Written by: Estexper Medical Editorial Team
Medically reviewed by: Fatih Karaca, MD
For people considering obesity treatment, gastric sleeve surgery and endoscopic sleeve gastroplasty (ESG) both reduce stomach capacity to support portion control and weight loss, but they use different approaches and have different recovery profiles.
In Short
Gastric sleeve surgery generally produces greater average weight loss than ESG, but it involves surgery and permanent removal of part of the stomach. ESG is performed through the mouth without abdominal incisions or stomach removal and usually has a shorter recovery, although average weight loss is generally lower. The most suitable option depends on factors such as BMI, reflux symptoms, medical history, treatment goals and assessment by a qualified multidisciplinary team.
What Is Gastric Sleeve Surgery?
Laparoscopic sleeve gastrectomy, often called gastric sleeve surgery or LSG, is a metabolic bariatric operation. During the procedure, a substantial portion of the stomach is removed, leaving a narrower, sleeve-shaped stomach. Patients generally feel full after eating smaller portions.
LSG is an established surgical treatment for obesity and can provide significant weight loss. It may also improve obesity-related metabolic health, although individual results vary and ongoing nutrition, physical activity and medical follow-up remain important.
Because part of the stomach is removed, LSG permanently changes the stomach. It also involves general anesthesia, abdominal incisions and the usual risks associated with surgery.
What Is Endoscopic Sleeve Gastroplasty?
Endoscopic sleeve gastroplasty is performed through the mouth using an endoscope. The physician places a series of internal sutures to reduce and reshape the stomach, creating a sleeve-like configuration without removing stomach tissue or making external abdominal incisions.
ESG is less invasive than LSG and generally has a shorter recovery and hospital stay. It may be considered for selected adults who prefer a nonoperative approach, are unwilling or unable to undergo surgery, or may have a higher risk from surgical intervention. ESG is an important endoscopic option, but it is not considered equivalent to gastric sleeve surgery in expected weight loss or metabolic impact.
ESG is generally considered within a comprehensive obesity-treatment programme that includes nutritional guidance, behavioral support and medical follow-up. The procedure does not eliminate the need for long-term lifestyle changes.
Gastric Sleeve vs Endoscopic Sleeve Gastroplasty: Key Differences
| Feature | Gastric sleeve surgery | Endoscopic sleeve gastroplasty |
|---|---|---|
| Approach | Laparoscopic surgery through abdominal incisions | Endoscopic procedure performed through the mouth |
| What happens to the stomach? | Part of the stomach is permanently removed | The stomach is reshaped with internal sutures; no stomach is removed |
| Expected weight loss | Generally greater than with ESG | Clinically meaningful, but generally lower than with LSG |
| Hospital stay | Usually longer than ESG | Usually shorter; some patients may be discharged the same day or after overnight observation |
| Recovery | Requires recovery from surgery and abdominal incisions | Usually a less invasive recovery, with temporary pain and nausea possible |
| Reflux considerations | May cause or worsen gastroesophageal reflux in some patients | Comparative evidence suggests a lower risk of new-onset reflux, although outcomes vary |
| Long-term certainty | More established as metabolic bariatric surgery | Long-term durability and comparisons remain less certain |
Which Procedure Produces More Weight Loss?
Based on current comparative research, gastric sleeve surgery generally produces more weight loss than ESG. A systematic review published in 2026 that included 13 comparative studies found greater total body weight loss, excess weight loss and BMI reduction after LSG at both six and 12 months.
A 2022 meta-analysis of 6,775 patients reported that LSG produced approximately 7.5 to 9.9 percentage points more total body weight loss than ESG at six and 12 months, and approximately 7.6 percentage points more at 24 months. In one comparative academic-centre study, total body weight loss at 12 months was approximately 29% after LSG compared with approximately 18% after ESG.
These figures describe results across study groups and should not be treated as a personal prediction. The studies included patients with different baseline BMIs, medical conditions and treatment preferences. Differences in follow-up and patient selection may influence the results, and most comparative evidence is observational rather than based on randomized trials.
In practical terms, LSG may be considered when a patient prioritizes greater expected weight loss and is medically suitable for surgery. ESG may be appropriate when a patient values a less invasive approach and accepts that average weight loss may be lower.
Risks and Safety
Risks of gastric sleeve surgery
Because LSG is an operation, it carries risks related to anesthesia, abdominal surgery and stomach resection. Recovery can involve pain, nausea, reduced energy and temporary difficulty progressing through the postoperative diet. Surgical complications are possible, and the procedure may cause or worsen gastroesophageal reflux in some patients.
Gastric sleeve surgery permanently changes the stomach. This is an important consideration for anyone comparing it with a stomach-preserving procedure. The treating surgeon should explain the potential benefits, risks and symptoms that require medical attention before treatment.
Risks of endoscopic sleeve gastroplasty
ESG avoids abdominal incisions and stomach removal, so its recovery is generally less invasive. Temporary abdominal or upper abdominal pain, nausea and vomiting can occur after the procedure. Patients also need to follow a staged diet while the stomach adapts and the sutures heal.
Although serious complications are generally reported less often or as less severe with ESG than with LSG in comparative studies, safety estimates vary. The available studies differ in design, patient selection and definitions of complications. ESG is not risk-free, and the endoscopist should discuss procedure-specific risks and the possible need for further treatment.
Reflux and digestive symptoms
Reflux is an important part of the decision. Meta-analytic evidence suggests a lower risk of new-onset gastroesophageal reflux after ESG than after LSG. However, reflux results are heterogeneous and cannot predict what will happen to every individual. Patients with existing reflux symptoms should discuss them carefully during the consultation.
Recovery After Each Procedure
Recovery after gastric sleeve surgery
Recovery after LSG includes healing from abdominal surgery and gradually returning to normal activity. The hospital stay is generally longer than after ESG. Patients usually progress through liquids and other staged foods according to the surgeon’s instructions, while monitoring hydration, tolerance and symptoms.
Because LSG is a surgical procedure, return to normal routines may take longer than after ESG. The exact timing depends on the patient’s health, the surgical team’s protocol and the presence of any complications. Follow-up appointments are important for monitoring recovery, nutrition and weight loss.
Recovery after ESG
ESG commonly has a shorter hospital stay. Practical recovery information from Cleveland Clinic notes that some patients may leave on the same day or after overnight observation, although discharge depends on individual symptoms and the treating team’s assessment.
Temporary pain, nausea and reduced appetite are common considerations. The diet is progressed gradually from liquids toward soft and solid foods under professional guidance. Some people return to work relatively quickly, but the appropriate timeline depends on the type of work, general health and symptom control.
Patients travelling internationally for treatment should plan sufficient time for the procedure, medical review, early follow-up and recovery before returning home. The clinic should provide written instructions, emergency contact information and a plan for continuing follow-up after the patient leaves the country.
Who May Be a Candidate?
ESG may be considered for carefully selected adults, commonly those with a BMI in the 30–40 range, people who prefer to avoid an operation, or patients whose medical condition makes surgery less desirable. BMI alone does not determine suitability. Eating behavior, previous weight-loss attempts, reflux, medications, psychological readiness and ability to attend follow-up are also relevant.
LSG may be considered when a patient needs or prefers a surgical metabolic procedure and is medically suitable for anesthesia and surgery. It may be more appropriate when a greater degree of weight loss is a central goal, provided the potential benefits outweigh the surgical risks.
Neither procedure is suitable for everyone. A physician should review medical history, current medications, previous procedures, nutritional status and expectations. Patients should also understand that long-term results depend on sustained dietary and lifestyle support rather than the procedure alone.
How to Prepare for Treatment in Turkey
International patients should request a detailed medical assessment before travelling. This may include medical records, BMI and weight history, current medications, previous endoscopy or surgery reports and information about reflux or other digestive symptoms. The treating team should confirm which procedure is recommended and explain why.
Before booking, ask about the qualifications of the medical team, the facility where treatment will take place, the expected length of stay, what is included in follow-up and how complications would be managed. Written instructions should cover fasting, medications, transport, accommodation, dietary progression and contact arrangements after returning home.
A consultation should also clarify that comparative research has limitations. LSG generally offers more weight loss, while ESG generally offers a less invasive recovery. Choosing between them is a medical decision, not simply a comparison of advertised outcomes.
Which Is Better: Gastric Sleeve or ESG?
There is no single best procedure for every patient. Gastric sleeve surgery may be better suited to a medically appropriate patient who prioritizes greater expected weight loss and accepts permanent stomach removal, surgical risks and a longer recovery.
ESG may be better suited to a patient who prioritizes a nonoperative, stomach-preserving approach, wants a shorter recovery or may face greater risk from surgery. The trade-off is that average weight loss is generally lower, and long-term durability and metabolic effects are less certain than with established metabolic bariatric surgery.
The decision should be made after an individualized consultation with a qualified bariatric surgeon, gastroenterologist and, where appropriate, nutrition and psychological professionals.
Frequently Asked Questions
Is ESG the same as a gastric sleeve?
No. Gastric sleeve surgery removes part of the stomach through laparoscopic surgery. ESG reshapes the stomach with endoscopic sutures and does not remove stomach tissue. The American Society for Metabolic and Bariatric Surgery states that ESG is not equivalent to metabolic bariatric surgery in expected weight loss or metabolic effects.
Is ESG safer than gastric sleeve surgery?
ESG generally has a less invasive recovery and comparative studies often report shorter hospital stays and lower or less severe morbidity. However, findings vary between studies, and ESG still has potential complications. Individual safety depends on health status, experience of the treatment team and appropriate patient selection.
Will weight return after either procedure?
Weight outcomes vary, and no procedure guarantees permanent weight loss. Ongoing nutrition, physical activity, behavioral support and medical follow-up are important after both ESG and LSG. Your medical team should explain how follow-up will be organized after treatment.
Can international patients have ESG or LSG in Turkey?
International patients may be assessed for treatment in Turkey, but suitability must be determined by the treating medical team. Patients should arrange pre-treatment evaluation, recovery time, travel planning and continuing medical support before returning home.
Medical References
- Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: comparative effectiveness, safety, and metabolic outcomes: A Systematic Review and Evidence Synthesis — Obesity Surgery / PubMed.
- Comparative Effectiveness and Safety Between Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: a Meta-analysis of 6775 Individuals with Obesity — Obesity Surgery / PubMed.
- IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management — International Federation for the Surgery of Obesity and Metabolic Disorders.
- Endoscopic Sleeve Gastroplasty (ESG) FAQ & CPT Code Information — American Society for Metabolic and Bariatric Surgery.
- Endoscopic Sleeve Gastroplasty, Laparoscopic Sleeve Gastrectomy, and Laparoscopic Band for Weight Loss: How Do They Compare? — Surgical Endoscopy / PubMed.
- Endoscopic Sleeve Gastroplasty: Procedure & Side Effects — Cleveland Clinic.
