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Endoscopic gastric stapling, known medically as endoscopic sleeve gastroplasty, is a weight-loss procedure performed through the mouth with an endoscope carrying a suturing system. The stomach wall is folded inwards and held with full-thickness stitches, so the cavity narrows into a tube-like shape closer to the result of a surgical sleeve. Its distinguishing feature is that there are **no abdominal incisions and no part of the stomach is removed**. It is usually offered to people with class one or class two obesity in whom structured diet and activity programmes have not worked, or to those who do not want surgery or cannot tolerate it for medical reasons. Average weight loss is expected to be less than after a surgical sleeve, but complications are generally fewer, recovery is faster, and conversion to a surgical option later remains possible if needed. What it does not do: it is **not a full substitute for sleeve gastrectomy or gastric bypass** in people with a very high body mass index or with type 2 diabetes that needs a stronger metabolic effect. It does not remove loose skin and does not target localised fat. It does not treat binge or emotional eating without behavioural and dietetic support. And it does not correct severe reflux or a large hiatal hernia — indeed these may rule the procedure out altogether. **The stitches can also loosen or partly give way over time**, so the cavity widens and weight returns in anyone who has not changed their habits. Candidacy is decided by multidisciplinary assessment with diagnostic endoscopy: a bariatric surgeon or a gastroenterologist trained in advanced endoscopy, together with a dietitian, psychological evaluation and blood tests. Clinical assessment is what separates a suitable candidate from an unsuitable one, and commitment to nutritional follow-up afterwards is what protects the result long term.
Body mass index is calculated, coexisting diseases, medicines and eating habits are reviewed, and an upper endoscopy excludes an active ulcer, a large hiatal hernia or severe inflammation. Surgical and medical alternatives are explained honestly, along with the expected differences in outcome.
The procedure is performed under general anaesthesia with a secured airway, since it takes time and needs stability. An endoscope carrying the suturing system is passed through the mouth into the stomach, the view is cleared and the shape of the cavity is assessed before suturing begins.
The wall is suctioned into the device head and full-thickness sutures are then placed in successive rows that draw the wall inwards. This is repeated along the greater curvature until the cavity folds in and the volume available for food is reduced.
The stomach is re-examined endoscopically to confirm that the fold is even, the stitches are secure and there is no bleeding or mucosal tear, and the remaining channel is checked to be wide enough for food to pass without obstruction.
The patient is woken and observed and goes home the same day or after one night. A staged diet supervised by a dietitian begins, with prescribed stomach-protective medicines and anti-nausea drugs, plus regular follow-up over the coming months.
Tell the team about all your medicines and supplements, especially blood thinners, anticoagulants, diabetes drugs and heartburn medicines, and never stop or change a dose yourself — your doctor manages diabetes treatment around fasting. Mention drug allergies, previous stomach or abdominal surgery, and any experience with anaesthesia. Complete the endoscopy, blood tests and the nutritional and psychological assessments and bring the reports. Follow any prescribed preparatory diet, and follow the anaesthetist's fasting instructions precisely, because food left in the stomach cancels the procedure and raises the risk of aspiration. Stop smoking. Arrange a driver, plan two to five days off, and book your first dietetic follow-up before the procedure.
Expect cramps, nausea, a full feeling and spasms during the first 24 to 72 hours; these are usually controlled with the prescribed medicines. Follow the staged diet: clear fluids, full fluids, puree, soft food and then solids over several weeks under dietetic supervision. Sip fluids in small frequent amounts to avoid dehydration, avoid fizzy drinks, straws and large pieces of food, chew thoroughly and stop at the first sense of fullness. Take the prescribed stomach-protective medicines and vitamins, walk early and increase activity gradually, and avoid strenuous effort for one to two weeks. **Seek care immediately for: severe or increasing abdominal pain, fever, rapid heartbeat, breathlessness or chest pain, persistent vomiting or inability to drink fluids, or vomiting blood or black stools.**
Usually 45 to 90 minutes, with discharge the same day or after one night of observation.
الدكتور داوود محمود داوود — استشاري جراحة السمنة والمناظير والجراحة العامة في الأردن، وحاصل على البورد الأردني في الجراحة العامة، وعضو في جمعية الجرّاحين الأردن…
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