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Endoscopic Sleeve Gastroplasty (ESG)

Endoscopic Sleeve Gastroplasty (ESG)

Gastric Sleeve Plication Surgery
Endoscopic Sleeve Gastroplasty (ESG), also called the Endo Sleeve, is a newly emerged weight loss procedure that shrinks the stomach’s size endoscopically with a suturing device without the need for surgery. ESG limits the amount of food you can eat, leading to significant weight loss. Patients undergoing Endoscopic Sleeve Gastroplasty have a lower risk for complications and faster recovery than traditional weight loss procedures. Like other bariatric methods, ESG requires a commitment to lifestyle changes, healthier eating habits, and exercise.

How Does ESG Work?

Being a non-surgical option, ESG mimics gastric restriction by reducing the dimensions of the stomach internally. An endoscopic suturing probe, the Overstitch, creates a smaller stomach. The overstitch instrument creases the stomach with a triangular stitching pattern producing a banana-shaped tube. The stitching and folding method are similar to gastric plication surgery.

First, markings are made along the greater curve of the stomach, including the anterior and posterior wall, using the argon plasma coagulator to guide the placements of the Prolene sutures. About 12 running sutures, typically in a triangular pattern, connect the front and back of the stomach. The final step is to tighten the sutures, pulling the two walls together to create the new sleeved stomach.

  • Endoscopic Sleeve Gastroplasty reduces the stomach size by about 70%
  • Due to the endoscopic techniques used, patients recover much faster with fewer complications
  • This procedure doesn’t require the use of laparoscopic devices or any removal of stomach tissue

What are the Advantages of ESG?

Since this is an incision-less procedure, visible scarring is eliminated and recovery time is faster. No cutting or severing of tissue is required, leading to fewer infection risks. Patients with lower BMIs can qualify for ESG.

What are the Disadvantages of ESG?

Non-surgical procedures are appealing, but they can lack long-term results for a higher expense. Lower excess weight loss is also expected compared to the gastric sleeve since no hunger hormones, known as Gherlin, are removed from the stomach. There is also the potential risk of developing ulcers or partial opening of the stomach pouch, causing the weight to regain.


Some potential risk associated with ESG can include:

  • Blood clots
  • Leaks
  • Bleeding
  • Stomach trauma

Cost of Sleeve ESG Surgery

The average cost of Endoscopic Sleeve Gastroplasty varies depending on the choice of hospital, surgeon, and location. The cost of ESG can range from $6,000 to $23,000. When people choose to have this surgery abroad they can save themselves thousands (Mexico Bariatric Surgery costs about 1/5 to 1/3 the cost of the United States).

Country Price
Mexico $6,000 – $9,000
United States $15,000 – $20,000
Canada $18,000 – $23,000
Australia $15,500 – $18,000
India $10,500 – $13,000
Thailand $12,500 – $14,000
Costa Rica $10,500 – $13,000


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