Apollo Endoscopic Sleeve Gastroplasty (ESG)


Apollo Endoscopic Sleeve Gastroplasty (ESG) is an exciting development in obesity treatment that offers people a safe and effective alternative to the established weight loss options. Its main attraction is that it is non-surgical so people benefit from a lower risk profile and faster recovery time.

Apollo endoscopic sleeve

Endoscopic sleeve gastroplasty is a newer type of weight-loss procedure. Endoscopic sleeve gastroplasty reduces the size of your stomach using an endoscopic suturing device without the need for surgery. This procedure may be an option if you’re significantly overweight — a body mass index of 30 or more — and diet and exercise haven’t worked for you.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. And the procedure is minimally invasive, reducing the risk of operative complications.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

Why it’s done

Endoscopic sleeve gastroplasty is performed to help you lose weight and potentially lower your risk of serious weight-related health problems, including:

  • Gastroesophageal reflux disease
  • Heart disease and stroke
  • High blood pressure
  • Sleep apnea
  • Type 2 diabetes

Endoscopic sleeve gastroplasty and other weight-loss procedures or surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits. Endoscopic sleeve gastroplasty is less invasive and risky than other forms of bariatric surgery.

Who it’s for

Endoscopic sleeve gastroplasty is often an option for people who aren’t candidates for other bariatric surgeries. The procedure is available to people whose body mass index (BMI) is above 30 who haven’t been successful maintaining weight loss with other methods.

But endoscopic sleeve gastroplasty isn’t for everyone who is overweight. A screening process helps doctors see if the procedure might be beneficial for you. And you must be willing to commit to healthy lifestyle changes, regular medical follow-up and participate in behavioral therapy.

Endoscopic sleeve gastroplasty isn’t appropriate for anyone who has gastrointestinal bleeding, a hiatal hernia larger than 3 centimeters or who’s had prior stomach surgery.

Given that endoscopic sleeve gastroplasty is a new procedure, it might not be covered by your health insurance.

Apollo Endosleeve

The operation itself

The ESG procedure is done using a device called an Overstitch; a device that is placed into the stomach through the mouth that enables us to place a number of sutures (stitches) inside the stomach to significantly reduce its capacity by up to 80%.

As the procedure requires about an hour to complete we do it under general anaesthetic for your comfort. However, unlike surgery, we do not need to make any incisions to access the abdominal cavity thus reducing the risk to you and enabling a faster recovery.

Weight loss with the ESG

The weight loss results with ESG are excellent. Initially we were seeing weight loss similar to that for gastric band at 50-60% excess weight loss after 2 years, however the latest results are more encouraging. The Longitudinal Compression technique used is now delivering over 50% excess loss in the first 6 months which is comparable to surgical sleeve and gastric bypass.

We always stress to patients that we need to wait to see long term results, 5 years plus, to be satisfied with the long-term benefits of the procedure but the fact we are seeing over 50% at 6 months and generally 60% at 2 years is very positive. It is too early to tell but we expect that the technique used will encourage enduring weight loss as well as good results for the short term.

As with all weight loss procedures there is a small proportion (about 10-20%) for whom the procedure is unsuccessful and for whom it is best to consider a surgical procedure.

Apollo Endoscopic Sleeve Murat Ustun


In early studies on endoscopic sleeve gastroplasty, the procedure has shown a favorable safety profile. Pain and nausea may occur for several days after the procedure. These symptoms are usually managed with pain and nausea medications. Most people feel better after two days.

In addition, although it’s not designed to be a temporary procedure, endoscopic sleeve gastroplasty can be reversed. In some cases, it can also be converted to bariatric surgery.

Because the procedure is still new and not in wide use, questions remain about its long-term effectiveness and risks.

How you prepare

If you qualify for endoscopic sleeve gastroplasty, your health care team will give you specific instructions on how to prepare for your procedure. You may need to have various lab tests and exams before surgery. You may have restrictions on eating, drinking and which medications you can take. You also may be required to start a physical activity program.

It’s helpful to plan ahead for your recovery after the procedure. For instance, arrange for help at home if you think you’ll need it. Recovery from endoscopic sleeve gastroplasty generally only takes a day or two.

What you can expect

Endoscopic sleeve gastroplasty is done in the endoscopy unit as an outpatient procedure. General anesthesia is used for the procedure, so you’ll be unconscious.

The procedure is done using an endoscope, a flexible tube with a camera and an endoscopic suturing device attached. The endoscope is inserted down your throat into the stomach. The tiny camera allows the doctor operating the endoscope (endoscopist) to see and operate inside your stomach without making incisions in your abdomen.

Using the endoscope, the doctor places approximately 12 sutures in the stomach. The sutures change the structure of your stomach, leaving it shaped like a tube. This restricts the amount of calories your body absorbs.

The procedure takes about 90 minutes. After the endoscopic sleeve gastroplasty, you’ll awaken in a recovery room, where medical staff monitors you for any complications.

The majority of people leave go home the same day after recovering from sedation. Some people might require a short admission to the hospital for one day or less for observation after the procedure.

After Apollo endoscopic sleeve gastroplasty

After the procedure, you generally won’t be allowed to eat for about eight hours. Then, you’ll be allowed to start a liquid diet, which you need to continue for at least two weeks. Over four weeks, you’ll move on to semi-solid foods, and then to a regular healthy diet.

You’ll also have medical checkups and meet with a nutritionist and psychologist frequently after your procedure.


Endoscopic sleeve gastroplasty can lead to significant weight loss. The amount of weight you lose also depends on how much you can change your lifestyle habits.

But studies have shown promising results. A recent study of people with an average BMI around 38 found that endoscopic sleeve gastroplasty led to an average weight loss of 39 pounds (17.8 kilograms) after 6 months. After 12 months, weight loss was 42 pounds (19 kilograms).

In a study of people with an average BMI of about 45, the procedure resulted in an average weight loss of about 73 pounds (33 kilograms) during the first six months.

As with other procedures and surgeries that lead to significant weight loss, endoscopic sleeve gastroplasty may improve conditions often related to being overweight, including:

  • Gastroesophageal reflux disease
  • Heart disease or stroke
  • High blood pressure
  • Severe sleep apnea
  • Type 2 diabetes

The evidence we have suggests people can expect to lose about 15-18% of their starting weight (generally 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. Also, we’ve 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. This is similar to the weight loss with a gastric band but as we said above, the latest results with the new technique are comparable to surgical sleeve and bypass.

    Weight loss  
  % of starting weight Start weight 16st Start weight 20st
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

Here is a summary of published weight loss data:

  Participants Avg weight loss at 2 years
Alqahtani et al 1600 15-20%
Lopez-Nava et al 248 18.6%
Sharaiha et al 91 20.9%

In the Lopez Nava study we saw that nearly all of the weight loss was achieved in the first 6 months

In February 2019 Apollo Endosurgery, Inc., a global leader in less invasive medical devices for bariatric and gastrointestinal procedures, announced the publication of Outcomes of Endoscopic Gastroplasty (“ESG”) in 1,000 Consecutive Patients from a single center – King Saud University, Riyadh, Saudi Arabia featured in Gastrointestinal Endoscopy (GIE) – https://doi.org/10.1016/j.gie.2018.12.012.

According to this publication, in these first 1,000 consecutive patients that treated with Endoscopic Sleeve Gastroplasty, patients experienced a 100% remission for hypertension related comorbidities, a 70% remission rate for type 2 diabetes with the remaining 30% showing significant improvement. Study confirmed that ESG is a safe, well-tolerated, and effective procedure. In addition, patients also achieved 64.7% excess weight loss at 18 months follow-up, which is comparable to results achieved with other surgical bariatric interventions.

Endoscopic Sleeve

Other benefits of the ESG

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. Therefore patients benefit from a faster recovery time and lower post-operative risks, both incidence rate and severity.

Studies also show that the rate of complications with ESG is low too. One study showed the post-operative complication rate to be as low as 2.4% (AlQuatani et al December 2018).

When weight-loss surgery doesn’t work

It’s possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don’t follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.

How much is the ESG?

The price for an ESG may vary  depending on location and medical history but the price is very similar to that for the surgical sleeve. This reflects the fact that hospital, surgeon and anaesthetist costs are the same.

Apollo Endoscopic Sleeve Gastroplasty


Apollo Endoscopic Sleeve Gastroplasty


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