If you are considering undergoing bariatric surgery or having a non-surgical weight loss procedure such as Suture Sculpt endoscopic sleeve gastroplasty (ESG) it is important to evaluate both the pre-procedure and post-procedure dietary requirements.

Both bariatric surgery and endoscopic sleeve gastroplasty have diets that must be followed before the procedure and after. Keep in mind that both procedures significantly reduce your stomach capacity and your stomach will need time to heal.

The pre-bariatric surgery diet and the post-bariatric surgery diet are more restrictive and each phase lasts longer than the diets associated with Suture Sculpt ESG. Today we are going to talk about some of the differences in the dietary requirements associated with each weight loss procedure.

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What Is The Difference Between Bariatric Surgery vs ESG?

To understand why the dietary restrictions are different for bariatric surgery and endoscopic sleeve gastroplasty, let’s briefly review each procedure.

Bariatric Surgery

Bariatric surgery is a term used to describe surgical procedures that promote weight loss by reducing a patient's stomach size and/or altering their digestive system. Bariatric surgical procedures include a gastric sleeve, gastric bypass, gastric lap band, and duodenal switch surgeries.

Most bariatric surgeries begin with a surgeon cutting and removing approximately 75% of the patient's stomach (gastric sleeve) and stapling the remaining edges together. Some also re-route the intestines to shorten the length of digestion time restricting the number of calories that can be absorbed by the body (gastric bypass and duodenal switch).

Endoscopic Sleeve Gastroplasty (ESG)

ESG is a non-surgical procedure that reduces the size of the stomach by re-shaping it and suturing the new smaller shape in place. No portion of the stomach is excised or removed. There are no alterations made to the patient’s digestive system.

The “Nothing After Midnight” Rule

Regardless of what type of surgery or procedure a patient is about to undergo if it requires the use of general anesthesia the “after-midnight” rule applies. Patients will be instructed to not eat or drink ANYTHING after midnight the day immediately before the procedure.

This rule is very important and is in place for the safety of the patient to reduce the risk of pneumonia and possible death due to aspiration during the procedure.

Pre-Procedure Diet Bariatric Surgery vs ESG

Each surgeon will provide their patients with at least two diets they will need to follow before and after having their weight loss procedure. The specific diets and durations will vary by patient and by procedure but may include a pre-procedure liver shrinking diet, a pre-procedure liquid diet, and a post-procedure liquid diet that gradually transitions to solid food.

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Bariatric Surgery Diets

The Liver-Shrinking Diet

The liver is positioned directly over the stomach and many patients that are undergoing bariatric surgery have enlarged livers. The surgeon can have a difficult time safely working around a liver that is enlarged. The liver shrinking diet is designed to make the size of the liver more manageable and ensure a successful surgical outcome.

It is important to understand if the surgery begins and the liver is enlarged and will inhibit the surgeon’s ability to proceed, your surgery may be canceled. You will already be opened up and require recovery but your procedure will not be completed.

Pre-Surgery Diet

The diet that is required prior to bariatric surgery for each patient will vary due to factors such as their body mass index (BMI), current health conditions, age, etc.

Sometimes, patients are given a strict diet to follow before bariatric surgery to reduce their current BMI. Studies have shown that the higher the patient’s BMI the more risk of developing complications. Also, a recent study outlined the increased difficulty surgeons encounter when performing bariatric surgery on severely obese individuals due to abdominal wall thickness. Pre-operative diets are intended to reduce the risk of complications during and after bariatric surgery.

What Does A Pre-operative Bariatric Surgery Diet Look Like?

Patients may begin their pre-op diet for up to three months before undergoing bariatric surgery depending on their BMI and circumstances. Next, they will switch to an all-liquid diet a week or two before surgery.

A sample schedule for one day during the liver-shrinking diet may look like this:

<table class="iksweb"><caption>Sample of One Day Menu – Liver Shrinking Diet</caption><tbody><tr><th>Meal</th><th>Approved Food Selection or Protein Shake</th></tr><tr><td>Breakfast</td><td>One protein shake (see guidelines below)</td></tr><tr><td>Snack</td><td>1 serving of fruit (1 cup of berries or melon or 1/2 cup of other types of fruit)</td></tr><tr><td>Lunch</td><td>One protein shake</td></tr><tr><td>Snack</td><td>Light Greek yogurt (1 cup)</td></tr><tr><td>Dinner</td><td>3‐6 ounces lean protein (see examples below) 1 cup of approved vegetables (non‐starchy) OR 2 cups salad with 2T light dressing</td></tr><tr><td>Snack (optional)</td><td>One protein shake</td></tr></tbody></table>

During each day 64 ounces of liquid should be consumed but not with meals. It is best to drink them at least 30 minutes before or after a meal. Approved liquids include water and other sugar-free, non-carbonated, non-caffeinated liquids.

Sample sources of lean protein include:

• Fish;
• Shellfish;
• Skinless turkey or chicken;
• 90%+ lean beef loin, or round;
• 90+ ground beef or ground turkey;
• Pork loin;
• Tofu.

All the above proteins should be baked, broiled, or grilled. Nothing fried or breaded. Follow the portion guidelines given to you by Guidelines for your surgeon.

Protein shake guidelines

• < 200 calories;
• < 5 gm of sugar;
• < 15 gm carbohydrates.

The All-liquid Pre-Op Diet Before Weight Loss Procedures

The duration of the all-liquid diet will vary by patient and the type of bariatric procedure; however, the bariatric liquid diet before surgery is substantially longer than for ESG patients.

An all-liquid diet consists of:

• Protein shakes for a meal;
• Water-based fluids that are non-carbonated and contain zero caffeine and zero calories such as water, flavored water, and sugar-free beverages;
• 8 oz of either decaf coffee or tea per day;
• 8 oz of sugar-free gelatin per day;
• 1 or 2 sugar-free popsicles per day <20 each per day;
• 1 sugar-free beverage with electrolytes such as propel or Powerade zero per day.

Comparison Chart: Bariatric Surgery vs ESG Pre-Op Diet Duration

<table class="iksweb"><caption>Comparison Chart: Bariatric Surgery vs ESG Pre-Op Diet Duration</caption><tbody><tr><th>Procedure</th><th>Duration of Pre-Op Liver Shrinking Diet</th><th>Duration of All Liquid Diet Before Procedure</th></tr><tr><td>Bariatric Surgery</td><td>Up to 6 weeks depending on BMI</td><td>2 weeks</td></tr><tr><td>Suture Sculpt ESG</td><td>Typically not required</td><td>2 days</td></tr></tbody></table>

Post-Procedure Diet Bariatric Surgery vs ESG

Patients that have had a portion of the stomach removed or their digestive system altered require more time to recover than those who undergo endoscopic sleeve gastroplasty. While both groups of patients will begin with clear liquids and gradually work up to solid food, it will take surgery patients much longer before they reach the solid food stage.

The chart below compares the bariatric surgery vs Suture Sculpt ESG timeline for a patient to return to solid foods.

Chart: Timeline For Returning To Solid Foods Bariatric Surgery vs ESG

<table class="iksweb"><caption>Chart: Timeline For Returning To Solid Foods Bariatric Surgery vs ESG</caption><tbody><tr><th></th><th>Bariatric Surgery</th><th>ESG</th></tr><tr><td>Clear Liquids</td><td>First 2 weeks after surgery</td><td>First 7 days after ESG</td></tr><tr><td>Pureed Foods</td><td>3d and 4th week after surgery</td><td rowspan="2">8-30 days after ESG patients can begin to eat both pureed and soft foods</td></tr><tr><td>Soft Foods</td><td>2 months after completing pureed foods</td></tr><tr><td>Solids and Stabilization</td><td>Starts month 4 after surgery and is long-term</td><td>31 days and long-term</td></tr></tbody></table>

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ESG Post-Procedure Approved Foods

First 7 Days After the Procedure - Clear Liquids

• 100% grape, apple, or cranberry juice;
• Clear beef, vegetable, or chicken broth;
• Sugar-free popsicles or gelatin;
• Sugar-free Crystal Light or similar;
• Decaf Coffee or tea.

Days 7-30 – Full liquid/Puree

• Protein shakes (following guidelines);
• Lite Greek yogurt;
• Skim milk or unsweetened almond milk or soy milk);
• Tomato juice or V8;
• Scrambled eggs;
• Sugar-free pudding;
• Cream Soups with no chunks (you can strain cream of chicken, mushroom, or broccoli).

Beginning at day 31 and going forward, endoscopic sleeve gastroplasty patients may begin eating solid foods according to the guidelines provided by their bariatric doctor.

Suture Sculpt ESG patients may begin exercising as soon as they feel able - typically after about a week.

The pre-bariatric surgery diet requirements are much more involved than what the patients undergoing ESG must follow and ESG patients also return to eating solid foods much faster than patients who must follow the post-bariatric surgery diet.

Both ESG and Bariatric Surgery Require Lifetime Changes

While the techniques and requirements may be different for bariatric surgery and Suture Sculpt ESG the goal is the same. Both procedures help patients lose weight and keep it off by restricting the amount of food they can eat at one time and possibly inhibiting calorie absorption.

Patients who undergo any type of restrictive weight loss procedure can not normally eat enough to fulfill their daily nutritional requirements. Patients will need to take supplemental vitamins after bariatric surgery for the rest of their lives.

If you need help losing weight and keeping it off, Batash Endoscopic Weight Loss Center is here to support you during your entire journey. From choosing the procedure that is best for you to nutritional guidance, a highly qualified team of professionals can help you achieve your weight loss goals. Contact us today to set up a consultation to learn more.

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