The table describes general differences only. Your clinician must assess which option is appropriate.
| Factor | ESG | Gastric sleeve |
|---|---|---|
| Technique | Endoscopic suturing through the mouth | Laparoscopic surgery through small abdominal incisions |
| BMI guidance | Individual assessment; higher BMI may make surgery or another treatment more appropriate | Usually 35+ or 30+ with related conditions; history and anatomy decide suitability |
| Expected result | 13.6% average TBWL at 1 year in MERIT; 15.9% at 5 years in the eligible follow-up subset | Usually greater weight loss at 6–24 months; results vary by patient and programme |
| Hospital stay | Usually 1 night; some patients may leave the same day | Usually 2–3 nights |
| Recovery and travel | Desk work often about 1 week; allow about 4–5 nights in Istanbul | Desk work commonly 1–2 weeks; travel follows surgical clearance |
| Anatomy | No abdominal incision or stomach removal; sutures reshape the stomach | About 75–80% of the stomach is permanently removed |
| Reflux | New reflux reported in 1.3% in the MERIT trial | New or worsened reflux is a recognised consideration |
| Starting price | From £5,700 | From £2,450 for sleeve-only Ultra Eco; £4,550 Relaxation and £4,900 Luxury |
ESG uses Apollo OverStitch through the mouth to place full-thickness sutures along the greater curve of the stomach. No stomach tissue is removed and there are no abdominal incisions. A surgical sleeve uses laparoscopic access to remove about 75–80% of the stomach, leaving a narrow tube; the change is permanent.
Both procedures use general anaesthesia and require a staged nutrition plan. ESG usually takes about 60–90 minutes and usually involves one night of observation. Sleeve surgery commonly takes about 60 minutes and generally involves a two- to three-night stay.
The MERIT randomised trial reported 13.6% average total body weight loss after ESG at one year. A prospective single-centre cohort included 216 patients overall; 68 were eligible for five-year follow-up, and 82% of those had complete follow-up. Mean five-year TBWL was 15.9%. Ten-year conference reporting is emerging evidence and should not be used as a confirmed individual prediction until the original source is verified. Sleeve surgery generally produces more weight loss at 6–24 months, but requires lifelong nutritional monitoring after permanent stomach removal.
Reflux is another decision point. New reflux was reported in 1.3% in the MERIT ESG trial; a surgical sleeve can cause or worsen reflux in some patients. Existing reflux, a hiatal hernia, medicines, BMI and previous procedures should be discussed before choosing.
Answers reflect published evidence and the approved Istanbul Bariatric Center pathway.
Neither procedure is universally better. ESG avoids incisions and stomach removal, while a surgical sleeve generally produces greater weight loss but permanently changes anatomy. A clinician should assess your history, anatomy, medicines and goals rather than use a generic ranking.
MERIT reported 13.6% average total body weight loss after ESG at one year, while a five-year follow-up reported 15.9%. Sleeve studies usually report greater loss at 6–24 months. Study averages are not an individual prediction.
ESG patients often return to desk work in about one week, while surgical sleeve recovery is commonly longer. The treating team confirms discharge, activity and flight timing for the individual patient.
ESG starts at £5,700 for Relaxation and £6,850 for Luxury. Sleeve pricing starts at £2,450 for the sleeve-only Ultra Eco option, with £4,550 Relaxation and £4,900 Luxury options. Your written quote confirms scope.
Reflux history is important. The MERIT trial reported new reflux in 1.3% after ESG, while a surgical sleeve can cause or worsen reflux in some patients. A clinician should assess existing reflux, hiatal hernia and medication before recommending either option.
Because ESG does not remove stomach tissue, a later endoscopic revision or surgical procedure may remain possible for selected patients. That is not a guarantee; the anatomy, weight response and clinical reason for revision must be reviewed.