Endoscopic Sleeve Gastroplasty, with a second step that targets the stomach’s hunger hormone.
What Is ESG Max?
ESG Max is an informal name for an advanced, non-surgical weight loss procedure that builds on the well-established Endoscopic Sleeve Gastroplasty (ESG). It adds a second step — Gastric Fundal Mucosal Ablation (GFMA) — which treats the part of the stomach that produces most of the body’s hunger hormone, to further support metabolic health and long-term weight loss.
Understanding the Basics: What Is ESG?
Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive procedure that reduces the size of your stomach with sutures placed from the inside. The result is a narrow, sleeve-shaped stomach that holds less food and empties more slowly, so you feel full sooner and on fewer calories. Unlike surgical sleeve gastrectomy, ESG involves no external cuts and no removal of stomach tissue, and recovery is usually quicker.
What’s New in ESG Max?
The “Max” in ESG Max refers to the addition of Gastric Fundal Mucosal Ablation (GFMA). In this step, the lining of the fundus — the upper part of the stomach, and the main site where ghrelin, the hunger hormone, is produced — is treated with controlled heat using argon plasma coagulation (APC) or a similar endoscopic technique.
By reducing ghrelin levels, GFMA aims to:
- Reduce appetite
- Reduce hunger cravings
- Support long-term fullness and metabolic health
Why the Gastric Fundus Matters
The gastric fundus plays a major role in regulating appetite and fullness through hormone signalling. Ghrelin, produced largely in the fundus, stimulates appetite and increases food intake. By treating this area, ESG Max aims to address not just how much food your stomach can hold, but the biological drive to eat in the first place.
Benefits of ESG Max
- Non-surgical and incision-free
- Addresses the hormonal driver of hunger, not just stomach size
- May improve on the results of ESG alone
- Faster recovery than surgical sleeve gastrectomy
- May improve blood sugar control and other metabolic markers
Is ESG Max Right for You?
ESG Max may suit you if you:
- Have a higher starting BMI and need to lose more than 20% of your total body weight to reach a healthy target
- Want a less invasive alternative to laparoscopic sleeve gastrectomy (LSG)
- Have tried diet and lifestyle changes without sustained success
- Want a procedure that addresses both stomach size and appetite regulation
A consultation with Dr Fazal will confirm whether you’re a candidate and set out a treatment plan for your situation.
The Procedure: What to Expect
ESG Max is performed under general anaesthetic, using an endoscope passed through the mouth — there are no incisions. The procedure takes about 90–120 minutes and involves:
- Ablating the fundal mucosa using APC to reduce ghrelin production
- Placing endoscopic sutures to reduce the size of the stomach
You’ll usually stay one night in hospital for fluids and comfort, and most patients return to normal activities within a few days.
Results So Far
Early studies suggest that ESG Max may result in:
- Greater weight loss than ESG alone
- More appetite suppression
- Better blood sugar control in people with type 2 diabetes
More research is underway, and early outcomes have been encouraging.
Why Choose Gastroscope Clinic for ESG Max?
Gastroscope Clinic has one of the highest Endoscopic Sleeve Gastroplasty caseloads in Queensland, and bariatric endoscopy is the focus of the practice rather than a sideline. Dr Fazal’s approach is precision, careful patient selection, and evidence-based practice.
- High ESG caseload – One of the largest ESG volumes in Queensland.
- Specialised bariatric endoscopy – A practice focused on minimally invasive weight-loss procedures.
- Personalised patient care – Treatment plans matched to your history and goals.
- Modern endoscopy facility – Current-generation endoscopic equipment.
Bariatric endoscopy has been the focus of this practice since it opened, and we hold to careful patient selection, thorough follow-up, and honest discussion of what each option can and can’t do.
Ready to Take the Next Step?
If you’d like to find out whether ESG Max is an option for you, book a consultation with Dr Fazal. You’ll need a referral from your GP.
Request an AppointmentDisclaimer: This article is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider.