach anatomy remains intact but has been stitched to leave a smaller « banana » shaped stomach. The procedure works by reducing the stomach capacity and slowing down the speed at which food passes into the bowel. The food goes into a small pocket at the top of the stomach before working its way down through the smaller stomach, and emptying into the bowel.

The procedure takes about 90 minutes.

After the procedure

After the endoscopic sleeve gastroplasty, you’ll awaken in a recovery room, where medical staff monitors you for any complications. The majority of people leave go home the same day after recovering from sedation or the day after the procedure.

Patients generally follow a liquid diet for a brief amount of time after the procedure. Diet and exercise remain an integral part of a patient’s health regimen before and after the procedure, with a multidisciplinary team of doctors including an endocrinologist and nutritionist to monitor one’s food intake and metabolic health before and after the procedure.

Interest and benefits

The major benefit of the endoscopic sleeve gastroplasty is that it is performed endoscopically through the mouth. This means that unlike surgery, there is no cutting or stapling, no scarring and no wounds.


Endoscopic sleeve gastroplasty leads to significant weight loss broadly comparable to those obtained with gastric banding.

Findings demonstrate that patients may lose 30% to 60% of their excess body weight within six months of their procedure. Not only does a patient see a decrease in body weight, but often related comorbidities such as high blood pressure, diabetes and sleep apnea can improve after having this procedure.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires commitment to a healthier lifestyle.

You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.


In early studies on endoscopic sleeve gastroplasty, the procedure has shown a favorable safety profile.

Pain and nausea may occur for several days after the procedure. These symptoms are usually managed with pain and nausea medications. Most people feel better after two days.

Because the procedure is still new and not in wide use, questions remain about its long-term effectiveness and risks.