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Op. Dr. Murat Üstün
Endoskopik Tedavi

Endoscopic Sleeve Gastroplasty vs Gastric Sleeve: Comprehensive Comparison

Quick Answer

Compare ESG (Endoscopic Sleeve Gastroplasty) and gastric sleeve surgery: invasiveness, weight loss outcomes, recovery time, reversibility and patient selection criteria.

Two procedures dominate the modern obesity treatment landscape: Endoscopic Sleeve Gastroplasty (ESG) and Laparoscopic Sleeve Gastrectomy (gastric sleeve). Both reduce stomach volume, yet they differ significantly in invasiveness, reversibility, recovery and long-term results.

What Is ESG?

ESG is performed entirely through the mouth using a flexible endoscope — no skin incisions. A suturing device reduces gastric volume by 70-80%. Performed in 60-90 minutes, most patients are discharged the same day.

  • No incisions — no scarring
  • Partially reversible
  • Day-case procedure
  • Low complication rate
  • Return to activities in 1-2 weeks

What Is Gastric Sleeve?

LSG permanently removes approximately 75-80% of the stomach through small abdominal incisions, leaving a narrow tube-shaped stomach. It is one of the most widely performed bariatric surgeries globally.

  • Permanent and highly effective
  • Reduces hunger hormones (ghrelin)
  • Requires 1-2 overnight hospital stays
  • Irreversible

Key Differences

FeatureESGGastric Sleeve
IncisionsNone3-5 small
ReversibilityPartialIrreversible
Recovery1-2 weeks2-4 weeks
Weight loss (12mo)15-20%25-35%

Which Is Right for You?

ESG suits patients with BMI 30-40 who prefer a non-surgical approach. Gastric sleeve is recommended for BMI 40+ or serious obesity comorbidities requiring greater, permanent weight loss.

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FAQ

Is ESG more painful than gastric sleeve?

ESG has no skin incisions and is generally associated with less discomfort. Gastric sleeve recovery is also well-tolerated but takes longer.

How long do ESG results last?

ESG weight loss can remain effective for up to 5 years with lifestyle changes and regular follow-up.

Frequently Asked Questions

What is sleeve gastrectomy (gastric sleeve)?

Sleeve gastrectomy removes approximately 75–80% of the stomach laparoscopically, leaving a narrow sleeve shape. This reduces stomach capacity and lowers ghrelin (hunger hormone) production. It is the most commonly performed bariatric procedure worldwide.

Does the stomach stretch back after sleeve gastrectomy?

The stomach adapts slightly over 1–2 years but does not return to its original size. Maintaining portion control, limiting refined carbohydrates, and attending regular follow-up appointments supports long-term success.

How much weight can I lose with sleeve gastrectomy?

Most patients lose 60–70% of their excess weight within 12–18 months. Results improve with protein-first eating and regular exercise. Starting BMI and dietary adherence are the strongest predictors of outcome.

Sleeve gastrectomy or gastric bypass — which should I choose?

Sleeve gastrectomy is simpler with no intestinal rerouting and no malabsorption. Gastric bypass offers higher diabetes remission and weight loss, and is preferred for reflux patients. The right choice is assessed individually by Dr. Üstün based on your BMI, metabolic conditions, and history.

What are the risks of sleeve gastrectomy?

The most serious complication is a staple-line leak (0.5–3%). Other issues include staple-line bleeding, stricture, and long-term vitamin/mineral deficiencies. Choosing a high-volume, JCI-accredited centre like Liv Hospital Istanbul significantly reduces risk.