OverStitch Endoscopic Sleeve Gastroplasty

What is OverStitch or Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic Sleeve Gastroplasty or OverStitch (ESG) is a minimally invasive procedure, without incisions or cuts, and non-surgical that allows for reducing the size of the stomach to ensure a successful weight loss journey. Performed under light sedation and on an outpatient basis, the procedure is simple and patients return to their normal routine after a few days of recovery at home.

Who Is a Candidate for OverStitch or Endoscopic Sleeve Gastroplasty (ESG)?

Apollo OverStitch procedure or Endoscopic Sleeve Gastroplasty (ESG) is ideal for patients who have a BMI of at least 30 and have not had success losing weight with diet and exercise. It is also a less invasive option for those who are unwilling or unable to undergo gastric bypass or those whose physical condition is an impediment to performing bariatric surgery. The most important condition is to commit to the health and nutrition program during treatment. We recommend OverStitch or Endoscopic Sleeve Gastroplasty (ESG) for people who are looking for an effective, long-term weight loss solution.

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How Does the OverStitch Procedure Work?

OverStitch or endoscopic sleeve gastroplasty is a 100% endoscopic procedure, which is performed from inside the stomach and does not require abdominal cuts or incisions. The doctor inserts an endoscope (a camera attached to a flexible tube) through the mouth and into the stomach. The endoscope is equipped with a suture system that allows stitches to be placed in the stomach. The bariatric OverStitch procedure takes approximately 30 to 45 minutes. After the procedure, the stomach is up to 80% smaller than its initial size, which limits the amount of food eaten and makes the patient feel full. It also limits the number of calories absorbed by the stomach and also prolongs the time that food remains in the stomach, which makes the feeling of satiety last longer.

Who Should Perform My Endoscopic Procedure?

Due to the specific skill required, endoscopic procedures are better performed by a gastroenterologist than a surgeon. In our case, Dr. Federico Gregory was the first gastroenterologist in Puerto Rico and one of the first doctors in the country to perform the OverStitch procedure or endoscopic sleeve gastroplasty. Endoscopy is the primary skill used by a gastroenterologist on a daily basis, while surgeons typically perform far fewer endoscopic procedures in a day’s work. For a procedure as technically challenging as Endoscopic Sleeve Gastroplasty or OverStitch, this experience is important. Dr. Gregory has performed many endoscopic procedures to date. He frequently educates and trains other physicians from across the country, as well as internationally, on procedures such as the OverStitch. We’re not bragging, we’re just saying… we know what we’re doing.

How Much Weight Will You Lose with Endoscopic Sleeve Gastroplasty or OverStitch?

OverStitch or Endoscopic Sleeve Gastroplasty is currently the most effective non-surgical weight loss procedure, producing up to 20% total body weight loss within 1 year. Although results may vary depending on the person undergoing this procedure and the behavior of their body, most patients will lose 70% of their excess weight or more. Aside from great weight loss, our patients have reported better blood pressure, better blood sugar control, and improvement in sleep apnea. Commitment to the program is the most important factor for the success of this treatment. Carefully follow your doctor’s recommendations and adhere to nutrition and exercise plans. Your Innova Weight Loss Solutions medical team will work with you to help you achieve your weight loss goals.

 How much weight you’ll lose?

Why choose Innova Weight Loss Solutions for your Gastroplasty?

Endoscopic experience

ESG procedure is one of the most technically challenging endoscopic procedures and requires a high level of endoscopic skill. Dr. Gregory, a Board-Certified Gastroenterologist and Endoscopist, is a leader and educator in the field of endoscopic weight loss and regularly trains physicians across the country in endoscopic suturing techniques.

Bariatric excellence

Bella Vista Hospital, where Dr. Gregory performs the procedure, is an accredited Comprehensive Center for Bariatric Surgery, Center of Blue Distinction for Bariatric Surgery, and Center of Excellence in Bariatric Surgery. Although your ESG weight loss procedure is an outpatient procedure, performed on the same day, you will have the support of a comprehensive, knowledgeable, and award-winning bariatric center.

Medical access 24 hours a day,
7 days a week

Whether you live in Puerto Rico or travel from another country, you will receive the highest level of concierge care, with direct access to your doctor 24 hours a day, 7 days a week, via a personal cell phone, text messages, and emails. We remain committed to your success throughout your weight loss journey.

How Does ESG Compare to the Surgical Sleeve Gastrectomy?

Type of ProcedureNon-surgical (endoscopic)Surgical
Is Hospitalization Required?No, same day procedureYes, 1-3 days
Return to Work2-3 days1-2 weeks
Average Excess Weight Loss50%-60%60%-70%
Average Total Body Wieght Loss20%20%-30%
Major ComplicationsRare <1%2-6% (0.11% mortality)
Covered by Insurance?NoYes (if eligible)
Endoscopic Sleeve Gastroplasty (ESG)
Laparoscopic Sleeve Gastroplasty (ESG)

Frequently Asked Questions

What is Endoscopic Sleeve Gastroplasty (ESG)?

ESG surgery is an endoscopic technique, without cuts or incisions, which reduces the size of the stomach using a suture device inserted through the mouth until it reaches the stomach. The size of the stomach is reduced up to 70% by folding and suturing the stomach with the device. After the procedure is completed, the stomach is shaped like a sleeve, similar to a sleeve gastrectomy surgery.

How is ESG different than a Surgical Sleeve Gastrectomy?

The main difference is that Endoscopic sleeve gastroplasty or ESG is non-surgical. There are no cuts or scars and it is performed through the mouth using an endoscopic suture system (OverStitch). This allows a rapid recovery of the patient and a minimum of adverse reactions as it is minimally invasive. The procedure is performed on an outpatient basis. Although OverStitch or ESG reduces the size of the stomach to a similar degree as surgical sleeve gastrectomy, it does not involve the removal of any portion of the stomach or any type of incision as is necessary for bariatric surgery.

How many sutures are placed in the stomach?

Up to 7 sutures can be placed along the greater curve of the stomach. all organisms are different and the number of sutures can vary for this reason or because of the size of the patient’s stomach.

Are the sutures permanent or dissolvable?

The sutures are made of (polypropylene), a very durable and resistant material. These sutures are not dissolvable and are considered permanent.

What happens to the sutures after I heal?

After the OverStitch procedure or Endoscopic Sleeve Gastroplasty (ESG), the intent of the internal sutures is to keep the stomach in its new sleeve shape until it is completely healed. After this process in which the stomach has healed, the sutures will remain in the stomach wall. Over time, the stomach hardens and tends to stay in its smaller form. Therefore, the role of the sutures becomes less important over time. The sutures do not represent any long-term risk for the patient, to the point that the patient forgets that he has the sutures in his stomach.

How long does the procedure take?

This procedure takes approximately 40 minutes maximum. The procedure is performed under light sedation in an endoscopy suite. You will be in a recovery room for 1 to 2 hours after the procedure. After this, you will be discharged and will be able to return home without any inconvenience.

When can I return to work?

We recommend taking 2-3 days off after the procedure to rest and recover. after this time you will be able to return to your normal activities without any problem.

How much weight can I lose with ESG?

Weight loss may vary based on your starting weight, motivation, and adherence to our diet and exercise recommendations. Studies show an average of 20% loss of total body weight and up to 60% loss of excess weight. It usually takes 6 to 12 months or more to lose weight.

Is the procedure permanent?

Once the stomach has healed, it will remain a smaller size and shape for the long term. Studies say that weight loss after OverStitch or ESG is maintained for up to 5 years. The key to maintaining your weight loss is following the recommendations of our team of professionals and maintaining a regular exercise regimen. A very important tip is that overeating can lead to weight regain and/or sleeve failure over time, as with any weight loss procedure.

Can the sutures come loose?

The sutures in the endoscopic sleeve gastroplasty or ESG procedure must remain in place and not become loose or thin. It should be noted that suture failures have been reported and have been experienced at a very small rate (less than 1%) in. If necessary, it can be sutured again to further tighten the sleeve.

What does the “Restriction” feel like after ESG?

The feeling of satiety can be different in each patient, in general, it will change over time. For the first few days or weeks, you will only be able to eat a liquid diet, eventually, you can start with soft foods. Some patients describe a feeling similar to indigestion, satiety, or even discomfort with much smaller portions than they were used to. For some patients, this is very noticeable. For others, it may take a little longer. It is important to eat slowly to allow the brain to process food and produce this sensation. After several months, the feeling of fullness will still occur at a much earlier point in time at mealtimes.

What happens to the part of the stomach that is sutured?

During the ESG endoscopic sleeve gastroplasty procedure, the greater curve of the stomach is sutured together, creating a “thick” stomach wall while the blood supply remains completely intact. As the stomach heals completely, it looks normal from the inside, although smaller. So far there are no known long-term risks after this minimally invasive procedure.

Can you see the sutures with an x-ray?

Each of the sutures has a small metal plate on its end. These plates are visible by X-rays. They are materials that do not pose any long-term risk. and they have no restrictions if the patient requires an MRI after the procedure.

What are the most common side effects?

As with any procedure, the most common side effects are abdominal pain, bloating, cramps, and sometimes nausea. These are usually mild and are treated with pain relievers and anti-nausea medications. Fatigue may occur for 1-2 weeks after the procedure due to low initial caloric intake but will improve over time.

What is the risk of serious side effects?

Although the risks associated with ESG are much lower than those of bariatric surgery, like any surgical or non-surgical procedure, there is a risk of up to 1% of serious adverse effects, such as bleeding, infection or injury to the stomach.

Am I a candidate for this procedure?

Anyone who is suffering from obesity and has not achieved the desired weight loss through diet and exercise is a candidate for this or other procedures at Innova Weight Loss Solutions. A specific weight or body mass index (BMI) is not required for the procedure, although most patients will have a BMI between 30 and 40. However, this procedure has been performed effectively in people with a higher BMI and who are definitely not interested in undergoing surgical treatments such as bariatric surgery.

Who cannot have ESG?

The main contraindication to the ESG or OverStitch procedure would be the presence of a known stomach problem, such as an ulcer or a hiatal hernia that is too large. Significant health problems or bleeding disorders would also be a contraindication that would require much more study to determine if the procedure is feasible or not.

Does ESG affect the hunger hormone Ghrelin?

The Ghrelin hormone is the one directly involved in maintaining body weight. It is produced by the stomach and increases when we have an empty stomach. as well as decreases after eating. With endoscopic sleeve gastroplasty or OverStitch, ghrelin levels remain very low for a few months, since much of the stomach is folded and stitched. They then gradually return to normal. Some studies suggest that ghrelin levels may decrease after the ESG procedure, although probably to a lesser degree and for a shorter time. However, because the stomach is smaller after OverStitch, the amount of food needed to “turn off” ghrelin should be significantly less.

Why don’t you suture the top of the stomach?

With ESG, the upper part of the stomach (called the Fundus) is left as is. This part of the stomach has a very thin wall and is in close proximity to other organs (such as the spleen, diaphragm, and lungs), and therefore putting stitches near this area is considered a risk. The fundus is left fully intact, and the configuration of the stomach after this procedure is more like a bag on a narrow sleeve. This is different from vertical sleeve gastrectomy (VSG), which creates a long, narrow tube. The stomach in endoscopic sleeve gastroplasty tends to be more wrinkled and bag-shaped, due to the sutures that are made.

Can I exercise or lift weights after ESG?

The simplest answer is “yes”. There are no specific exercise restrictions immediately after the ESG procedure. However, we recommend starting with a light walk first, even on the day of the procedure, as it helps a lot at the time of recovery. Once you consistently meet your protein and fluid goals, you can start exercising more intensely. In general, at Innova Weight Loss we recommend avoiding very strenuous exercise for 3-4 weeks, as your caloric intake may be too low to support at first (you can feel tired very easily). After the first month, you should be able to do any form of exercise without limitation. It is always advisable to consult with your doctor.

Is it Ok to get pregnant after ESG?

Again the quickest answer is YES. Once you have recovered from your endoscopic sleeve gastroplasty procedure, it is safe to become pregnant, although we generally recommend waiting a minimum of 6 months before seeking pregnancy. We advise patients that fertility may be increased after this procedure, due to the metabolic improvements associated with weight loss.

What happens if I don’t lose as much weight as I want, or if my weight loss is slower than expected?

Our team of professionals will closely monitor your progress after the OverStitch procedure, to ensure that your weight loss is on a healthy and successful path. It is very common for there to be periods of slower weight loss during the process of the first 12 months.

Can the ESG procedure be repeated?

Yes. If the initial procedure was unsuccessful, this procedure can be safely repeated or adjusted with satisfactory results.

If I don’t succeed with ESG, could I go on to have a Bariatric Surgery?

Yes. Some patients have made the decision to perform a surgical procedure without any complications.