Endoscopic Sleeve Gastroplasty (ESG)

What is Endoscopic Sleeve Gastroplasty?

Endoscopic sleeve gastroplasty (ESG) is one of the newer weight loss procedures available to help patients with obesity. It works by reducing the size of your stomach using an endoscopic device which can suture, removing the need for surgery. The surgery is usually available to people considered significantly overweight, with a BMI of 30+, where diet and exercise have not worked.

Dr Rehan Haidry is a highly experienced endoscopist able to safely perform this procedure. It is a lower risk option for people looking at surgical weight loss surgeries as it is minimally invasive. The aftercare process is more straightforward to but after an ESG, patients still need to be committed to permanent healthy lifestyle changes and endeavour to maintain a healthy diet and exercise.

Benefits of an ESG

An ESG has become much more popular than alternative weight loss procedures due to its minimally invasive nature.

Using an endoscope, the skin does not need to be cut and opened, leaving no external scars. Similarly, the recovery process is quicker, and most patients do not need an overnight stay in hospital.

This makes in attractive and safe alternative to more invasive bariatric surgery.

Why Consider an ESG?

Patients may be considering an ESG to help lose weight and minimise the risk of health problems which become more likely and dangerous when your weight is increased. Being overweight or obese heightens your risk of:

  • Type 2 diabetes
  • Sleep apnoea
  • High bloody pressure
  • Heart disease
  • Gastroesophageal reflux disease

ESG and other weight loss surgeries are usually offered or considered once you have exhausted other methods to lose weight.

Endoscopic sleeve gastrectomy (ESG) – An exciting, safe and effective alternative to surgery for weight loss!

Dr Haidry is one of the first endoscopists in the United Kingdome to offer this new and innovative treatment at the London Clinic. He spent time in Belgium learning to perform the procedure before working with his Bariatric Colleagues to introduce the procedure to University College Hospital which became the first NHS site to offer this exciting procedure to patients. The London Clinic is now the first private unit in London to offer this procedure. Please arrange an appointment to see Dr Haidry at 116 Harley street if you would like to discuss this procedure further to see if you are eligible.


Here he gives an overview of the procedure and the patients it may help.

Why do we need an alternative to surgery for patients who are overweight in the United Kingdom?

There is a growing need for therapy for patients who are overweight and obese, as in the UK, 27% of adults have been diagnosed with obesity, body mass index of 30 kg/m2 or more. Obesity is associated with increased morbidity and mortality. Weight loss reduces obesity-linked co-morbidities with greater weight loss leading to greater health improvement. Lifestyle interventions are the cornerstone of reducing body weight but rarely lead to more than 3% weight loss. Currently, there are limited drugs available that show significant and sustained weight loss. In contrast bariatric surgery, leads to marked sustained weight loss with improvement in health and improved life expectancy

According to NICE guidance bariatric surgery should be considered as a treatment option for people with a body mass index (BMI) of 40 kg/m2 or more or people with a BMI of 35 kg/m2 or more with an obesity-associated co-morbidity. NICE guidance was updated in 2014 stating that people with type 2 diabetes (T2D) of recent onset (within 10 years) with a BMI of 35 kg/m2 or more should have an expedited referral for consideration for bariatric surgery. In addition, people with a BMI between 30 and 34.9 kg/m2 could also be considered. However, access to surgery is extremely limited with less than 1% of eligible people accessing surgery. These patients exist within the bariatric service at present with limited options other than medical therapy which is not often the solution.

What is this new procedure and how does it work?
The endoscopic sleeve gastroplasty (ESG) is a novel technique which has already been widely implemented in the USA, Mainland Europe, Australasia and South America although less frequently in the UK. This procedure allows a reduction of the capacity of the stomach and may also exert effects through reducing the exposure of gastric cells to nutrients thereby affecting hormonal release which in turn controls appetite and satiety. It is carried out in the endoscopy unit with existing endoscopic equipment and deep sedation.

In an Endoscopic Sleeve Gastroplasty, the doctors creates a narrow pouch, or sleeve within your stomach, using an endoscope (a camera which passes from your mouth into your stomach. This reduces the size of your stomach with the aim of helping you to lose weight. ESG uses the Apollo Endosurgery OverStitch Device, which allows the endoscopist to perform plications (stitches) along the greater curvature of the stomach, creating a reduction is the volume of the stomach similar to a sleeve gastrectomy seen in surgery.

The procedure involves an upper endoscopy and a subsequent application of sutures to the greater curve of the stomach to reduce the capacity of the stomach. The procedure aims to reduce the size of your stomach by about 70%. This means food stays in your stomach for longer making you feel more full and for longer.

This will be used in patients with obesity who are either unable to undergo bariatric surgery or who would not be willing to do so. The procedure is carried out in endoscopy under full anesthesia by Dr Haidry and his team. All our patients will need to come through a bariatric Multi disciplinary team and be counselled by dieticians and endocrinologists at the London Clinic to ensure we look after all their needs before and after the procedure.


Here is short animation of the procedure to show who the sutures work in the stomach.

In addition, if you have the procedure you will have special dietary advice given to help you lose weight and reduce risk of problems after the procedure. Below you will find some more detailed information on the potential benefits of the procedure, the procedure itself and the risks and alternatives to the procedure. Please do ask our team if there is anything which is not clear or which you would like more information about.

What are the potential benefits of losing weight for people with obesity?

For people with obesity, losing weight can significantly improve the symptoms of diseases like heart disease, diabetes, high blood pressure and joint and sleep problems. In addition, losing weight can reduce the risk of these diseases happening at a later stage. Having a lower weight can also improve the life expectancy of people with obesity.

People considering these sorts of procedures need to be committed to making permanent changes to their eating habits and lifestyle. The procedure is very much the start of the treatment.

Who is suitable for this procedure?

The decision of the suitability for the procedure has to be made by Dr Haidry and also an experienced team as this may not be suitable for everyone with obesity. At present the ESG is offered to these patients:

  • They have a BMI (body mass index) of 40-45kg/m2 – you can find a calculator for this at: https://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx
  • They have a BMI of 35-45 kg/m2 and a health problem like diabetes or sleep apnoea which would be improved by losing weight
  • They have tried to lose weight through other methods over a prolonged period of time without success
  • They are aged over 18 years old
  • They do not have another medical or psychological condition which makes them unsuitable for the procedure
  • They are able to have a general anaesthetic
  • They do not smoke
  • They are committed to long term follow up and dietary advice
How much weight will I lose with the ESG?

Weight loss after the operation is initially very swift but this will settle down after the first few weeks. It is important not to compare your weight loss with any other patient as it is very individual. There may be some weeks in which your weight loss slows down or stops and this is perfectly normal.

On average, people can lose up to 30% of their excess weight in the first 6 months after having an ESG. Recent data from the USA published in May 2019 show that after 5 years ESG is effective in achieving durable significant total body weight loss of 15%. Maximum weight loss is generally achieved by 24 months after the procedure, after which patients tend to regain a small amount of their lost weight.

Please make an appointment to meet with Dr Haidry If you are interested in ESG.

ESG Procedure

Endoscopic sleeve gastroplasty is carried out under general anaesthetic.

The procedure is carried out using an endoscope fitted with an endoscopic suturing device. The endoscope is inserted through the throat and down into the stomach. The camera attached to the endoscope allows the doctor to operate inside the stomach without the need to cut into the abdomen. Through the endoscope the doctor can place sutures into the stomach, changing its shape into more like a tube, which limits the number of calories your body can consume.

The procedure usually takes around 90 minutes and most patients can go home the same day.

After ESG

Most patients are advised to rest for at least 2-3 days after the procedure but can then return to regular activities such as work. As you cannot it as much you may feel fuller quicker, and this can be difficult to get used to but becomes easier over time. ESG requires patients to be committed to a healthy lifestyle and will not lead to the desired results alone.

Dr Rehan Haidry is an experienced endoscopist, well versed in the ESG procedure. He and his team can work with you to discuss your options and help decide whether this procedure is the best choice for you. Contact his office today to book an appointment.

Get In Touch

For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams on:

Tel: 0203 423 7609  |  Email: rhaidrymedsec@ccf.org