Endoscopic Sleeve Gastroplasty (ESG)
Sustainable weight loss with no surgery, no incisions, no stomach tissue removed. Internal endoscopic sutures reshape the stomach and reduce its volume by 60–75% in a one-hour outpatient procedure. Expected 15–20% body-weight loss over 12 months, with outcomes documented out to 10 years.
15–20%
weight loss
1 hour
day procedure
No incisions
endoscopic only
First consultation is complimentary. No commitment until full eligibility is confirmed.
Expected outcome
15–20%
of total body weight over 12 months
The science
Why ESG works where diets and injections stall
Why losing weight is biologically hard
Your body defends a "set point" weight. When you lose weight through diet alone, basal metabolic rate slows and hunger hormones rise — pulling weight back up. This is not a willpower problem; it is hard-wired physiology that evolved when food was scarce. Lasting weight loss requires changing the anatomy or hormonal signalling — not just eating less.
Why GLP-1 medications rebound when you stop
GLP-1 medications (Ozempic, Wegovy, Mounjaro) work brilliantly — while you take them. They temporarily mimic a natural hunger-suppression hormone. But they do not reset the body's defended set point. The STEP 1 trial extension (Wilding et al., 2022) showed that participants who stopped semaglutide regained most of their lost weight within a year. ESG, by contrast, modifies anatomy permanently.
How ESG fixes physiology — without surgery
The reshaped stomach holds less food (early satiety), empties more slowly (prolonged fullness), and appears to naturally increase the body's own GLP-1 secretion. This three-way mechanism acts on the same gut-brain axis that GLP-1 medications target — but anatomically and without ongoing injection. Outcomes are sustained because the anatomy itself has changed.
Every claim on this page is supported by peer-reviewed research indexed on PubMed. Full citations at the bottom of this page.
Is ESG right for me?
ESG sits between gastric balloon (smaller loss, 6 months) and surgical sleeve (larger loss but with incisions and hospital stay). It suits patients who want durable weight loss without surgery.
✓ Likely a good candidate if
- ✓BMI 30–40 (class I–II obesity)
- ✓Or BMI 27–30 with diabetes / hypertension / NAFLD
- ✓Tried diet and lifestyle without lasting results
- ✓Want durable loss without surgical risk
- ✓Committed to a 12-month structured program
✗ Not a good fit if
- ✗Active GI bleeding or severe peptic ulcer
- ✗Large hiatal hernia (>5 cm)
- ✗Severe uncontrolled GERD needing surgery
- ✗Prior gastric or bariatric surgery
- ✗BMI > 50 — surgical bariatric may be more appropriate
The program
What to expect across 12 months
Eligibility check & planning
Week 0 — Consultation
Meet with the consultant and dietitian. We review your medical history, medications, BMI, lab work, and goals. A pre-procedure upper endoscopy rules out a large hiatal hernia or H. pylori. We walk through the program in full and agree on a procedure date.
ESG — one-hour endoscopic procedure
Procedure day
Day-procedure under conscious sedation (no general anaesthesia). The consultant places the suture pattern through the endoscope, reshaping the stomach into a tubular sleeve. You go home the same day with anti-nausea medication, IV fluids if needed, and the WhatsApp number of your dedicated nurse.
Clear liquids + healing phase
Week 1
Clear liquids only for the first 7 days to allow the sutures to settle. Anti-nausea medication and acid suppressants prescribed. Daily WhatsApp check-ins from our nurse. Most patients lose 3–4 kg in this week from appetite reduction alone.
Full liquids → soft foods (staged)
Weeks 2–6
Gradual progression: full liquids (smoothies, yogurt drinks, protein shakes) for weeks 2–3, then soft foods (eggs, cottage cheese, blended soups) weeks 4–6. Three small meals plus two snacks per day, high protein. Weekly dietitian sessions to lock in the new eating pattern.
Active weight-loss phase
Month 2 onwards
Solid foods, structured eating plan. Monthly consultant visits + monthly dietitian. Average weight loss curve: ~5% body weight by month 1, ~10% by month 3, ~15% by month 6, peak ~18–20% by month 12. Lab work checked at 3 and 6 months for vitamin/protein status.
Long-term maintenance
Month 12 — Year 10
Annual follow-up visits to monitor weight, nutrition, and the integrity of the sleeve anatomy. The 10-year follow-up study (Jirapinyo, 2023) showed sustained weight loss in patients who maintained their lifestyle plan. ESG can be revised or combined with a GLP-1 maintenance phase if needed.
Why DIGEST for your ESG?
Advanced endoscopy expertise
ESG is a technically demanding procedure. Our consultants have decades of advanced therapeutic endoscopy experience — the same skill set used for ERCP, EUS, and complex polypectomy.
12-month follow-up included
Monthly consultant visits + 8–10 dietitian sessions + daily WhatsApp during the first 6 weeks. The program continues long after the procedure — that's where durable results come from.
Evidence-based protocol
We follow the ASGE-ESGE 2024 guideline for endoscopic bariatric therapy. Pre-op workup, suture pattern, post-op diet, and long-term monitoring all align with peer-reviewed best practice.
Bariatric dietitian on-team
A dedicated bariatric dietitian guides you through the four diet phases. Most patients credit the dietitian — not the procedure — as the single biggest factor in their long-term results.
The team
Consultants with advanced therapeutic endoscopy training
Prof. Abdulrahman Al-Jabreen
Professor & Consultant in Gastroenterology, Hepatology & Endoscopy
- Therapeutic ERCP and EUS
- Inflammatory bowel disease
- Liver disease and viral hepatitis
Prof. Majid Al-Madi
Professor & Consultant in Gastroenterology, Hepatology & Endoscopy
- Advanced therapeutic endoscopy
- Acute and chronic GI bleeding
- Liver disease and fatty liver
Pricing
All-inclusive package — the procedure, anaesthesia, dietitian, every monthly follow-up, lab monitoring, and long-term maintenance. No hidden add-ons.
Complete program
12 months · all-inclusive
Personalised quote after pre-op workup
Get it on WhatsApp
- Initial consultation + pre-procedure workup
- Pre-procedure upper endoscopy (rule out hernia/H. pylori)
- The ESG procedure (1 hour, conscious sedation)
- Bariatric dietitian (8–10 sessions)
- Monthly consultant follow-ups (12 visits)
- Daily WhatsApp support for first 6 weeks
- Lab work at months 1, 3, 6, 12
- Annual long-term review
Interest-free instalments available via Tabby and Tamara. Insurance does not typically cover elective bariatric procedures.
Frequently asked
Scientific references
- Kumar N, Abu Dayyeh BK, Lopez-Nava G, et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc. 2018;32(4):2159–2164. PMID: 29075966
- Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomized trial. Lancet. 2022;400(10350):441–451. PMID: 35908555
- Jirapinyo P, Kumar N, Shaikh S, et al. Ten Year Efficacy of Endoscopic Sleeve Gastroplasty. Gastrointest Endosc. 2023;97(6):AB34–AB35.
- Jirapinyo P, Hadefi A, Thompson CC, et al. ASGE-ESGE guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity. Gastrointest Endosc. 2024;99(6):867–885. PMID: 38639680
- Vargas EJ, Rizk M, Gomez-Villa J, et al. The effect of endoscopic sleeve gastroplasty on gastric emptying, motility, and hormones. Gut. 2023;72(6):1073–1080. PMID: 36241388
- Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–1564. PMID: 35441470
ESG is a real medical procedure, not a quick fix. Outcomes depend on your commitment to the diet plan and lifestyle change. Patients who skip dietitian visits or revert to old eating patterns lose less than the average. We decline to enroll patients who are not medically appropriate, regardless of their preference.
Start your transformation today
A complimentary 30-minute consultation to review eligibility, plan your goals, and pick the right option (ESG, balloon, or other). No commitment.