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Non-Surgical 'Sleeve' - Endoscopic Sleeve Gastroplasty (ESG)

Non surgical sleeve comparison

Exclusive Non-Surgical 'Sleeve'

Same weight loss benefits without surgery or scars. Safer, lower risk procedure

At Healthier Weight we are the first UK clinic to offer the traditional surgical sleeve and the new non-surgical alternative, the endoscopic sleeve gastroplasty (ESG).

Which is the better option for you will depend on how you view the risks and benefits. The traditional sleeve (1) is a more invasive procedure with a generally higher risk profile, particularly that of staple line leakage, but it's been shown over many years to deliver excellent weight loss results. The ESG (2) is less invasive with faster recovery times but as a new procedure, there is little data available on medium and long term outcomes. The available studies show good weight loss, broadly comparable to those with gastric banding, we simply need more time to see the long term effect. This is true of all new procedures.

Surgeon Jamie Kelly

What is an endoscopic sleeve gastroplasty?

The endoscopic sleeve gastroplasty is a new procedure for those who want the benefits of weight loss surgery but from a less invasive, non-surgical procedure. It involves stapling the stomach from the inside to significantly reduce its capacity by about 80%. After the procedure, the stomach remains intact but has been stitched from top to bottom to leave a smaller banana shaped stomach through which the food you eat passes.

The major benefit of the endoscopic sleeve gastroplasty is that it is performed endoscopically with a stitching device placed into the stomach through the mouth. This means that unlike surgery, there is no cutting or stapling, no scarring and no wounds. The procedure is carried out by pioneering surgeon  Jamie Kelly, in Southampton, under general anaesthetic and usually takes 1-1.5 hours. 

The procedure works by reducing stomach capacity and slowing down the speed at which food passes into the bowel. The food you eat goes into a small pocket at the top of the stomach before working its way down through the reduced, banana shaped stomach, and emptying into the bowel.  

Read our frequently asked questions on the ESG 

Am I eligible for an endoscopic sleeve gastroplasty?

We will explain all of your options, including all pros and cons, at consultation, but as a guide, you may be eligible if:

  • Your BMI is 32-45kg/m2 (if you have weight related health issues eg type 2 diabetes, surgery may be more suitable) - Check BMI
  • You've tried to lose weight through diet and lifestyle changes
  • You don't want the maintenance commitments of a gastric band
  • You don't want a more invasive procedure such as the surgical sleeve gastrectomy 
  • You want a procedure that is more effective in the long term than a gastric balloon

What results can I expect? 

It isn't possible to predict how much weight you will lose following an endoscopic sleeve gastroplasty as results vary according to many factors including your willingness to adapt your diet and your physical activity.

The evidence we have suggests patients can expect to lose about half of their excess weight over a 12-18 month period*. At this stage, because this is still a new procedure, longer term weight loss results are not yet available.

  Weight loss (of starting weight)     
At 6 months 
16.8% *
At 12 months 
18.2% *
At 18 months
19.8% *

Based on a group of 242 patients with a mean starting BMI of 37.8

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*Weight loss surgery results and benefits differ for each individual. Results cannot be guaranteed
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What's the difference between a Non-Surgical Gastric 'Sleeve' (ESG) and Gastric Sleeve Surgery?

The surgical sleeve gastrectomy is an excellent procedure and we recommend it to several patients every month. As always, there are pros and cons for each, the table below is designed to help you compare the differences or read more about how the ESG compares with surgical weight loss procedures.


  Endoscopic Sleeve Gastroplasty Gastric Sleeve Surgery
Procedure Type Endoscopic (instruments placed through mouth) Laparoscopic (instruments placed through incisions in abdomen)
Scarring  None  Typically 5 abdominal scars 
Remaining stomach function  Stomach left intact 80%+ stomach removed
Recovery period  2-3 days  About 2 weeks 
Future options  Revision of ESG, surgical sleeve or gastric bypass Revision to gastric bypass
Expected weight loss  Approx. 50% excess weight at 1 year (2 year data not yet available) * 60-70% weight loss at 2 years *
Historical data  New procedure (see below)  More established procedure with long term results
Risk profile  Relatively lower risk Relatively higher risk 

Still unsure which of these operations is going to be best for you? See endoscopic sleeve gastroplasty or surgical gastric sleeve or read our Frequently Asked Questions

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Endoscopic Sleeve Gastroplasty Risks

The endoscopic sleeve gastroplasty, or non-surgical gastric sleeve, is a new procedure. As such, there is uncertainty about long term outcomes but from the information available from the centres who have pioneered the procedure in the United States and in Europe, we consider the technique to be a potentially major advancement in the treatment of obesity. 

The procedure is approved by the appropriate regulatory bodies in the UK and in Europe, and is safe for use in the UK. Indeed the device used to perform the ESG, the "Overstitch", is in use already within the NHS for revisional surgery procedures. A rigorous training and sign off process is followed by any UK consultant using the device in order to ensure the highest standards at all times.

Any procedure of this type, however, involves an element of risk and these will be explained in full at your consultation. Risks include:

  • Anaesthetic related risk, e.g. reaction
  • Haemorrhage
  • Perforation of the stomach
  • Pneumoperitoneum and pneumo thorax
  • Laceration of the oesophagus or stomach

Importantly, the key major risk associated with the surgical sleeve, that of staple line leakage, does not apply with endoscopic sleeve gastroplasty.

Peace of Mind Warranty - At Healthier Weight our all inclusive package also includes a 30 day warranty for additional peace of mind. If, following your endoscopic sleeve gastroplasty procedure, you have an extended stay in hospital or you need to return to theatre within 30 days, we will meet any related hospital and consultant costs.

Aftercare nurse

Endoscopic Sleeve Gastroplasty Aftercare and Support

Any weight loss procedure is only as good as the long term commitment of the patient, and the long term support of the clinic. Your procedure package includes a 12 month aftercare period during which our surgeon and clinical team will be in touch at regular intervals. Following this aftercare period, you will continue to have access to telephone and email support, and our patient forum for life.

For prices & finance options, get a quote online or call 0121 693 4488

*Weight loss surgery results and benefits differ for each individual. Results cannot be guaranteed

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*Weight loss surgery results and benefits vary and are different for each individual. As such, Healthier Weight cannot guarantee specific weight loss goals.