Endoscopic Sleeve Gastroplasty (ESG)

What is ESG?

Endoscopic Sleeve Gastroplasty (ESG) is an advanced endoscopy procedure that changes the stomach from a pouch shape to a sleeve shape. The non-surgical procedure means no incisions on the abdomen, as it’s completed via the mouth with a special endoscopic device called the ApolloSX.

ESG is one of the newer weight loss procedures for obesity and is a lower risk option than bariatric surgery. Aftercare is straight forward, but patients still need to be committed to permanent healthy lifestyle changes, like healthier food choices and regular exercise. ESG reduces the amount of calories a person consumes, as the stomach volume is reduced. Patients report feeling full and satisfied after a small meal, whereas before they would have felt hungry and not satisfied.

Why ESG?

ESG has become much more popular than conventional weight loss surgeries due to its minimally invasive nature. Using an endoscope means 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.

ESG and other weight loss surgeries are usually considered once a patient has exhausted other methods to lose weight. However only a fraction of NHS patients (less than 5%) are eligible for weight loss surgery according to NICE guidelines (as a BMI of >35 and type 2 diabetes diagnosis is needed) and less than 1% of eligible people ever actually access bariatric surgery on the NHS.

European Guidance formally recognised ESG as an appropriate procedure for patients with a BMI of 30+. This is why many obesity patients, particularly those with a BMI less than 35, seek treatment privately.

A recent study (the MERIT study) found the ESG procedure to be five times more effective than lifestyle changes alone. It tracked the obesity outcomes of patients who received a diet, fitness and lifestyle programme alone and those who received the programme and ESG.  Those who had the ESG procedure lost 49% of their body weight on average vs. just 4% in the control group. ESG patients also demonstrated improvements in diabetes, hypertension, non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome compared to controls, as well as improvement in gastroesophageal reflux disease (GORD).

Bariatric surgery or ESG?

ESG takes around 45 minutes – half the time of conventional bariatric surgeries. The ApolloSX is a special ‘stitching’ device that quickly marks out the section of the stomach to be divided and then sutures the walls together in a triangular pattern. A second line of straight sutures runs along after. The stomach stitched away is not cut or removed and the complication rate is low – 1-2% – making it much safer than traditional bariatric surgery. It can be done as a day case, meaning patients can be discharged the same day.

The ESG procedure is currently available at the Cleveland Clinic Hospital in London and is covered by most private insurers. The Cleveland clinic offers ESG alongside a multi-disciplinary support programme (with psychologist, dietitians and surgeons involved in patient’s care). The centre is closely aligned with the Cleveland Clinic in Ohio, one of the biggest centres in the world for obesity procedures, including ESG.


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