Endoscopic Weight Loss in Greenville, SC
Incisionless ESG, TORe, and sleeve revision — same-day outpatient care
No Incisions
Through the mouth only
Same-Day Discharge
Back to routine in 2–3 days
80+ Procedures/Year
Dedicated endobariatric program
You can lose a meaningful amount of weight without surgery. Endoscopic weight loss procedures reshape the stomach from the inside, working through the mouth. No incisions. No scars. No hospital stay.
Dr. Kalpit Devani is a double board certified interventional gastroenterologist and Director of Endoscopy in Greenville, South Carolina. He has placed more than 1,000 endoscopic sutures and built an endobariatric program that now performs more than 80 procedures a year. Patients come to him from Greenville, Spartanburg, Anderson, and across the Upstate.
Primary
ESG
Endoscopic sleeve gastroplasty for adults who want real weight loss without ever having surgery.
ESG in Greenville →After bypass
TORe
Transoral outlet reduction when weight returns after Roux-en-Y gastric bypass.
TORe overview →After sleeve
Sleeve Revision
Sleeve-in-sleeve endoscopic revision when a gastric sleeve has stretched over time.
ESG across the Upstate →Endoscopic Sleeve Gastroplasty (ESG)
A smaller stomach — without removing any of it
While you are asleep under general anesthesia, Dr. Devani passes a flexible endoscope fitted with a suturing system through your mouth and into the stomach. He places a series of full thickness sutures, usually six to eight suture patterns, that fold the stomach in on itself. The result is a narrow sleeve roughly 70 to 80 percent smaller than the original stomach.
A smaller stomach changes how eating feels. You fill up sooner, and food empties more slowly, so smaller meals satisfy you longer. The procedure takes about an hour. Because there are no incisions, there is nothing to heal on the outside.
13.6%
MERIT trial weight loss at 1 year
~15%
Average across published series
~2%
Serious complications (MERIT)
What the evidence shows
ESG is backed by a large randomized trial. In the MERIT study, published in The Lancet in 2022, patients who had ESG lost an average of 13.6 percent of their total body weight at one year. Patients on diet and lifestyle changes alone lost less than 1 percent. Across the broader published literature, average weight loss is approximately 15 percent, and studies with five years of follow-up show the results hold for most patients.
Results vary from person to person, and the procedure works best inside a real program. Ours includes dietitian visits and scheduled follow-up. If you have heard claims about ESG that sound too good or too alarming, we sorted out the common ESG myths separately.
ESG vs. Gastric Sleeve Surgery
| Factor | ESG | Gastric Sleeve Surgery |
|---|---|---|
| Incisions | None | Yes |
| Tissue removed | None | ~80% of stomach |
| Reversible | Yes — sutures can be revised | No |
| Recovery | Days | Weeks |
| Future options | Surgery and medication remain open | More limited |
Surgery still produces more total weight loss on average. Part of Dr. Devani's job is telling you honestly which side of that line you are on. Read ESG vs. bariatric surgery for a fuller comparison.
TORe: Weight Regain After Gastric Bypass
Weight regain after Roux-en-Y gastric bypass is common, and it is usually anatomy, not willpower. Over the years, the outlet between the stomach pouch and the small intestine stretches. Once that connection widens, food passes through quickly, fullness fades, and the restriction that made the bypass work is gone. We wrote more about why weight comes back after bariatric surgery.
TORe treats the anatomy without another operation. Working through the mouth, Dr. Devani places sutures around the stretched outlet to bring it back toward its original size. When the pouch itself has enlarged, he can tighten that too. The procedure usually takes 30 to 60 minutes, and most patients go home the same day.
TORe also works alongside medication. Some patients combine it with GLP-1 drugs. Others choose it when they stop those drugs and the weight starts to return.
What the data show
A randomized, sham controlled trial showed that suturing the outlet produces significantly more weight loss than a sham procedure.
8–10%
Total body weight loss in year one (published series)
For a 250 pound patient, that is 20 to 25 pounds — without a second operation. Follow-up studies extend out to five years.
Published outcomes
~15%
Total body weight loss at one year (largest multicenter series)
Evidence comes from cohort studies rather than a randomized trial, so it is younger than for primary ESG — but for a sleeve patient facing a second operation, it is a real alternative worth weighing first.
Endoscopic Sleeve Revision After Gastric Sleeve
Sleeve gastrectomy is the most common weight loss operation in the country, and for most people it works. But the sleeve can stretch over the years. When it does, the restriction fades, hunger comes back, and so does the weight. Surgical revision has been reported in more than 1 in 10 sleeve patients.
Endoscopic sleeve revision, also called sleeve-in-sleeve, re-restricts the stretched sleeve through the mouth using the same suturing technique as ESG. No incisions. No conversion to another operation. Same-day discharge. The procedure usually takes under an hour and uses fewer sutures than a first-time ESG.
Three Procedures at a Glance
All three are done through the mouth with no incisions, and most patients go home the same day. The difference is who each one is for.
| ESG | TORe | Sleeve Revision | |
|---|---|---|---|
| Who it is for | BMI 30 to 50, no prior weight loss surgery | Weight regain after gastric bypass | Weight regain after gastric sleeve |
| What it does | Reduces stomach volume with sutures | Tightens the stretched bypass outlet | Re-restricts the stretched sleeve |
| Average weight loss at one year | 13.6 percent in the MERIT trial, approximately 15 percent across published studies | 8 to 10 percent in published series | About 15 percent in the largest multicenter series |
| Strength of evidence | Randomized trial plus five year follow-up | Randomized sham controlled trial plus five year follow-up | Multicenter cohort studies, a newer evidence base |
Not sure which group you fall into? The candidacy section below covers each one.
Are You a Candidate?
The honest answer comes from a consultation — including an upper endoscopy in most cases
ESG
- BMI between 30 and 50
- Diet and exercise without lasting results
- Want to avoid surgery or don't qualify
- Ready for structured follow-up
TORe
- Prior Roux-en-Y gastric bypass
- Regained weight
- Endoscopy shows stretched outlet or pouch
Sleeve Revision
- Prior sleeve gastrectomy
- Regained weight
- Endoscopy shows sleeve dilation
Some patients should not have these procedures — including pregnancy, large hiatal hernia, active stomach ulcers, bleeding disorders, suspected stomach cancer, or untreated eating disorders. Dr. Devani reviews your history and medications before scheduling anything.
What to Expect
Before
Consultation, dietitian visit, insurance review, and post-procedure care and expectation.
Day of
General anesthesia in an outpatient setting. ESG takes about an hour; TORe and sleeve revision are usually shorter. Home the same day with a driver.
First week
Nausea and cramping for 2–3 days, managed with medication. Liquids → soft foods → regular diet over ~6 weeks. Desk work in 2–3 days.
After that
Scheduled dietitian visits and progress tracking with Dr. Devani. Read more in our guide to life after ESG. Life after ESG.
Side Effects and Risks
The common side effects are nausea, cramping, and sometimes vomiting in the first few days. Constipation, heartburn, and bloating can linger for a few weeks. These are expected and manageable.
Serious complications are uncommon, about 2 percent in the MERIT trial, but no procedure is risk free. Dr. Devani goes through the risks that apply to you, in detail, at your consultation.
Frequently Asked Questions
Is ESG surgery?
No. ESG is done entirely through the mouth with an endoscope. There are no incisions, no scars, and nothing is removed. It is a procedure, not an operation, and you go home the same day.
Am I a candidate for ESG?
Most candidates are adults with a BMI between 30 and 50 who have tried diet and exercise without lasting success and either want to avoid surgery or do not qualify for it. Pregnancy, active stomach ulcers, certain bleeding problems, a large hiatal hernia, and untreated eating disorders rule it out. A consultation gives you a definite answer.
How much weight can I lose with ESG?
In the MERIT randomized trial, ESG patients lost an average of 13.6 percent of their total body weight at one year. Published averages across thousands of patients are approximately 15 percent. For a 250 pound person, that is roughly 34 to 38 pounds in the first year. Results vary and depend on following the diet and follow-up plan.
Is ESG permanent?
The sutures are made of permanent material, and over time scar tissue helps hold the new shape. Like every weight loss procedure, including surgery, the sleeve can stretch over years. If it does, it can be retightened with new sutures.
Can ESG be reversed?
Technically, yes. Very few patients ever need it, and reversal carries its own risks, so it is a decision made with your doctor.
What is recovery like after ESG or TORe?
Most patients are back to routine activity, including desk work, in two to three days. Expect nausea and cramping for the first few days, a liquid diet at the start, and a return to regular food over about four weeks.
Does insurance cover ESG or TORe?
Coverage varies by plan and is changing. Some plans cover these procedures and many still do not. Our office checks your benefits before anything is scheduled and walks you through self pay pricing and financing options if needed.
I regained weight after gastric bypass. Do I need another operation?
Usually not. If your outlet or pouch has stretched, TORe can restore the restriction through the mouth in an outpatient procedure, with no incisions and no revision surgery.
I regained weight after gastric sleeve. Can it be fixed without another surgery?
Often, yes. If your sleeve has stretched, it can be re-restricted through the mouth with endoscopic suturing, a procedure called sleeve-in-sleeve. It is done in a single day with no incisions. In the largest published series, patients lost around 15 percent of their body weight in the first year. It is worth considering before a re-sleeve or a conversion to gastric bypass.
What happens if I stop taking a GLP-1 medication like Ozempic or Wegovy?
The weight usually comes back. In one large study, patients regained about two thirds of the weight they had lost within a year of stopping. ESG and TORe change the stomach itself, so the result does not depend on staying on a medication. Some patients combine both approaches.
Do these procedures replace diet and nutrition counseling?
No. The procedure creates the restriction, and the program around it makes the weight loss last. Dietitian visits, a staged diet plan, and scheduled follow-up are part of care here, not an add-on.
Endoscopic Weight Loss for Greenville and the Upstate
Dr. Devani sees patients from Greenville, Spartanburg, Anderson, Greer, Simpsonville, Easley, and across Upstate South Carolina. If you have been going back and forth on bariatric surgery, or you had a bypass years ago and the weight is coming back, a consultation gives you a straight answer about your options.
Request a consultationPhysicians can refer patients directly for endobariatric evaluation through the same page.
See also: What is ESG | ESG vs. bariatric surgery | Life after ESG | Common ESG myths | TORe explained | Weight regain after bariatric surgery