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Non Surgical Sleeve - Endoscopic Sleeve Gastroplasty

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

Non-Surgical Sleeve - Endoscopic Sleeve Gastroplasty

Exclusive Non-Surgical 'Sleeve'

Similar 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 a new non-surgical alternative, the endoscopic sleeve gastroplasty (ESG).

If you have a question you would like to discuss in person, please call us. All of the team here are trained in all the procedures and will be happy to discuss things.


What is an endoscopic sleeve gastroplasty?

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

The major benefit of the ESG 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 about an hour. 

It 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 

Who should choose an ESG?

An ESG is a good option if you :

  • Don’t want the maintenance commitment of a gastric band, e.g. band fills
  • Don’t want the risks and recovery time associated with a surgical procedure
  • Don’t want a procedure that leaves visible scarring
  • Want a non surgical procedure that gives better long term results than a gastric balloon


Am I eligible for an endoscopic sleeve gastroplasty?

Your consultant will explain all of the options available to you at your 1:1 consultation. As a guide, you will be eligible for ESG if:

  • Your body mass index is in the range 32-45 kg/m2 – check BMI
  • You’ve tried and failed to lose weight through diet and lifestyle changes
  • Your weight is having an impact on your health and/or your day to day life

Important: If you are living with weight related co-morbidities, such as type 2 diabetes, the surgical weight loss procedures are likely to be more beneficial for you.

These notes are for guidance only and your consultant will make an assessment based on the full picture presented at consultation.

Check your BMI here

What results can I expect? 

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

The evidence we have suggests people 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 available.

The weight loss results in the chart below are the published results from a study of 248 ESG patients. They show average total body weight loss (TBWL) as a percentage of the starting weight.  We’ve also shown how much weight this equates to assuming different starting weights.

In summary, based on the published data you can expect to lose just over half of your excess weight after 24 months after your procedure. This is similar to the weight loss with a gastric band and a little below the weight loss we’d expect with a surgical sleeve or gastric bypass

  Weight loss (of starting weight) Weight loss assuming start weight of 16 stone   Weight loss assuming start weight of 20 stone 
At 6 months 
15.2% * 34lbs 43lbs
At 18 months
18.6% * 42lbs 52lbs
Based on a group of 248 patients with a mean starting BMI of 37.8
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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 sleeve.


  Endoscopic Sleeve Gastroplasty Gastric Sleeve Surgery
Procedure Type Endoscopic (instruments placed through mouth) Laparoscopic (instruments placed through incisions in abdomen)
Visible scarring  None  Typically 5 abdominal scars 
Remaining stomach function  Stomach left intact 80%+ stomach removed
Expected recovery period  2-3 days  About 2 weeks 
Future options  Revision of ESG, surgical sleeve or gastric bypass Revision to gastric bypass or revision of gastric sleeve
Expected weight loss  Approx. 50-60% excess weight at 2 years 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 ESG is a new procedure. As such, there is uncertainty about long term outcomes but from the information available from the centres who have pioneered it in the United States and in Europe, we consider the technique potentially to be a major advancement in the treatment of obesity. 

The procedure is approved by the appropriate regulatory bodies in the UK and in Europe. 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 involves an element of risk and these will be explained in full at your consultation. Risks include:

  • Perigastric inflammatory fluid collootion
  • Anaesthetic related risk, e.g. reaction
  • Haemorrhage
  • Perforation of the stomach
  • Pneumoperitoneum and pneumo thorax
  • Laceration of the oesophagus or stomach
  • Mild abdominal pain, nausea and vomiting

Importantly, the major risk associated with the surgical sleeve, that of 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 (ESG) 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.

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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.