13.6 percent
Of total body weight at one year
That is the randomized trial average, roughly half of excess weight. Broader series average 15 to 20 percent, and for a 250-pound patient that is 35 to 50 pounds.
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216-377-7257 [email protected]Lyndhurst
5035 Mayfield Rd, Suite 100Westlake
25200 Center Ridge Rd, Suite 1100Coming soon to Karas Weight Loss and Wellness. ESG is not yet available at the practice. Consultations are open now, and qualified patients will be scheduled first at launch.
For everyone who has looked at bariatric surgery and thought not for me, there is a version with no incisions, no scars, nothing removed, and a return to work measured in days. ESG reshapes the stomach from the inside using a suturing device passed through the mouth. Dr. Linden Karas is bringing it to Karas Weight Loss and Wellness, and consultations are open ahead of the launch.
What It Is
In an ESG, a flexible endoscope carrying a suturing system is passed through the mouth into the stomach under general anesthesia. Working entirely from the inside, the physician places a series of full-thickness stitches that fold the stomach in on itself, gathering it into a narrow tube about 70 percent smaller than it started.
The result mimics the shape of a surgical sleeve, which is where the name comes from, with the defining difference that nothing is removed and the abdomen is never opened. Some patients hear it called the accordion procedure, after the way the folds gather.
The smaller stomach fills quickly, and the altered shape empties more slowly, so fullness arrives sooner and stays longer. The whole thing takes about 60 to 90 minutes and you go home the same day.
Who It Is For
ESG occupies the gap that surgery and dieting leave between them. It fits:
ESG is not the right tool at higher BMIs where surgery has the larger effect, and a large hiatal hernia or certain stomach conditions rule it out. Screening happens at consultation.
The Experience
ESG is done as a same-day case under general anesthesia, 60 to 90 minutes, with discharge a few hours later. There are no incisions to heal, so recovery is about the stomach settling rather than wounds closing.
Expect cramping and nausea for a few days, managed with medication. Most patients return to work within two to three days and hold off on strenuous exercise for four weeks while the folds mature.
The diet ladder is compressed compared with surgery: about two weeks of liquids, then pureed and soft foods, with regular small portions by roughly one month. Long-term rules are the familiar ones, protein first, fluids between meals, and a daily multivitamin, with a lighter supplement burden than surgical patients carry because nothing was bypassed or removed.
Results
The landmark randomized trial ran across US centers with over 200 patients. Broader published series run higher.
13.6 percent
That is the randomized trial average, roughly half of excess weight. Broader series average 15 to 20 percent, and for a 250-pound patient that is 35 to 50 pounds.
80 percent
Diabetes, blood pressure, or sleep apnea improved in eight of ten trial patients within the first year.
At least 10 percent
Follow-up drives outcomes. Patients who stay engaged with their program keep losing, and most maintain at least 10 percent total body weight loss long term.
Two facts belong next to those numbers. Surgical sleeve patients lose more, roughly 25 percent of body weight, so ESG is a smaller tool by design. And the stitches hold the stomach while the program holds the result.
Safety
Safety is ESG’s headline. Across the published literature, serious complications run about 2 percent, against roughly 15 percent for a surgical sleeve when all complications are counted. Hospitalization for pain or nausea after ESG occurs in about 1 percent and significant bleeding in half a percent. No deaths have been reported in the published literature.
New-onset reflux, the surgical sleeve’s known weakness, is nearly absent after ESG, at 0 to 2 percent against 15 to 31 percent for surgery.
The tradeoffs are real too. Stitches can loosen over years, weight regain happens without habit change, and about one patient in ten responds minimally. Unlike a surgical sleeve, ESG burns no bridges: it can be tightened again, converted to a surgical sleeve or bypass later, or reversed in select cases, because nothing was removed.
Compare Your Options
For years ESG lived outside insurance entirely. That started changing in January 2026, when the procedure received a permanent CPT billing code, the first step toward routine coverage, and some plans have begun paying. Most patients still pay cash today, and the practice quotes one all-inclusive number before you commit. Financing with easy monthly payments is available through CareCredit and Cherry, and checking your options does not affect your credit score.
| ESG | Gastric sleeve | Allurion balloon | GLP-1 medication | |
|---|---|---|---|---|
| What happens | Stomach folded smaller with internal stitches through the mouth | About 80 percent of the stomach removed | A swallowed balloon occupies the stomach for four months | Weekly or daily medication |
| Anesthesia | General, same-day discharge | General, same-day for most patients | None | None |
| Recovery | Back to work in two to three days | Two weeks to desk work | A few uncomfortable days | None |
| Typical weight loss | 13 to 20 percent of body weight | 25 to 30 percent of body weight | 10 to 15 percent of body weight | 10 to 15 percent while taking it |
| Reversible | Yes in select cases, nothing removed | No | Yes, it passes on its own | Yes, and weight often returns |
| Availability here | Coming soon | Available now | Available now | Available now |
If you want the gentler option now, the Allurion balloon program is available today, and the gastric sleeve remains the strongest tool for larger goals.
Questions
Soon. Consultations are open now, and patients evaluated before launch are scheduled first. Call 216-377-7257.
There are no incisions and nothing is removed, so it is a procedure rather than an operation. It is done under general anesthesia through the mouth, and you go home the same day with unbroken skin.
The randomized trial averaged 13.6 percent of total body weight at one year, and broader series run 15 to 20 percent. For most patients that means 30 to 50 pounds, with results tracking how closely you work the program afterward.
The surgical sleeve removes 80 percent of the stomach permanently and produces more weight loss. ESG folds the stomach smaller with internal stitches, keeps everything you were born with, and trades some effect for far lower risk and faster recovery.
Most patients work from home the next day or return to the office in two to three days. Cramping and nausea for the first few days are normal. Strenuous exercise waits four weeks.
It can, the same way any stomach can be out-eaten. If loosening happens years later, ESG can be tightened again endoscopically, which is a modest touch-up rather than a repeat of the whole procedure.
Almost never, and this is one of its quiet advantages. New reflux after ESG runs 0 to 2 percent in published data, against 15 to 31 percent after a surgical sleeve.
The door stays open. ESG can be converted to a surgical sleeve or bypass, because nothing was removed. Some patients use ESG as their proof of concept before committing to surgery, and others never need more.
Coverage is beginning. ESG received a permanent CPT billing code in January 2026 and plans are starting to pay, though most patients still self-pay today. The practice checks your benefits and quotes one all-inclusive price either way.
Very possibly, and this is exactly who ESG exists for. The qualifying threshold is a BMI of 30, well below surgical criteria. The consultation settles it.
Financing Available
Financing is available for bariatric surgery, the Allurion balloon, Mag-DI and the medical weight loss program. Apply online in minutes, get a decision fast, and pay in monthly installments instead of all at once. Checking your options does not affect your credit score.
See financing options
Promotional financing on purchases of $200 or more, including no interest if paid in full within the promotional period, plus longer plans with fixed monthly payments on larger amounts. Prequalify online with no effect on your credit score. Accepted at Karas Weight Loss and Wellness.
CareCredit financing details →
Monthly payment plans up to 60 months, with 0% APR for qualifying applicants. Apply in about a minute with a soft credit check that does not affect your score. High approval rates, including for patients who have been turned down for a card before.
Cherry payment plan details →Financing is subject to credit approval. Get your written quote at a consultation and the office will help you set up a monthly payment plan. Read the full financing details.
Next Step
Consultations are open ahead of the launch, and patients evaluated first are scheduled first.
Limited time
One visit with Dr. Karas covers the surgical options and the medical weight loss program with GLP-1 medication management, at the Lyndhurst or Westlake office, at no charge.
Or call 216.377.7257Free consultation
Free for new patients at both the Lyndhurst and Westlake offices.
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