ESG vs Mounjaro
Serving patients across London, Surrey, Essex, Kent, and Hertfordshire.
ESG vs Mounjaro
ESG (endoscopic sleeve gastroplasty) and Mounjaro (tirzepatide) can produce similar amounts of weight loss, but they work in completely different ways. Mounjaro is a weekly injection that reduces appetite for as long as you keep taking it. ESG is a one-off, non-surgical procedure that permanently reduces how much your stomach can hold. Consultant bariatric surgeon Mr Georgios Vasilikostas explains how they compare and when one, the other or both may be right for you.
ESG vs Mounjaro at a Glance
| ESG | Mounjaro (tirzepatide) | |
|---|---|---|
| What it is | Non-surgical endoscopic procedure | Prescription weekly injection |
| How it works | Stitches reduce stomach capacity by around 65–70%, so you feel full sooner | Acts on appetite hormones (GIP and GLP-1) to reduce hunger and slow stomach emptying |
| Treatment | One procedure, 45–90 minutes, usually home the same day | Ongoing weekly injections |
| Typical weight loss | 15–25% of total body weight at 12 months | Around 15–21% of body weight at 72 weeks in clinical trials, depending on dose |
| Downtime | Around 3 days off work | None, though side effects are common when starting or increasing the dose |
| Common side effects | Temporary nausea and discomfort for a few days | Nausea, diarrhoea, constipation, reflux |
| BMI guide | 30+ | Set by prescribing guidance and your clinician |
How Each Treatment Works
Mounjaro
Tirzepatide mimics two gut hormones that tell the brain you are full and slow the rate your stomach empties. Appetite drops, portions shrink and weight falls, usually most quickly in the first year. Because the effect depends on the medication, appetite tends to return when treatment stops.
ESG
Under general anaesthetic, Mr Vasilikostas uses the Apollo OverStitch™ system, passed through the mouth, to stitch the stomach into a narrow sleeve shape. There are no incisions and no tissue is removed. The smaller stomach fills up faster, so you eat less without relying on medication. Learn more about ESG in London.
Which Is Right for You?
| Medication may suit you if you: | ESG may suit you if you: |
|---|---|
| Would prefer to avoid any procedure | Have a BMI of 30 or more |
| Are happy to continue treatment long term | Have plateaued on Mounjaro but still need to lose weight |
| Tolerate the side effects well | Want to stop injections without losing your progress |
| Couldn’t tolerate the side effects of weight-loss injections | |
| Want a one-off treatment rather than ongoing costs | |
| Want to avoid surgery and the removal of stomach tissue |
If you have a higher BMI, see how ESG compares with gastric sleeve surgery.
Can You Combine ESG and Mounjaro?
Yes, in some cases. Mr Vasilikostas uses combination therapies that pair a procedure with medication. Some patients use medication to lose weight before ESG, some move to ESG when medication results plateau, and some use both together for a period. The right plan depends on your BMI, health and goals, and is agreed at your consultation. See our Mounjaro exit plan.
Plateaued on Mounjaro?Talk to a Specialist
Mr Georgios Vasilikostas is a Consultant Upper GI and Bariatric Surgeon with more than 25 years’ experience and over 4,000 weight-loss procedures. He offers the full range of options, from non-surgical ESG and gastric balloons to gastric sleeve and bypass, so your recommendation is based on what is right for you. Book your consultation or call 020 3100 1364.
This page is for general information and does not replace medical advice. Do not change or stop prescribed medication without speaking to your prescriber.
ESG vs Mounjaro FAQs
Is ESG better than Mounjaro?
Neither is better for everyone. Average weight loss can be similar, but ESG is a one-off procedure that keeps working without ongoing treatment, while Mounjaro works only for as long as you take it.
Can I have ESG after Mounjaro?
Yes. Many patients consider ESG after a plateau on Mounjaro, or when they want to stop injections. Mr Vasilikostas will advise on timing and whether to continue or stop medication.
Will I regain weight after ESG like after stopping Mounjaro?
ESG permanently reduces stomach capacity, so it does not wear off in the way medication does when stopped. Long-term results still depend on following the recommended diet and lifestyle changes.
Is ESG more expensive than Mounjaro?
ESG has a higher upfront cost (£9,000–£13,000 in the UK), but it is a one-off. Medication is an ongoing monthly cost, so over several years the total can be comparable or higher. 0% finance is available for ESG.
Is ESG surgery?
No. ESG is performed through the mouth with an endoscope, so there are no incisions or scars. It is carried out under general anaesthetic and most patients go home the same day.
Before and After
We invite you to view our Weight Loss Treatment Before & Afters, here at the GV Weight Loss Clinic in London. Click on an image below to learn more about the patient and the procedure.
Patient Testimonials
“I liked and felt confident with Mr Vasilikostas from the beginning. An expert in his field, he made me feel very comfortable and explained everything in a way I could understand. I felt in safe hands. My surgery was exactly as he had described, as was my recovery. His manner and engagement was very professional with a human touch. I am very pleased I was referred to him to help with my situation.”
“Mr Vasilikostas has been the most professional and down to earth surgeon I have ever met. From beginning to end he has provided me with the best care, and was honest about everything with me.”
“Hands down, probably the best Dr / Surgeon I’ve ever seen. Skilful hands, great attitude and very well experienced. Attention to details and a lot of … a lot of passion into what he does. It’s evident from how everything went with my complicated surgery.”
“Mr Vasilikostas took the time to explain everything in detail about the procedure and ensured that I understood everything. His approach was friendly and professional and I really felt like he cared. He responded really quickly to email communications and was able to reassure me regarding the process. His holistic approach allowed me to undergo the procedure safely despite my other medical conditions. I highly recommend him for anyone who needs kind caring competent Dr.”
