Albertans living with obesity who want to lose weight and keep it off long-term now have a new semi-surgical option that is minimally invasive and publicly funded.
The procedure, called an endoscopic sleeve gastroplasty (ESG), involves a patient’s stomach being stitched into a smaller size — but it’s all done from the inside of the body, via a person’s throat.
The Royal Alexandra Hospital in Edmonton is the first in Alberta to offer ESG.
During the approximately 90-minute process, the patient is put under general anaesthesia while the surgical team inserts a thin, flexible tube with a camera down the mouth to reach the stomach.
The doctors then use tools through the endoscope to stitch the stomach, from the inside, into a smaller organ to reduce its size. They don’t cut away or remove the tissue, as is done in some other bariatric weight-loss procedures.
“The technology is actually quite impressive, allowing us to do this fairly minimally invasive approach,” said Royal Alex gastroenterologist Dr. Kirles Bishay.
The result: a smaller stomach that gets full faster, resulting in less food being consumed overall — putting a patient in a calorie deficit that leads to weight loss.
“This is a technology that’s a true game-changer,” said bariatric surgeon Dr. Noah Switzer, who said his field has evolved drastically from the early days of “stomach stapling.”
While ESG is intended to be permanent, Switzer said because no part of the organ is removed, it can be reversed completely.
“This is the future of bariatric surgery,” he said, adding with other procedures patients often have to take Tylenol 3 or other strong painkillers afterwards, but not with ESG.
“Patients have no pain because it’s all on the inside. So they can come in the morning and leave the same day with no incisions.”
Bishay and Switzer brought their different but complementary skill sets to help patients at the Adult Bariatric Specialty Surgery Clinic.
The endoscopic procedure is jointly performed by the surgeon and gastroenterologist though the Royal Alex clinic, which is the only facility in Alberta where it’s available.
Their first procedure was done Dec. 5, 2025, and more than 10 patients have received the treatment in Edmonton.
The procedure can be done alongside taking GLP-1 weight loss medications like semaglutide (Ozempic and Wegovy) or tirzepatide (Mounjaro and Zepbound).
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In a nutshell, those drugs slow down stomach emptying and the rate at which food moves through the intestines — meaning it takes more time to be digested and absorbed, leading to longer satiety and more stable blood sugar levels.
But it comes at a cost: depending on the dosage, weight loss medications can run a patient nearly $500 a month and are not covered by many private insurance plans. The cost is currently coming down as Health Canada approves generic semaglutide.
ESG offers a more permanent, one-time solution compared to the drugs alone, which when stopped often result in weight regain and thus are considered a lifelong medication for those with obesity.
“It’s a lot less invasive. It’s quite a bit easier to get it over,” said Mary-Ann Thurber, who had ESG done at the beginning of February and is now nearly 100 lbs. lower than her highest weight.
Thurber, 65, has struggled with obesity since she was a teenager: “50 years of losing and gaining, you know, the usual pattern that people go through.”
Thurber found short-term success with Wegovy, diet changes and exercise — which led to her dropping 80 pounds.
Losing weight is one battle — but keeping it off long-term is another challenge entirely.
“There’s really good anti-obesity medication out there, patients are losing a lot of weight through these medications,” Switzer said. “But they’re like, ‘Well, I don’t want to stay on this medication forever or long-term, or I can’t afford it, or I don’t like the side effects associated with it.’”
“So this is the other option where complication rate is very small, the benefits are really large.”
As a patient of the Edmonton Adult Bariatric Specialty Surgery Clinic, Thurber was offered the new procedure as an alternative, long-term treatment option.
“This was not so much about losing a lot more weight — although I hoped I would — but it was about giving me another tool to kind of maintain my weight,” Thurber said.
Thurber is proud of her weight loss success and glad she said yes to ESG.
“I was feeling good before with the 80 pounds but somehow this kind of made it even better,” she said, adding she was uncomfortable going through with the more traditional routes like gastric bypass surgery.
“I’ve lost another 12 pounds with a procedure and I feel really good.”
Gastric bypass or other procedures requiring surgery often have a four to six week recovery time but Thurber said she bounced back in half that time — she even asked her doctor to clear her to return to work early, after three weeks.
“The first week or two was not rough at all, it was quite easy. You’re having liquid diets and soft food diets, so there is a recovery time and you sleep a lot but yeah, it was fine,” Thurber said.
She has adjusted to having smaller portions and eating slower, saying if she overeats she’ll feel sick.
“When you look around at people who are… ‘regular sized’… I would say, that’s what they do. So now that’s why I’m doing it,” Thurber said.
The procedure hasn’t just benefited her physically — it’s also helped Thurber with her confidence and mental health.
Like many overweight people, she lived in shame and was self-conscious for many years — but not anymore.
“I feel better being out amongst people, which is this odd thing to say, but when you’re very heavy — you always think people are looking at you.
“Now I just don’t even worry about that.”
Seeking medical interventions for weight loss is becoming more common in society — Switzer said he’s seen a big increase in the past five to 10 years and encourages patients to pair surgery and medications like WeGovy or Mounjaro.
At the same time, the stigma of using GLP-1s is slowly fading as more evidence of their effectiveness comes to light.
Thurber encourages other people living with chronic obesity to look into such options to improve their long-term health and challenges those who judge to think twice.
“People shouldn’t be shamed for taking GLP-1s or for having procedures or surgeries like this.
“It’s a major battle to try and keep weight off, so anything that can help with that is huge.”
The Royal Alex is now home to the largest ESG program in Western Canada.
A referral to the Edmonton Adult Bariatric Specialty Surgery Clinic at the Royal Alex by a physician, nurse practitioner, or specialist is required for adults who struggle with obesity and meet clinic criteria.
In preparing for bariatric surgery, AHS says medical and psychological interventions are provided to patients to ensure they are successful pre- and post-surgery.
—with files from Daniela Germano, The Canadian Press