Endoscopic sleeve gastroplasty (ESG): the 'sleeve without surgery'

What is endoscopic sleeve gastroplasty (ESG)?

ESG — known in Arabic as "الكرمشة" (stomach plication/stitching) — is a procedure that reshapes the stomach into a smaller sleeve using stitches placed from the inside, through the mouth, with an endoscope. There are no incisions, nothing is removed, and the abdomen is never opened. Professor Jamal was among the first in the region to publish research on this technique.

How is ESG different from surgical sleeve gastrectomy?

The surgical sleeve removes 70–80% of the stomach permanently through small abdominal incisions, while ESG folds and stitches the stomach smaller from within, preserving the organ. Surgery produces more weight loss (25–30% vs roughly 15–20% for ESG), but ESG offers no scars, a gentler recovery, and potential reversibility — a genuine middle option between balloons and surgery.

How is the procedure performed?

Under general anesthesia, an endoscopic suturing system passes through the mouth into the stomach and places a series of full-thickness stitches that fold the stomach into a narrow tube, reducing its volume by roughly 60–70%. The procedure typically takes under an hour, and most patients go home the same day or after one night.

How much weight can I expect to lose with ESG?

Studies suggest around 15–20% of total body weight at one to two years when ESG is combined with a structured lifestyle program. Large published series and clinical trials have confirmed the durability of these results in the majority of patients.

Who is a good candidate for ESG?

ESG suits people with a BMI of roughly 30–40 who want a significant, lasting result without surgery — or selected patients with higher BMI who cannot or do not wish to have surgery. It also suits patients worried about the permanence of surgical sleeve. Candidacy is confirmed after endoscopic assessment of your stomach.

What are the risks and side effects?

Cramping, nausea and abdominal discomfort for a few days are expected and controlled with medications. Significant complications such as bleeding or leak are uncommon — published rates are low, and lower than surgery — but no procedure is risk-free, which is why experience with endoscopic suturing matters.

What is the recovery like?

Most patients return to normal activity within a few days — faster than surgery. The diet progresses from liquids to soft food to balanced meals over about four weeks, with dietitian follow-up throughout.

Can ESG be repeated or converted to surgery later?

Yes. If needed, the stitches can be reinforced (re-ESG), and ESG does not close the door to sleeve gastrectomy or bypass later. This flexibility is one of its most reassuring features for patients hesitant about surgery.

ESG, balloon or surgery — how do I choose?

Think of it as a ladder: balloons (about 10–15% weight loss, temporary), ESG (about 15–20%, durable, no incisions), and surgery (25–35%, the most powerful and most studied). Where you fit depends on your BMI, health conditions, previous procedures and goals. Because Professor Jamal performs all of these — and is board-certified in obesity medicine — the advice you receive is about what fits you, not what fits one tool.

How do I book?

Book a consultation with Professor Jamal at Kuwait Hospital, Sabah Al-Salem — WhatsApp +965 60621662 or phone +965 22207777 — or online from anywhere via the DAWI app.

This article is educational and does not replace personalized medical advice.