Understanding ESG, A Minimally Invasive Advancement In Obesity Management

KUALA LUMPUR, Oct 21 (Bernama) -- Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive procedure that reduces stomach capacity without the need for surgical intervention. It is being explored as part of a broader approach to managing obesity under medical guidance.

According to Sunway Medical Centre, Sunway City (SMC) Consultant Gastroenterologist & Hepatologist and Bariatric Endoscopist, Dr Yong Karl King, obesity, long treated as a cosmetic issue, has now been recognised globally as a disease requiring medical treatment, yet many patients continue to face unfair stigma and a lack of accessible options.

Dr Yong noted that half of Malaysian adults are either overweight or obese, a situation compounded by stigma and under-recognition.

“Obesity is not just in Malaysia, it is a global pandemic. Many people don’t seek medical help because they are worried about being stigmatised,” he said during an interview with Bernama recently.

He explained that traditional approaches to obesity treatment often oscillate between lifestyle modification and full bariatric surgery, leaving patients with few middle-ground choices.

“ESG is emerging as one of several possible medical procedures being explored to support patients struggling with obesity, under medical guidance. 

He said lifestyle changes, such as diet and exercise, remain critical, and surgery has been around for decades, but the most exciting development lies between anti-obesity medications and bariatric endoscopy.

“ESG is not a surgery. It is classified as a minimally invasive endoscopic procedure to remodel the stomach. The procedure is performed under general anaesthetics, through the mouth using an endoscope, and involves suturing or plicating the stomach to reduce stomach capacity without removing any parts of the intestine or stomach. There is no cutting, no scars whatsoever.

“Some studies have shown patients may experience average weight loss in the range of 14-17 per cent of total body weight loss over one year, provided they commit to lifestyle changes after the procedure. Results may vary between individuals,” he said.

Dr Yong, who is one of the early adopters and pioneered the setup of ESG at St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (UK), said ESG has several advantages over traditional bariatric surgery, including safety, reversibility and repeatability.

“If patients gain back weight after a few years, they can repeat it. If they don’t like the effect, another endoscopic procedure can be performed to remove the stitches. Such flexibility does not exist with surgery,” he added.

He said another benefit is that ESG can “bridge” high-risk patients for future bariatric surgery, time-critical major surgeries or fertility treatments.

While patient experiences vary, Dr Yong said a vast majority of patients tolerated the procedure well with reports of initial discomfort such as nausea, vomiting and mild abdominal cramp-like pain that typically subsides within days to months. Crucially, most patients undergoing ESG recover without the need for intensive care.

Despite its safety profile, Dr Yong cautioned that ESG, like any procedure, carries risks such as bleeding, infection and excessive weight loss, but all are relatively rare and manageable.

He stressed that patient safety is paramount, and a thorough evaluation is essential to determine if a patient is a suitable candidate for ESG.

He said eligibility criteria include being overweight or obese (BMI ≥ 27.5kg/m2) and having tried lifestyle modifications unsuccessfully with categories of patients including those unwilling to undergo surgery or long-term medication, those with obesity-related medical conditions such as diabetes and sleep apnoea, or those with high surgical risks, or those deemed unfavourable surgical candidates due to recent abdominal surgeries and under advice from their healthcare professional.

An emerging group, he added, consists of patients who have used weight loss medication but seek a more sustainable solution.

He said that in some countries, such as the UK, ESG has been incorporated into clinical services under selected health programmes. Its use in Malaysia is determined by local regulatory guidelines and clinical practice.

Dr Yong stressed that ESG is not a “panacea” or to eliminate hunger, but an adjunct to achieve food portion-control, by providing an earlier sense of fullness to allow patients to take charge of their own eating habits.

“I would like to emphasise that this is not a cosmetic procedure, but the ultimate goal is to prevent obesity related co-morbidities. The end goal is a lasting patient health improvement and satisfaction. They deserve to have choices beyond the extremes of lifestyle changes or surgery,” he said.

-- BERNAMA

(Disclaimer: This is a paid advertorial. BERNAMA assumes no responsibility for the content, accuracy and opinions carried in the article.)