Concierge bariatric endoscopy · UK
Endoscopic sleeve gastroplasty, incisionless, in a proper hospital.
A durable structural weight-loss procedure by a consultant bariatric endoscopist — Apollo Overstitch or POSE 2.0, general anaesthetic, sub-24-hour stay, and the 12-month multidisciplinary programme that makes it stick.
Why patients choose us
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A consultant bariatric endoscopist, in theatre
Not a wellness clinic and not a training list. A named endoscopist experienced in Apollo Overstitch or POSE, in a proper theatre with a full anaesthetic team.
- 02
The honest comparison with surgical sleeve
ESG loses roughly 15% of total body weight; a surgical sleeve loses closer to 25%. We say so before you decide — and we tell you when a surgical option is the better fit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — ESG, surgical sleeve, GLP-1 optimisation or something else — is impartial and costs you nothing.
Indicative pricing
What a private ESG costs in the UK.
Indicative all-inclusive ranges across our partner hospitals — device, theatre, hospital stay and 12-month programme. Firm figures within one working day.
In short
Apollo Overstitch ESG in our network: £10,000–£15,000, home within 24 hours.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| ESG with Apollo Overstitch (all-inclusive) | £10,000–£15,000 | 60–90 min GA | Same/next day |
| POSE 2.0 primary obesity procedure | £8,000–£12,000 | 40–70 min GA | Same/next day |
| Bariatric consultation and workup | £350–£700 | 45 min | Same visit |
| 12-month multidisciplinary programme | Usually included | — | Ongoing |
| Revision or repeat plications | £4,500–£8,000 | 45 min GA | Same/next day |
| Second opinion vs surgical sleeve/bypass | £200–£400 | 30 min | Same visit |
Prices vary by hospital, by device (Apollo Overstitch vs POSE 2.0), by anaesthetic and length of stay, and by whether the 12-month multidisciplinary programme is bundled. ESG is not routinely commissioned on the NHS — most cases are self-pay, with selective insurer cover.
The problem
The right procedure for your BMI, the right hospital for the work.
ESG is oversold and undersold in equal measure — pitched as a substitute for surgery where it is not, dismissed as ineffective where it is a good fit. We give you the honest answer for your BMI and health.
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Not sure it is enough?
For a BMI above 45–50 the honest answer is often surgical sleeve or bypass. We say so before you commit.
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Worried about surgery?
No incisions, sub-24-hour stay, serious complication rate under 2% — and the anatomy is not permanently altered.
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Want it done properly?
A named consultant bariatric endoscopist, a proper hospital, and a 12-month multidisciplinary programme included from day one.
The journey
From enquiry to 12-month review — what happens, in order.
One team from first message to the one-year mark — the follow-up is the point, not an afterthought.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A day at the hospital
Phase 3 · After
12-month programme
- 01
Before
You tell us what is going on
A short, confidential form. Current BMI, weight history, what you have already tried — including GLP-1 medication — and any relevant medical conditions.
- 02
Before
We come back with a recommendation
Within one working day: whether ESG, a surgical sleeve, a duodenal switch or medical therapy is the honest best fit, with an indicative price for each.
- 03
Before
Workup and lifestyle programme
Blood tests, dietitian and psychologist review, and enrolment in the mandatory pre- and post-procedure lifestyle programme. Two-week liquid diet immediately before.
- 04
On the day
Arrival at the hospital
Admission, consent and a chat with the endoscopist and anaesthetist. General anaesthetic for an upper endoscopy — no incisions on the abdomen.
- 05
On the day
The procedure itself
40 to 90 minutes in a proper theatre. Eight to twelve full-thickness plications through the Apollo Overstitch or POSE 2.0 device reduce the stomach volume by 60–70%.
- 06
On the day
Overnight or same-day home
Most patients go home within 24 hours. Written aftercare, contact numbers, and a clear diet-progression plan through liquids, purée and soft food over six weeks.
- 07
After
Follow-up over 12 months
Structured dietitian, psychologist and clinical review at 2, 6, 12, 26 and 52 weeks — the follow-up is what makes the weight loss stick.
Typical end-to-end workup: 3–4 weeks from enquiry to procedure. Structured follow-up: 12 months.
When it helps
When ESG is the right step — and when it is not.
The situations ESG fits well, plus the ones where the honest answer is a different procedure or medical therapy first.
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BMI 30–40 with failed lifestyle change
The main group ESG is designed for — a class I or II BMI where diet, exercise and often GLP-1 medication have not delivered lasting results.
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BMI 40–45 who decline surgical sleeve
For those who meet surgical criteria but want an incisionless, reversible alternative — accepting slightly less weight loss for a lower complication profile.
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Metabolic adjunct
Where weight loss is needed to control type 2 diabetes, fatty liver disease, hypertension or obstructive sleep apnoea and medical therapy alone is not enough.
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GLP-1 plateau or intolerance
For patients who have hit a weight plateau on semaglutide or tirzepatide, or cannot tolerate the medication, ESG is a durable structural option.
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Bridge before other surgery
Sometimes used to reduce operative risk before orthopaedic, fertility or transplant surgery where weight loss changes what is possible.
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Preference for reversibility
ESG changes no anatomy permanently — the stomach can, in principle, return to its original shape if the sutures are removed. That reversibility matters to some patients.
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Not suitable — BMI over 50
Above BMI 50 the weight loss from ESG is usually not enough. A surgical sleeve gastrectomy, gastric bypass or duodenal switch is the honest recommendation.
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Red flag: severe reflux or large hiatus hernia
Uncontrolled GORD or a large hiatus hernia makes ESG a poor choice. It should be assessed and often treated first, or a different procedure chosen.
Procedure options
ESG is one option — here are the others.
The devices, alternatives and adjuncts on the table — and which fits which problem.
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Apollo Overstitch ESG
The most studied device. An endoscopic suturing platform that places full-thickness plications along the greater curve, reducing gastric volume by 60–70%.
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POSE 2.0 (USGI Incisionless)
An alternative platform placing tissue anchors to plicate the stomach body and fundus. Shorter procedure, comparable weight loss in published series.
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Endoscopic sutured gastroplasty
The generic term for the same idea — full-thickness endoscopic plications to restrict gastric volume. Used interchangeably with ESG in the literature.
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Surgical sleeve gastrectomy
The laparoscopic gold standard: removes 80% of the stomach permanently. Greater weight loss (~25% TBWL at 5 years) but higher complication rate and irreversible.
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Gastric bypass or duodenal switch
Malabsorptive procedures for higher BMIs or metabolic disease. Not directly comparable to ESG — different mechanism, different risk profile.
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GLP-1 medical therapy
Semaglutide or tirzepatide can deliver 15–20% weight loss but requires ongoing injections. Often combined with ESG rather than replaced by it.
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Revision ESG
Repeat plications where the original sutures have loosened. Simpler than surgical revision and preserves future options.
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Consultation only
An honest discussion of whether any procedure is needed at all, and which one fits — no obligation, no pressure to book.
Our vetted UK network
A small panel of bariatric endoscopists, we picked them.
Consultant bariatric endoscopists in London and a handful of regional centres, each with a full multidisciplinary team behind them. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every endoscopist in our network.
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Consultant bariatric endoscopists with at least 50 ESG cases performed
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Full multidisciplinary team — dietitian, psychologist, bariatric physician
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12-month structured follow-up programme included in the price
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Same-team escalation to surgical bariatrics if ESG is not the right answer
Safety, evidence and recovery
What to expect — honestly, and with the data.
ESG is a well-studied procedure with a strong randomised trial (MERIT, NEJM 2022) and five-year durability data. The trade-offs are real and worth understanding before you commit.
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A serious procedure, done in a proper hospital
Under general anaesthetic in a licensed theatre with a full endoscopy and anaesthetic team. Sub-24-hour stay for most patients.
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A low but real complication rate
Serious adverse events occur in under 2% — bleeding, perforation (under 0.5%), perigastric abscess and venous thromboembolism are the main ones to know.
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Nausea and cramping in the first week
Almost universal. Controlled with anti-emetics, PPIs and the liquid diet. It settles as the stomach adapts.
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The two-week liquid diet is non-negotiable
Two weeks of clear then full liquids, then two weeks of purée, then two weeks of soft food before normal texture returns. Rushing this is the commonest cause of pain.
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A mandatory lifestyle programme
ESG is a tool, not a treatment on its own. Structured dietitian and psychology input over 12 months is what makes the weight loss durable.
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Weight loss is real but less than surgery
Roughly 15–20% total body weight loss at 12 months, holding around 15% at five years — vs 20–25% for surgical sleeve at five years.
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Reversible, in principle
The plications can be released or will loosen over time — no stomach tissue is removed. Future surgical options remain open.
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Not usually funded by the NHS
ESG is not routinely commissioned in the UK. Most cases are self-pay. Some insurers cover it selectively — we check before you book.
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Red flags after the procedure
Fever, severe abdominal pain that is not settling, vomiting blood, or breathlessness with calf swelling need same-day medical review or A&E — not a wait-and-see.
Reading your operation note
Your ESG operation note in four parts. Read the last one first.
Whichever device was used, the note the endoscopist sends you keeps to the same shape.
A quiet reminder
Endoscopic language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication, BMI and device chosen
Why the procedure was done — BMI, comorbidities, previous attempts — and whether Apollo Overstitch or POSE 2.0 was used.
- 02 Technique
Anaesthetic, plication count, findings
Anaesthetic used, number and position of plications placed (typically 8–12), estimated gastric volume reduction, and any incidental endoscopic findings.
- 03 Findings
Reflux, hiatus hernia and mucosa
Notes on the oesophagus, hiatus, gastric mucosa and any biopsies taken — including anything relevant to future reflux risk.
- 04 Impression
Diet plan, follow-up and safety-net
Read this first: the six-week diet progression, the dietitian and clinical review schedule, and the exact symptoms that mean pick up the phone the same day.
Recognised by major UK insurers
Cover for ESG varies significantly by insurer. Most cases in the UK are self-pay, with selective cover where a clear medical indication is documented. We confirm the position with your insurer before booking.
Frequently asked
Everything we get asked about ESG.
Quick answers on weight loss, cost, safety, reversibility and how ESG compares with surgical sleeve and GLP-1 medication.
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What is an endoscopic sleeve gastroplasty?
ESG — also called endoscopic sutured gastroplasty — is an incisionless weight-loss procedure. A consultant endoscopist uses the Apollo Overstitch or POSE 2.0 device down an upper endoscope to place 8–12 full-thickness plications along the stomach, reducing its volume by 60–70%. It mimics a surgical sleeve without removing any tissue.
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How much weight will I lose with ESG?
The MERIT randomised trial (NEJM, 2022) and long-term series report roughly 15–20% total body weight loss at 12 months, holding around 15% at five years. That is meaningful and durable, but less than the ~25% at five years typical of a surgical sleeve gastrectomy.
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How does ESG compare with a surgical sleeve gastrectomy?
Surgical sleeve loses more weight (about 25% vs 15% at five years), is irreversible, and has a serious complication rate of around 6%. ESG loses less weight, is reversible in principle, and has a serious complication rate under 2%. The right choice depends on your BMI, health and preferences.
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Who is a good candidate for ESG?
Most commonly a BMI of 30–40, up to 45, where lifestyle change and often GLP-1 medication have not delivered lasting results. Above BMI 50 a surgical procedure is usually the honest recommendation. A large hiatus hernia or severe reflux may make ESG unsuitable.
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What does an ESG cost privately in the UK?
Roughly £10,000–£15,000 all-inclusive for Apollo Overstitch and £8,000–£12,000 for POSE 2.0 — covering the procedure, hospital stay and 12-month multidisciplinary programme. NHS commissioning is not routine; most cases in the UK are self-pay.
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What are the risks and complications?
Serious adverse events occur in under 2% of cases. The main ones to know are gastric perforation (under 0.5%), gastrointestinal bleeding, perigastric abscess, and venous thromboembolism. Nausea and abdominal cramping in the first week are almost universal but short-lived.
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What is recovery like — and the diet afterwards?
Most patients are home within 24 hours. Two weeks of liquids, two weeks of purée, two weeks of soft food, then normal textures — a six-week progression. A structured dietitian and psychology programme runs alongside for 12 months.
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Is ESG reversible?
In principle, yes. No stomach tissue is removed, and the plications can loosen over time or be released endoscopically. Future surgical options — sleeve gastrectomy or bypass — remain open if needed.
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Can I have ESG if I am on Wegovy or Mounjaro?
Yes — ESG and GLP-1 medications are often combined rather than treated as alternatives. Many patients have plateaued on medical therapy and use ESG as a durable structural tool alongside it. The team will advise on timing.
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What does NICE say about ESG?
NICE has issued interventional procedure guidance supportive of endoscopic gastroplasty with special arrangements for consent, clinical governance and audit. It is not, however, routinely commissioned by the NHS in England.
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