ESG Post-op Instructions

Endoscopic Sleeve Gastroplasty (ESG) Pre-op and Post-op Instructions

The Endoscopic Sleeve Gastroplasty is ideal for patients who are moderately overweight and want to begin with a less invasive weight loss procedure. Patients who are ready to start a healthy, new lifestyle that incorporates regular exercise and dietary modifications will benefit greatly from a managed weight loss program.  Studies performed to date have demonstrated excellent weight loss results, however this requires a commitment to dietary modification and exercise.  Furthermore, it has been shown that adherence to follow up with the dietician and adherence to the dietary recommendations improve success.

The weight loss results with this procedure are superior to the results obtained with diet and exercise alone, or those achieved with appetite suppressant medications alone.Sustained weight loss is achievable with the assistance of our support team, and we are committed to your long-term weight loss success!

Please watch this video to better understand the ESG procedure

The Federal Drug Administration (FDA) has approved the Apollo Overstitch device for tissue apposition in the United States.

Qualifications for the Endoscopic Sleeve Gastroplasty procedure:

The Intragastric Balloon Procedure is ideally suited for patients who:

  • Have a BMI >/= 30 (the best results are seen with patients having a BMI 30-40)
  • Have been unable to achieve their weight loss goals through diet and exercise.
  • Are uncomfortable with, or ineligible for, other types of weight loss surgery.
  • Are willing to participate in a medically supervised diet and behavior modification program.
  • Are considered to be at least 25 pounds overweight.

Conditions that would prevent a patient from having the procedure include:

  • Previous gastric surgery
  • Any inflammatory disease of the gastrointestinal tract
  • Potential upper gastrointestinal bleeding or other congenital anomalies
  • Large hiatal hernia or structural abnormality in the larynx or esophagus
  • Any condition that would hinder endoscopy
  • Unwillingness to participate in the supervised diet and behavior modification program
  • Drug or alcohol addiction
  • Pregnancy or breastfeeding
  • Past or present psychological disorders (untreated or non-compliant with therapy)
  • Regular use of blood thinners

Initial Visit for Endoscopic Sleeve Gastroplasty

Becoming a candidate for an intragastric balloon will be based on several factors:

  1. Your medical history
  2. Your weight loss goals
  3. Previous methods attempted to lose weight
  4. Your commitment to our team’s managed weight loss program
  5. Your comfort level with the endoscopic sleeve procedure
  6. Depending on your personal medical history, additional recommendations may be made, such as clearance for general anesthesia by your primary care provider, labs, EKG, etc…
  7. Completion of a psychological assessment

Prior to Your Procedure

You will be started on a clear liquid diet 2 days before the procedure. You should avoid food and liquid for 12 hours, as you will be under a general antesthetic during the procedure.  Typically this will mean nothing to eat or drink after midnight (except AM medications approved by your surgeon).

The Day of Your Endoscopic Sleeve Gastroplasty

Your procedure will be at JourneyLite of Cincinnati, 10475 Reading Road, Cincinnati OH 45241.  If you have any questions for the center, they can be reached at 513-259-2488.  Maps/directions can be found at JourneyLite.com.  Please visit the JourneyLite website as soon as possible and pre-register with the link in the upper right corner of the home page.

The procedure is generally uncomplicated and lasts 1-2 hours. You will regain awareness quickly and be monitored until your doctor discharges you, typically the following morning.  You will be given detailed instructions on your aftercare.  Someone will need to be available to drive you home.  You cannot take an Uber!

After Your Endoscopic Sleeve Gastroplasty

We will start you on a clear liquid diet and monitor you for tolerance. The staff will get you up and walking the day of the procedure, this is IMPORTANT. You may have some discomfort for 1-2 days and we will use medication to help.  You may also experience some nausea/vomiting or a sensation of spasms/cramps behind your breastbone. Again, medications will be used to help with these symptoms.

As nausea and vomiting is common  in the first week after ESG,  you will be provided the following medications:

  • Zofran (ondansetron):  
    • Dissolve one to two tablets under the tongue every 8 hours for nausea for 7 days.
  • Levsin (hyoscamine):
    • Dissolve one to two tablets under tongue every 4 hours as needed for spasm or cramping.

If vomiting persists despite the use of these medications, please contact us for further instructions.

Endoscopic Sleeve Gastroplasty Post-op Diet

  • Days 1-7 – clear liquids
    • 100% fruit juice (apple, grape, cranberry)
    • Clear broth (chicken, beef, and vegetarian)
    • Sugar free popsicles
    • Sugar free gelatin
    • Water and/or ice chips
    • Crystal Light or Sugar Free Kool-Aid
    • Decaf Teas and Coffee
    • Fast Track Supplements (Dr. Curry’s products–fruit drinks, gelatin, protein bouillon, and hot beverages)
      • Avoid the following items days 1-7
        • Carbonated beverages
        • Sugary drinks (sweet teas)
        • Citrus juices (orange, grapefruit, pineapple) and tomato juices
        • Juice drinks (Hawaiian punch)
  • Days 7-30 – Full liquid/Puree
    • Protein Shakes (Premier shakes, Atkins, Low Carb Slim Fast
    • Yogurt (carbmaster, Fit and Lite Greek High Protein)
    • Milk (skim, 1%, skim milk, almond milk, soy milk) (all unsweetened)
    • V-8 juice, tomato juice
    • Scrambled eggs
    • Sugar free pudding
    • Cream Soup (strained) (cream of chicken, cream of mushroom, cream of broccoli)
    • Fast Track Supplements (protein shakes and pudding, oatmeal, mash potatoes, scrambled eggs, tomato soup)
      • Avoid the following items days 7-30
        • Foods with chunks or large pieces
        • Sugar desserts (ice cream, regular pudding, cream pies)
        • Carbonated beverages
  • Some Helpful Tips:
    • Plan 3 meals and 2 snacks.
    • Watch your posture during meals and while drinking fluids.  Sit tall and do not slouch.  This will help with tolerance.
    • Stop eating when you feel full (The sensation of a Hiccup means you are full and should stop).  One additional bite may be too much.
    • Do not drink 30 minutes before a meal and wait 30 minutes after to drink.
    • No eating 3 hours prior to bed.
    • Use your anti-nausea medications as prescribed by the physician.

As soon as you feel well enough (usually about 1 week), you may start an exercise program without restrictions.  We recommend getting an activity tracker, such as a FitBit, and aiming for 10,000 steps per day.  If you do this your weight loss will be greatly enhanced!

You will meet regularly with your support team to receive nutritional training and to monitor your progress. This will be an important part of your successful lifestyle change. For patients following the program, our goal weight loss during the first 6 months is 25-50 pounds.  Higher-BMI patients will typically be on the high end of this range, and lower-BMI patients on the lower end.  Please note that weight loss is not a guarantee with this procedure; there are some patients who do not follow the program and do not lose weight at all.  Follow Up visits will be scheduled at 1 week, 1 month, 3 months, then every 3 months for one year, every 6 months for the second year, then annually.  You are welcome to come in at any time if you are struggling with weight or are concerned that there is an issue.