If you’ve been researching weight loss solutions but aren’t ready for traditional surgery, you may be leaning towards less invasive options. If so, Endoscopic Sleeve Gastroplasty (ESG) might be the perfect fit for you.

This innovative, non-surgical weight loss procedure is helping patients lose significant weight without incisions, scars, or a lengthy recovery.

Q: What is Endoscopic Sleeve Gastroplasty (ESG)?

ESG is an endoscopic, incisionless weight loss procedure performed by a bariatric surgeon, who sutures the stomach with a specialized device called the ESG using the OverStitch Endoscopic Suturing System [JM1] to make your stomach smaller.

While under anesthesia, our specially trained surgeon, Dr. Shawn Stevenson, passes a suturing device and camera through your mouth. After they reach the inside of your stomach, Dr. Stevenson sews it into a smaller shape. The procedure makes the stomach 70-80% smaller. You eat less food, so your system absorbs fewer calories. Food stays in the stomach longer, and you feel full longer.

Q: How much weight can I lose?

Patients lose an average of 15–20% of their total body weight in 12–18 months, especially when combined with lifestyle changes. Results will vary by person. Patients need to follow a healthy diet and exercise program to lose weight. You may not lose weight if you do not adopt healthy habits. Your doctor’s clinical team, including dietitians, nutritionists, and/or exercise trainers, should help you on your weight loss journey.

Q: Is ESG permanent?

The sutures are made of a durable, permanent material that does not dissolve. However, the sutures can break. In the event the sutures break, you may not feel as full after eating as you did immediately after the procedure. If this happens, another procedure can be done to replace the broken sutures and restore the sleeve.

Q: What can I expect from recovery?

One of the biggest advantages of ESG is the rapid recovery timeline. Most patients are able to go home the same day and resume light activities within 24 to 48 hours. Compared to traditional bariatric surgery, the recovery experience is far more manageable—no hospital stay, no large incisions, and less post-operative pain.

Q: What are the most common side effects?

The most common side effects are gastrointestinal symptoms such as nausea, abdominal pain, vomiting, constipation, burping, or diarrhea. These symptoms typically resolve within 30-60 days. All procedures have risk. Patients should talk with their doctor and understand all risks before having any procedure.

Q: How long before I can eat normally?

Patients start with a liquid diet, gradually progressing to soft then regular foods by week 5. Appetite is usually reduced, helping with portion control.

It is recommended that reintroduction is gradual of regular foods with a focus on high-protein, low-sugar meals. Ongoing support from a nutritionist or care team is crucial during this transition. Patients are also encouraged to engage in regular physical activity and behavior coaching to reinforce long-term success.

Q: Who should not have ESG?

Patients who are unable to have an upper endoscopy, are pregnant, are using certain types of blood-thinning medications or have malignant tissue, large hiatal hernia, potentially bleeding gastric lesions, or eating disorders are not eligible for the procedure.

ESG using the OverStitch Endoscopic Suturing System is for adults with obesity (defined as having a Body Mass Index (BMI) between 30-50) who have not been able to lose weight or maintain weight loss through diet and exercise alone.

Q: Can ESG be used to revise or correct a previous Lap Band procedure?

Yes. ESG can be a safe, effective option for patients who previously had a Lap Band and are experiencing complications or have not achieved desired weight loss results. Since ESG is incisionless and performed through the mouth, it may be an appealing alternative to traditional revision surgery. Dr. Stevenson and his team evaluate each case carefully to determine if ESG is a suitable option for revision.

Q: Do I need supplements?

No, you are typically not required to take nutritional supplements or vitamins following an ESG. Follow your doctor’s instructions on any specialized diet plans during recovery.

However, patients need to follow a healthy diet and exercise program to lose weight. You may not lose weight if you do not adopt healthy habits. Your doctor’s clinical team, including dietitians, nutritionists and/or exercise trainers, should help you on your weight loss journey.

Q: Is ESG covered by insurance?

Some plans may offer coverage. We’ll work with you to verify benefits or explore financing options.

Q: Why Agave Surgical Associates and Dignity Health Medical Group?

Dr. Shawn Stevenson is only one of two surgeons FDA trained and certified by to perform this procedure in Arizona. He is also the only surgeon in the Phoenix area providing a single point of care without the need for additional gastroenterology specialists.  He offers advanced ESG techniques backed by years of accredited bariatric surgery experience, and certification from various gastrointestinal societies. Dr. Stevenson’s ESG training is inclusive of all steps of the procedure including clinical evidence, patient selection, prophylaxis techniques, follow-up care, and adverse event prevention, mitigation, and management.

Additionally, our weight loss team offers personalized nutritional guidance, ongoing behavioral and emotional support, and deeply cares about your success.