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.
Why patients choose us
- 01
An IFSO-accredited bariatric endoscopist, in a JAG-accredited unit
Not a general endoscopy list. A named therapeutic endoscopist with an established ESG case volume, in a unit built for bariatric endoscopy.
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Honest about the ceiling
ESG typically achieves 13 to 18% total body weight loss. If a surgical sleeve or bypass fits you better, we say so before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private ESG costs in London.
Indicative ranges across our partner units. Send your BMI and history and we quote firm figures across two or three options.
In short
ESG in our London network: £12,000 to £18,000 all-in, home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| MDT bariatric assessment and workup endoscopy | £1,400–£2,400 | 90 min | Same visit |
| ESG procedure, all-inclusive day case | £12,000–£15,000 | 60–90 min | Home same day |
| ESG with 12-month multidisciplinary follow-up | £14,000–£18,000 | 60–90 min | 12 months care |
| ESG combined with GLP-1 (semaglutide) programme | £16,000–£22,000 | 12 months | Combined pathway |
| Revision ESG after failed intragastric balloon | £13,000–£17,000 | 75–120 min | Home same day |
| Second-opinion review of prior bariatric plan | £250–£450 | 30 min | 48 hours |
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. We come back with a firm quote within one working day.
The problem
The right procedure, the right endoscopist, the right expectations.
ESG is powerful when it fits and disappointing when it does not. We are honest about the ceiling, the trade-offs against a surgical sleeve, and how to make the weight loss durable.
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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. We say so.
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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.
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Who is doing the procedure?
A named IFSO-accredited bariatric endoscopist with an established ESG case volume, in a JAG-accredited unit with surgical back-up.
The journey
From first enquiry to 12 months of follow-up, what happens, in order.
One team from first message to the annual review. MDT workup, day-case procedure, staged diet, dietitian and clinician follow-up across the first year.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us your BMI, history and goals
A short, confidential form. Height, weight, prior weight-loss attempts, prior balloons or surgery, and medications including GLP-1s.
- 02
Before
We come back with a recommendation
Within one working day: whether ESG fits, or whether a surgical sleeve, bypass or GLP-1 programme is the better call. Indicative price. An honest read either way.
- 03
Before
Bariatric MDT assessment
Specialist bariatric physician, endoscopist, dietitian and psychologist. Upper GI endoscopy to exclude hernia, ulcer or malignancy. HbA1c and lipids.
- 04
On the day
Arrival at the unit
Arrival, consent and a chat with the endoscopist and anaesthetist. A general anaesthetic in a fully equipped theatre-grade endoscopy suite.
- 05
On the day
The ESG itself
60 to 90 minutes. A gastroscope carries the Apollo OverStitch device. Six to twelve full-thickness sutures run along the greater curve to create a tubular stomach.
- 06
On the day
Home the same day or overnight
Anti-emetics, IV fluids and a short recovery. Most patients home the same day; some stay one night. No incisions, no scars, no drains.
- 07
After
Staged diet and 12-month follow-up
Liquids for 2 weeks, pureed for 2, soft for 2, then normal. PPI for 8 weeks. Dietitian and clinician reviews across the first year, with optional GLP-1 add-on.
Typical workup: 2 to 3 weeks. Recovery: 1 to 2 weeks. Follow-up: 12 months.
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.
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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.
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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.
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Revision after a failed intragastric balloon
ESG can consolidate the weight loss from an Allurion or Orbera balloon into a durable restrictive procedure.
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Prior open abdominal surgery
When adhesions or previous laparotomy make laparoscopic bariatric surgery high risk, an endoscopic route avoids the abdominal wall entirely.
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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.
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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.
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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.
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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.
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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.
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Revision ESG
Sutures are added or replaced after a previous ESG that has loosened, or after a removed intragastric balloon, to restore restriction.
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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.
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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.
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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.
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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.
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TORe (transoral outlet reduction)
Endoscopic suturing to tighten a dilated anastomosis after a previous gastric bypass, restoring restriction without redo surgery.
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Second-opinion review
A specialist review of your imaging, endoscopy report and prior bariatric workup, so the pathway you choose is the right one.
Our vetted London network
A small panel of bariatric endoscopists, we picked them.
Consultants working in HCA The Wellington Bariatric, King's Private Bariatric, Chelsea and Westminster Private Advanced Endoscopy, Imperial Private Charing Cross and London Bridge Hospital. Introductions made privately, once we understand your case.
Selection criteria
How we choose every endoscopist in our ESG network.
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IFSO-accredited bariatric endoscopists with a documented ESG case volume
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JAG-accredited units meeting BSG standards for advanced therapeutic endoscopy
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Full bariatric MDT: physician, endoscopist, dietitian and psychologist
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Surgical bariatric back-up on the same site for escalation or revision
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.
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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.
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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.
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Bleeding from a suture site is rare
Reported in fewer than 1 in 100 cases. Usually settles conservatively; occasionally needs a repeat endoscopy.
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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.
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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.
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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.
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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.
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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.
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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 quiet reminder
Bariatric language is precise and can read coldly, we translate it for you.
If you would like us to talk you through the report before your dietitian review, just ask.
- 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.
- 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.
- 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.
- 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.
Ready to explore ESG?
Send your BMI and history. We come back with a firm plan within one working day.
A named IFSO-accredited bariatric endoscopist, an all-inclusive quote across two or three London units, and an honest read on whether ESG, a surgical sleeve or a GLP-1 pathway fits you best.
Recognised by major UK insurers
Cover for ESG varies by insurer. Many treat it as an elective bariatric procedure and require pre-authorisation. We confirm cover before booking.
Frequently asked
Everything we get asked about ESG.
Quick answers on weight loss, cost, eligibility, and how ESG compares to a surgical sleeve or a GLP-1.
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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.
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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.
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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.
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What does ESG cost in the UK privately?
The ESG procedure as an all-inclusive day case in our network is typically £12,000 to £15,000. 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. We confirm a firm figure within one working day.
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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.
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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.
Related treatments
Looking for something else?
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Allurion swallowable balloon
A capsule-swallowed gastric balloon, no endoscopy required.
Learn more -
Intragastric balloon (Orbera)
Six months of endoscopically placed gastric restriction.
Learn more -
TORe (transoral outlet reduction)
Endoscopic revision of a dilated bypass anastomosis.
Learn more -
SADI-S bariatric surgery
Single-anastomosis duodeno-ileal bypass with sleeve.
Learn more -
GLP-1 weight-loss clinic
Medically supervised semaglutide and tirzepatide programmes.
Learn more -
Wegovy (semaglutide) programme
A structured 12-month Wegovy pathway with dietitian support.
Learn more -
Obesity guide
A patient guide to obesity, its causes and treatment options.
Learn more -
Send Enquiry
Tell us your BMI and history, we come back within a working day.
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