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Bariatric endoscopy · London

Endoscopic sleeve gastroplasty, without a single incision.

A day-case endoscopic procedure that reshapes the stomach into a narrow tube using the Apollo OverStitch device. No cutting, no scars, home the same day, and a return to normal life within two weeks.

A stethoscope on a clinical desk

Indicative pricing

What a private ESG costs in London.

Indicative ranges across UK units.

In short

£12,000 to £18,000 all-in, home the same day.

Procedure Indicative range
MDT bariatric assessment and workup endoscopy £1,400–£2,400
ESG procedure, all-inclusive day case £12,000–£15,000
ESG with 12-month multidisciplinary follow-up £14,000–£18,000
ESG combined with GLP-1 (semaglutide) programme £16,000–£22,000
Revision ESG after failed intragastric balloon £13,000–£17,000
Second-opinion review of prior bariatric plan £250–£450

Prices vary by unit, by which endoscopist does the case, by whether the package bundles 12 months of dietitian and clinician follow-up, and by whether a GLP-1 programme is combined.

The problem

The right procedure, the right endoscopist, the right expectations.

ESG is powerful when it fits and disappointing when it does not. This page sets out the ceiling, the trade-offs against a surgical sleeve, and how to make the weight loss durable.

  • Is ESG the right procedure for me?

    For a BMI well above 45, poorly controlled T2DM or severe metabolic disease, a surgical sleeve or bypass is usually the better answer.

  • What weight loss should I expect?

    Around 13 to 18% total body weight at 12 months, more with a GLP-1 added, less if lifestyle change does not follow. Quoted honestly before you commit.

  • Who is doing the procedure?

    Ideally an IFSO-accredited bariatric endoscopist with an established ESG case volume, in a JAG-accredited unit with surgical back-up.

Who it fits

When ESG is the right step, and when it is not.

The patient groups where ESG performs well, plus the signals that mean a surgical sleeve, bypass or GLP-1 pathway is the better answer.

  • BMI 30 to 40 with prior failed lifestyle attempts

    The core group for ESG. Documented attempts at diet, exercise and often GLP-1 therapy without durable weight loss.

  • BMI 40 or above who decline surgery

    A minimally invasive alternative when a laparoscopic sleeve or bypass is clinically indicated but the patient will not consent to surgery.

  • Revision after a failed intragastric balloon

    ESG can consolidate the weight loss from an Allurion or Orbera balloon into a durable restrictive procedure.

  • Prior open abdominal surgery

    When adhesions or previous laparotomy make laparoscopic bariatric surgery high risk, an endoscopic route avoids the abdominal wall entirely.

  • Patient preference for reversible restriction

    The sutures can, in principle, be released or will loosen over time. Not truly reversible in the surgical sense, but less anatomically final than a sleeve.

  • Unfit for a general laparoscopic anaesthetic

    Selected patients where cardiorespiratory risk makes a laparoscopic procedure unattractive. ESG still needs a GA but is shorter and less physiologically stressful.

  • When ESG is not enough - severe obesity, T2DM

    BMI well above 45, poorly controlled type 2 diabetes or severe metabolic disease usually needs a surgical sleeve or bypass for durable effect.

  • Red flag: uninvestigated reflux or dysphagia

    Significant GORD, hiatus hernia or swallowing symptoms need workup and often a different procedure. ESG can worsen reflux in some patients.

Procedure options

ESG sits in a wider bariatric ladder.

What each rung actually involves, from an intragastric balloon at one end to a Roux-en-Y bypass at the other, plus the endoscopic revision options after prior surgery.

  • Standard ESG (Apollo OverStitch)

    A running pattern of 6 to 12 full-thickness sutures along the greater curve reduces gastric volume by around 60% and creates a tubular sleeve. The current standard.

  • Revision ESG

    Sutures are added or replaced after a previous ESG that has loosened, or after a removed intragastric balloon, to restore restriction.

  • ESG plus GLP-1 combination

    Semaglutide or tirzepatide is layered onto ESG to add appetite suppression to the restriction. Higher total weight loss in early cohorts.

  • Intragastric balloon (Orbera, Allurion)

    A shorter, less invasive step. Six months of restriction with a saline-filled balloon. Less durable and a lower weight-loss ceiling than ESG.

  • Surgical sleeve gastrectomy

    A laparoscopic operation that removes 75 to 80% of the stomach. Around 30% total body weight loss on average, more durable, but incisions, leak risk and irreversible.

  • Roux-en-Y gastric bypass

    Restrictive and malabsorptive. Best evidence for type 2 diabetes remission and heavier initial weight loss. Longer stay and lifelong nutritional monitoring.

  • TORe (transoral outlet reduction)

    Endoscopic suturing to tighten a dilated anastomosis after a previous gastric bypass, restoring restriction without redo surgery.

  • Second-opinion review

    A specialist review of your imaging, endoscopy report and prior bariatric workup, so the pathway you choose is the right one.

Safety and recovery

What to expect afterwards, honestly.

ESG has one of the strongest early safety profiles in bariatric therapy. The things worth planning are the 1 to 2 weeks of nausea, the staged diet, the PPI, and the lifestyle work that makes the result last.

  • General anaesthetic in a full theatre

    ESG is done under general anaesthetic with anaesthetist support. Preoperative assessment is the same as for any elective GA.

  • Nausea and cramps for 1 to 2 weeks

    Post-procedure nausea, retching and abdominal cramps are common. Managed with anti-emetics, PPI and a staged liquid then pureed diet.

  • Bleeding from a suture site is rare

    Reported in fewer than 1 in 100 cases. Usually settles conservatively; occasionally needs a repeat endoscopy.

  • Gastric perforation is very rare

    Fewer than 1 in 200 published cases. When it occurs it is recognised early and, unlike a surgical sleeve, no staple line is at risk of leaking.

  • No leaks reported to date

    Because there is no cut in the stomach wall, the leak rate that dogs surgical sleeve gastrectomy has not been reported for ESG in the published literature.

  • Reflux can improve or worsen

    GORD outcomes are mixed. Many patients improve as weight comes off, some report worse symptoms. Preoperative reflux assessment is essential.

  • PPI for 8 weeks and staged diet

    Twice-daily PPI for 8 weeks. Liquids 2 weeks, pureed 2 weeks, soft 2 weeks, then normal food. Written plan and dietitian support included.

  • Sutures may loosen over years

    Long-term durability depends on lifestyle change. Real-world cohorts report about 65% of patients maintaining at least 10% total body weight loss at 5 years.

  • Red flags after discharge

    Severe abdominal pain, high fever, persistent vomiting, black stools or vomiting blood: call the unit or go to A&E the same day.

Reading your ESG report

Your ESG report in four parts. Read the last one first.

Whichever unit and endoscopist did the case, the report you receive keeps to the same shape.

A UK bariatric physician reviewing an ESG procedure report

A quiet reminder

Bariatric language is precise and can read coldly, so ask your team to translate it.

Ask your bariatric team to talk you through the report before your dietitian review.

  1. 01 Header

    Baseline BMI, comorbidities and workup

    Your starting weight and BMI, HbA1c, lipids, blood pressure, sleep apnoea screen and the findings of your workup upper GI endoscopy.

  2. 02 Technique

    Suture pattern and gastric volume reduction

    How many sutures were placed, the pattern along the greater curve, estimated volume reduction and any anatomical notes on hiatus or antrum.

  3. 03 Findings

    Complications and completeness

    Any intra-procedure bleeding, muscle purchase issues, or need for additional sutures. Confirmation that the tubular shape was achieved end of case.

  4. 04 Impression

    Diet plan and follow-up schedule

    Read this first: the staged diet, when to restart medications, PPI duration, and the schedule of dietitian and clinician reviews over the next 12 months.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for ESG varies by insurer. Many treat it as an elective bariatric procedure and require pre-authorisation.

Frequently asked

Common questions about ESG.

Quick answers on weight loss, cost, eligibility, and how ESG compares to a surgical sleeve or a GLP-1.

  • What is endoscopic sleeve gastroplasty (ESG)?

    ESG is an endoscopic weight-loss procedure that reshapes the stomach into a narrow tube using an internal suturing device (Apollo OverStitch). Six to twelve full-thickness sutures are placed along the greater curve of the stomach through the mouth, reducing gastric volume by around 60%. There are no external incisions, no scars and no cutting or stapling of the stomach. It is done under general anaesthetic as a day case or with one night in hospital.

  • How much weight will I lose with ESG?

    The MERIT randomised trial published in The Lancet in 2022 reported 13.6% total body weight loss at 52 weeks with ESG plus lifestyle, compared with 0.8% for lifestyle alone. Real-world 5-year cohorts show around 65% of patients maintaining at least 10% total body weight loss. Adding a GLP-1 such as semaglutide typically increases the total, though the evidence is still maturing. Long-term results depend heavily on the diet, activity and behaviour changes you sustain.

  • How is ESG different from a surgical sleeve gastrectomy?

    A surgical sleeve gastrectomy removes 75 to 80% of the stomach through keyhole incisions and achieves around 30% total body weight loss on average, with more durable results and better outcomes for type 2 diabetes. ESG does not remove any stomach, uses no incisions, has no staple line and therefore no reported leaks, is a shorter recovery of 1 to 2 weeks compared with 4 to 6 weeks, costs less, and is in principle reversible. The trade-off is a lower weight-loss ceiling of around 13 to 18% total body weight.

  • What does ESG cost in the UK privately?

    An ESG bundled with 12 months of multidisciplinary follow-up is £14,000 to £18,000. Combined ESG plus a 12-month GLP-1 programme is £16,000 to £22,000. Revision ESG after a failed balloon is £13,000 to £17,000.

  • Am I eligible for ESG?

    ESG is typically offered to adults with a BMI of 30 to 40 who have tried and failed lifestyle interventions, and to selected patients with a BMI of 40 or above who decline surgery, have prior open abdominal surgery, or are otherwise unsuitable for a laparoscopic sleeve. You need a bariatric MDT assessment covering physician, endoscopist, dietitian and psychologist, and a workup upper GI endoscopy to exclude hiatus hernia, ulcer or malignancy.

  • What are the risks and what is recovery like?

    Recovery is faster than surgical bariatrics: most patients go home the same day, take one to two weeks off work, and return to full activity within a fortnight. Post-procedure nausea, retching and cramps are common for one to two weeks and are managed with anti-emetics and PPI. Bleeding from a suture site is rare (under 1%). Gastric perforation is very rare (under 0.5%). Notably, no leaks have been reported in the published ESG literature, unlike surgical sleeve. Long-term success needs sustained lifestyle change.

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