Endoscopic Sleeve Gastroplasty (ESG)

An endoscope is a thin flexible tube with a camera on the end. It goes in through the mouth and down into the stomach. Nothing cuts through the skin.

Working through that scope, I place a line of sutures, which are stitches, along the inside wall of the stomach. Drawing those stitches together folds the stomach in on itself. The stomach becomes a narrower tube and holds less. It also empties more slowly, which changes the signals your gut sends about fullness.

No part of the stomach is removed. Nothing is implanted. There is no device to adjust, refill, or replace later.

Few physicians in Colorado perform ESG. That is the main reason people travel to see me for it.

People who want treatment for their metabolic health but do not want a surgical operation.

People who are not candidates for surgery, for reasons that come out during a medical evaluation.

People who have tried medication and structured lifestyle change and are still fighting their own physiology. That is not a personal failure. It is biology, and it responds to treatment.

ESG is not right for everyone. Some anatomy and some prior procedures rule it out. That is what the evaluation is for. [CLINICAL REVIEW: which prior stomach procedures does Dr. Good consider exclusions for ESG?]

Before. We start with a conversation and a full medical evaluation. I want to understand your history, your symptoms, and what you have already tried. If ESG is not the right tool for you, I will tell you that and explain what is.

The day of. The procedure is done under anesthesia, so you are asleep and feel nothing. You go home the same day. You will need someone to drive you.

After. You move through a staged diet, starting with liquids and working back toward regular food. We follow you closely, and that follow-up is part of the treatment, not an afterthought. [CLINICAL REVIEW: confirm Dr. Good's post-ESG diet stages and follow-up schedule.]