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Op. Dr. Murat Üstün
Endoskopik Tedavi

ESG (Endoscopic Sleeve Gastroplasty): Safe, Minimally Invasive Obesity Treatment

Quick Answer

Learn how Endoscopic Sleeve Gastroplasty (ESG) works, who qualifies, expected weight loss outcomes, and how it compares to sleeve gastrectomy and GLP-1 medications.

Endoscopic Sleeve Gastroplasty (ESG) is a breakthrough in non-surgical obesity treatment. Unlike traditional bariatric surgery, ESG requires no incisions. Using an endoscope inserted through the mouth, the surgeon places sutures to narrow the stomach by 70-80%.

Who Is a Candidate for ESG?

ESG is recommended for patients with BMI 30-40 who prefer a non-surgical approach or who do not meet criteria for bariatric surgery. Detailed specialist evaluation is essential.

Weight Loss Outcomes

Clinical studies show ESG achieves 15-20% total body weight loss over 12-24 months with significant improvements in type 2 diabetes, hypertension, and dyslipidaemia.

ESG vs Sleeve Gastrectomy

Unlike sleeve gastrectomy, ESG requires no incisions, has a faster recovery (return to normal activity in 1-2 weeks), and is partially reversible. Weight loss is somewhat less than surgical options but comparable to GLP-1 medications for BMI 30-40 patients.

Recovery

Liquid diet weeks 1-2, pureed foods weeks 3-4, gradual solid foods from month 2. Multidisciplinary follow-up with dietitian and psychologist is provided.

Is ESG Right for You?

Op. Dr. Murat Ustun offers a comprehensive evaluation to determine the most appropriate treatment — whether ESG, sleeve gastrectomy, gastric bypass, or another approach.

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Frequently Asked Questions

Is ESG permanent?

ESG is partially reversible. The sutures can be removed endoscopically if needed, though the stomach may not fully return to its original size.

How does ESG compare to the gastric balloon?

The gastric balloon is temporary (removed after 6-12 months), whereas ESG provides a longer-term structural change with generally greater and more sustained weight loss.

Sources: Cureus 2022 multicentre ESG study; Bariatric News 2024-2025.

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.