What Is Endoscopic Sleeve Gastroplasty?
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight loss procedure that reduces stomach volume by approximately 70% without any external incisions. Using an endoscopic suturing device (typically the Apollo OverStitch system), specialists at centers such as American Hospital Istanbul place a series of full-thickness sutures through the stomach wall from inside the stomach, creating accordion-like folds that permanently reduce the stomach's capacity.
The procedure takes 45-90 minutes under general anesthesia, and most patients are discharged the same day or after one overnight stay. There are no incisions, no staples, and no permanent implants. Weight loss averages 15-20% of total body weight or 50-60% of excess body weight at 2 years, placing it between the gastric balloon and surgical gastric sleeve in effectiveness.
ESG vs Surgical Gastric Sleeve
- ESG: No incisions, same-day discharge, 15-20% TBW loss, lower risk, potentially reversible
- Surgical Sleeve: 4-5 small incisions, 2-3 day hospital stay, 25-35% TBW loss, permanent stomach removal
- ESG complication rate: 1-2% vs Surgical sleeve: 2-4%
- ESG recovery: Return to work in 2-3 days vs Sleeve: 2-3 weeks
- ESG ideal BMI: 30-40 vs Sleeve ideal BMI: 35-60
- ESG can be repeated if additional weight loss is desired
- Surgical sleeve produces greater and more durable long-term weight loss
Cost Comparison by Country
ESG is one of the newest weight loss procedures and is priced between the gastric balloon and surgical sleeve. In the US, costs range from $10,000 to $16,000 and are rarely covered by insurance. Abroad, the same procedure using the same Apollo OverStitch technology costs $2,500-$8,000 at hospitals like Koç University Hospital, representing savings of 50-70%.
Endoscopic Sleeve Gastroplasty Cost Comparison 2025
| Country | Procedure Cost | All-Inclusive Package | Savings vs USA |
|---|---|---|---|
| USA | $10,000 - $16,000 | $11,000 - $18,000 | — |
| Turkey | $3,000 - $5,000 | $4,000 - $6,500 | Up to 65% |
| Mexico | $4,000 - $6,000 | $5,000 - $7,500 | Up to 60% |
| India | $2,500 - $4,500 | $3,000 - $5,500 | Up to 70% |
| Thailand | $5,000 - $8,000 | $6,000 - $9,500 | Up to 50% |
| Czech Republic | $4,000 - $6,500 | $5,000 - $8,000 | Up to 58% |
| Colombia | $3,500 - $5,500 | $4,500 - $7,000 | Up to 63% |
ESG is a newer procedure and may not be available at all bariatric centers. Verify that the clinic has specific ESG experience and the Apollo OverStitch or equivalent endoscopic suturing device.
The Procedure in Detail
During ESG, the endoscopist passes a flexible endoscope through the mouth into the stomach. Using the suturing device attached to the endoscope, 6-12 full-thickness sutures are placed in a specific pattern to create large plicating folds along the greater curvature of the stomach. This transforms the stomach from a rounded pouch into a narrow tube, mimicking the shape of a surgical sleeve without removing any tissue.
Clinical Results & Data
A landmark 2022 study published in The Lancet Gastroenterology & Hepatology followed 209 ESG patients for 5 years and reported mean total body weight loss of 15.9% at 5 years. Excess weight loss averaged 49.2% at 2 years. Comorbidity improvement included diabetes remission in 67% of patients, hypertension improvement in 54%, and dyslipidemia improvement in 51%. The major adverse event rate was 2.2%, with no procedure-related deaths.
Ideal Candidates for ESG
ESG is designed for patients with BMI 30-40 who prefer a non-surgical approach, patients who do not meet BMI criteria for traditional bariatric surgery, patients with medical conditions that make surgery high-risk, and patients who want to avoid the permanence of surgical procedures. It bridges the gap between medical weight management and surgical intervention. Liv Hospital Istanbul offers ESG as part of its comprehensive non-surgical weight loss program.
ESG was the perfect middle ground for me. I did not want surgery but the gastric balloon seemed too temporary. The endoscopic procedure took 60 minutes, I went home the same day, and was back at work on Monday. I have lost 48 pounds in 10 months.
Karen D., Canada — ESG in Prague
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Search ESG ClinicsFrequently Asked Questions
Is ESG as effective as surgical gastric sleeve?
ESG produces about 60-70% of the weight loss achieved by surgical gastric sleeve. Average total body weight loss is 15-20% with ESG versus 25-35% with surgical sleeve. However, ESG has significantly lower risk, faster recovery, and no permanent tissue removal.
Is ESG reversible?
While the sutures are designed to be permanent, they can theoretically be removed endoscopically. However, reversal is not commonly performed. The procedure can also be repeated if additional weight loss is desired.
How long is recovery after ESG?
Most patients return to work within 2-3 days and normal activities within a week. This is significantly faster than surgical gastric sleeve (2-3 weeks off work) because there are no incisions to heal.
Does insurance cover ESG?
Most US insurers do not cover ESG as it is still considered investigational by many. This makes the cost savings of having ESG abroad (50-70% less than US self-pay prices) particularly attractive.
Can ESG be done if I have had other stomach procedures?
ESG can be performed in many patients with prior procedures, but this depends on the specific previous surgery. Patients with prior gastric balloon, previous ESG, or certain other procedures may be candidates. A detailed evaluation is required.
How long should I stay abroad after ESG?
ESG requires only a 3-5 day trip abroad. The procedure itself allows same-day discharge, with 2-3 days of monitoring and recovery before flying home. This is significantly shorter than surgical bariatric tourism trips.