CONVERTING ESG TO VSG

Service Description

A Gastric Sleeve Endoscopic to Laparoscopic Revision involves converting an Endoscopic Sleeve Gastroplasty (ESG) into a Surgical Sleeve Gastrectomy (VSG). This is a growing area in revisional bariatric surgery, particularly as ESG becomes more common and some patients require a stronger or more durable surgical intervention. 🔁 Endoscopic Sleeve to Laparoscopic Sleeve Revision Converting ESG to VSG for Enhanced Restriction and Long-Term Outcomes What is ESG? Endoscopic Sleeve Gastroplasty (ESG) is a non-surgical, incisionless bariatric procedure where sutures are placed endoscopically inside the stomach to reduce its volume. It provides moderate weight loss and is often used in patients with BMI 30–40, or those not ready for surgery. ❌ Why Might ESG Fail or Be Revised? - Weight regain: Sutures stretch over time, reducing restriction - Inadequate weight loss: Especially in patients with higher BMIs - Suture loosening: Natural gastric motility can undo folds - Symptom recurrence: Hunger returns as stomach volume increases - Metabolic needs: Procedure doesn’t improve diabetes as well as surgical sleeve The Revision: ESG ➡️ Laparoscopic Sleeve Gastrectomy (VSG) What’s Involved? - Endoscopic Sleeve Assessment: To evaluate suture condition and anatomy. - Laparoscopic Surgery: ESG sutures are either removed or ignored. - Sleeve Gastrectomy: 70–85% of the stomach is removed, creating a banana-shaped sleeve as in primary VSG. ✅ Benefits of Conversion and Why It’s Valuable - Permanent anatomical change: Stronger, more durable restriction - Improved hormonal/metabolic effect: Greater ghrelin reduction than ESG - Better weight loss: ~60–75% excess weight loss vs. ~20–25% with ESG - Can be revised further: Converts easily to bypass or SADI-S if needed ⚠️ Risks and Considerations - Adhesions: ESG is scarless, but inflammation may exist - Staple line leak: Risk similar to primary VSG - May require advanced technique: Especially if previous ESG sutures are intact or embedded - Must ensure no contraindications from prior ESG 📈 Outcomes (Early Data) - % Excess Weight Loss: 60–75% in 1–2 years - Diabetes Remission: Up to 60% - GERD Risk: ~20% may develop or worsen reflux - Complication Rate: 2–6%, depending on surgeon experience 📌 Summary Converting Endoscopic Sleeve to Surgical Sleeve is a safe and effective revision, especially for patients needing stronger restriction and metabolic improvement after ESG.