Endoscopic Sleeve Gastroplasty (ESG)

ESG - Endoscopic Sleeve Gastroplasty

ESG stands for Endoscopic Sleeve Gastroplasty. The ESG is an incisionless operation as it is completed using endoscopy. The ESG reduces the size of the stomach and changes the shape of the stomach into a sleeve like structure. The operation is carried out without removing any part of the stomach or creating incisions in the abdominal wall. The ESG uses endoscopic technique using a camera and surgical instruments which access the stomach via the mouth and gullet.  

Operation technique

The procedure is carried out using gastroscopy (camera through the mouth) and advanced instruments that are attached to the gastroscope. 

Part of the stomach is then sutured (stitched) from the inside of the stomach. The suturing is done in a way that reduces the width and the length of the stomach and subsequently reduces its volume. 

Watch the short video to show the Gastric Sleeve technique:

How does the Endoscopic Sleeve Gastroplasty work?

The ESG works by making the size of the stomach smaller. That means that the ability of the stomach to receive food is significantly reduced. After the operation the patient will be able to eat less food than what they used to eat before the operation. As the ESG is a relatively new procedure we still do not know fully how the ESG works and there might be other mechanisms of actions for the ESG which aid weight loss. 

Also see, Why the ESG might be the future of bariatric surgery… ESG blog post

Benefits of the ESG


  • A lower risk procedure: The risk of complications is lower than the risk of complications with surgical operations like sleeve gastrectomy or gastric bypass. This is because the ESG does not involve incisions or staple lines that might bleed or leak. The procedure takes a shorter time to complete too, and this contributes to the reduction in risks. 


  • Fast recovery: The recovery is faster after the endoscopic sleeve. This is because there are no incisions (cuts) in the tummy wall.  


  • A reversible procedure: The operation is completely reversible. Some patients might change their mind after having the procedure or they might not be happy with the restriction associated with the procedure. The option of reversing the operation is something that some patients might appreciate.  


ESG - Incisionless Gastric Sleeve
Endoscopic Sleeve Gastroplasty
  • A revisable procedure: The procedure is completely revisable. If the stomach is too tight that the patient feels sick or vomits a lot, some of the sutures can be cut to adjust this. If the weight loss is little or the patient regained weight, it might be possible to tighten the stomach further. You do not burn any bridges by having this procedure. You can have a surgical sleeve or other operations after the endoscopic sleeve.


  • Less occurrence of reflux: The risk of reflux or worsening reflux is significantly less than sleeve gastrectomy. 


  • An evolving procedure: The ESG technique is constantly refined to achieve more weight loss and less complications.  

Endoscopic Sleeve Gastroplasty Results

Endoscopic Sleeve Gastroplasty Results

Ideal for treating mild to moderate obesity: The ESG is ideal for those patients with mild to moderate obesity with a lower BMI of 30 or above as they do not need to lose a significant amount of weight to achieve a healthy weight. 

Average weight loss: The average weight loss with the ESG is 18% (this is what is reported in the literature. However, there are several surgeons who report higher weight loss). 

Health benefits: Weight loss can control, improve, cure, or prevent health conditions that are caused by obesity such as Type 2 diabetes, high cholesterol, high blood pressure, risk of stroke reflux, polycystic ovaries and sleep apnoea. It can also improve the patient’s quality of life and might prolong patients’ lives. 

Preparation for ESG

Preparing for ESG Endoscopic Sleeve Gastroplasty
Dr Matilda Moffett - Support for Endoscopic Sleeve Gastroplasty

Initial Consultation with Mr Toumi: During this appointment you will discuss with Mr Toumi your current health, medical history, and past attempts to lose weight. You will also explore your suitability for the surgery, potential options and potential benefits and risks. 

Dietitian Appointment: You will have an appointment with our Bariatric Dietitian where your diet will be accessed, a post-op diet plan will be provided for your weeks following surgery. 

Psychologist Appointment: You will be seen by our specialist Psychologist who will further assess whether surgery is right for you. 

Pre-Operative Assessment: You will also need to have a Pre-Op assessment which may include: An electrocardiogram (ECG) and Blood tests. 

Operation and Recovery time

The procedure takes around one hour to complete. 

The procedure can either be done as a day case procedure (meaning you can return home the same day) or in some cases might require an overnight stay. 

One of the great advantages of the ESG is there are no restrictions to physical activity (including heavy lifting) after the procedure. Due to the lack of incisions, there is no risk of hernia following the ESG. 

Preparation for the ESG Endoscopic Sleeve Gastroplasty

Recovery after Endoscopic Sleeve Gastroplasty

Healing time: The technique of the Endoscopic Sleeve Gastroplasty means there are no incisions, therefore the recovery is quick.  

Pain relief: After discharge, most patients only need paracetamol for pain relief. 

Bathing after surgery: Unlike standard bariatric surgical operations where you are unable to bathe or swim for two weeks. It is immediately permitted to bath or swim when you feel ready after the procedure.

Driving after surgery: Patients can return to driving as soon as they recover from anaesthesia if you are able to look over your shoulder and perform an emergency stop without pain.  

Returning to work: Most patients can return to work within few days after their operation.  

Endoscopic Sleeve Gastroplasty Aftercare

Endoscopic Sleeve Gastroplasty Aftercare
Dawn Shotton Registered Dietitian for Endoscopic Sleeve Gastroplasty

Dietitian appointment: Following an ESG with Mr Toumi you are seen by our Bariatric Dietitian who will provide you with post Bypass diet plans for the short and long term.  

Regular follow up appointments: Further to this you will receive regular follow up appointments with Mr Toumi over 2 years following surgery to give you all the support that you need. 

Interested private ESG surgery in North East England? Book an appointment below.