ESG vs Gastric Sleeve

ESG vs Gastric Sleeve

Endoscopic sleeve gastroplasty (ESG) and gastric sleeve surgery both make the stomach smaller so you feel full sooner, but they are very different procedures. ESG reshapes the stomach from the inside with stitches and no incisions. A gastric sleeve permanently removes most of the stomach through keyhole surgery. In London, both are performed at The GV Clinic by consultant bariatric surgeon Mr Georgios Vasilikostas, so you get an unbiased recommendation based on your BMI, health and goals.

The Short Answer

• Choose ESG if you have a BMI of 30 or more, want to avoid surgery and stomach removal, and need to be back at work within days.
• Choose a gastric sleeve if you have a BMI of 40 or more (or 35+ with a condition such as type 2 diabetes) and need the greatest possible weight loss.
• Not sure? Mr Vasilikostas performs both, and will advise which suits you at your consultation.

ESG vs Gastric Sleeve:

	Endoscopic Sleeve Gastroplasty (ESG)	Gastric Sleeve Surgery
How it’s done	Endoscope passed through the mouth; stitches fold the stomach into a sleeve shape	Keyhole (laparoscopic) surgery through small abdominal incisions
Incisions / scars	None	Small keyhole scars
Stomach tissue removed	None – capacity reduced by around 65–70%	Around 75–80% of the stomach permanently removed
Anaesthetic	General anaesthetic	General anaesthetic
Procedure time	45–90 minutes	Discussed at consultation
Hospital stay	Usually home the same day	1–2 nights
Back to work	Around 3 days	3–5 weeks
Typical weight loss	15–25% of total body weight at 12 months	60–70% of excess weight (around 35% of total body weight)
BMI guide	30+	40+, or 35+ with an obesity-related condition
NHS availability	Not routinely funded; private only	Available with strict criteria and long waiting lists
Private cost (UK guide)	£9,000–£13,000	£11,000–£14,000

How Each Procedure Works

Endoscopic Sleeve Gastroplasty (ESG)

Under general anaesthetic, a flexible endoscope fitted with the Apollo OverStitch™ suturing system is passed through the mouth into the stomach. Mr Vasilikostas places a series of full-thickness stitches to fold the stomach into a narrow, tube-like shape. Nothing is cut or removed, and there are no external wounds. Read more about ESG in London.

Gastric Sleeve Surgery (Sleeve Gastrectomy)

Through small keyhole incisions, around 75–80% of the stomach is removed, leaving a slim sleeve-shaped stomach. The smaller stomach holds much less food, so you feel full sooner. The change is permanent. Read more about gastric sleeve surgery in London.

Weight Loss Results

ESG: patients lose on average 15–25% of their total body weight (around 50% of excess weight) within 12 months, with results shown to last beyond two years when combined with diet and lifestyle changes.

Gastric sleeve: patients typically lose 60–70% of their excess weight, with the fastest loss in the first three to six months and continued progress for up to two years.

Both procedures can improve obesity-related conditions such as type 2 diabetes, high blood pressure and sleep apnoea. With either option, long-term success depends on following the nutrition and lifestyle support provided by our team.

Which Is Right for You?

ESG may suit you if you:

• Have a BMI of 30 or above and haven’t achieved lasting results with diet and exercise
• Want to avoid surgery or the removal of stomach tissue
• Can’t take extended time off work
• Are not suitable for surgery because of another health condition
• Have regained weight after a previous sleeve or bypass

A gastric sleeve may suit you if you:

• Have a BMI of 40 or above, or 35 and above with type 2 diabetes, high blood pressure or another obesity-related condition
• Need the greatest amount of weight loss
• Are comfortable with a permanent surgical change and lifelong supplements

ESG is not usually suitable for people with a large hiatus hernia or conditions involving gastrointestinal bleeding. Mr Vasilikostas will review your medical history, examine you and discuss your goals before recommending either procedure.

Cost of ESG vs Gastric Sleeve in London

As a UK guide, private ESG costs £9,000–£13,000 and private gastric sleeve surgery costs £11,000–£14,000. At The GV Clinic, prices are tailored to your medical history and aftercare needs, and include your consultation, the procedure and follow-up support.

What About Weight-Loss Injections?

Mounjaro and other weight-loss injections are ongoing weekly treatments, while ESG and a gastric sleeve are one-off procedures. Some patients move to ESG or surgery when medication results plateau or when they want to stop injections. See our Mounjaro exit plan and our comparison of ESG vs Mounjaro.