Endoscopic Sleeve Gastroplasty vs Sleeve Gastrectomy

Dr. Christopher McGowan
August 26, 2020

Losing weight is never easy, especially when relying on cutting calories or adding exercise into your weekly routine. While healthy eating and exercise are important for overall health as well as trimming down, it can be difficult to actually achieve the kind of weight loss outcome you’ve really been hoping for. This is because these traditional weight loss methods are both time consuming and challenging to sustain. As advances in bariatric surgery have provided new possibilities, surgical options like laparoscopic sleeve gastrectomy (LSG) have increased in popularity. But at True You, we want to provide non-surgical alternatives like endoscopic sleeve gastroplasty (ESG) that can get you the same results without the need for incisions.

What’s the Difference Between These Two Procedures?

Like many types of weight loss surgery, both a sleeve gastrectomy and an endoscopic sleeve gastroplasty work by the same principle: reduce the size of the stomach in order to decrease the amount of food it can hold. With less food able to be ingested in a single setting, the goal is to achieve an ongoing caloric deficit that will, in time, force the body to burn excess fat for energy. 

One of the primary differences between the two types, however, comes down to how the surgery is actually performed. A sleeve gastrectomy, which is currently the most common form of bariatric surgery, is performed laparoscopically; this means that the doctor inserts a special camera and tools through incisions in the abdomen in order to perform the surgery on the stomach. Compared to open surgery, where a large incision allows direct access to the abdomen, laparoscopy is considered minimally invasive and therefore preferable in terms of recovery time and surgery-related complications.

By contrast (and as the name implies), the endoscopic sleeve gastroplasty procedure we offer at True You uses gastrointestinal endoscopy (GIE) technology, which involves a long, flexible tube that can be inserted through the mouth. An endoscope also has a camera and tools attached to the end, but the fact that no incisions have to be made through the abdomen make it even more safe and with fewer potential complications. Indeed, due to how noninvasive it is, an endoscopic sleeve gastroplasty isn’t even actually considered “surgery.” Because no incisions need to be made, the recovery process is very quick and with much less discomfort. Patients return home within 1-2 hours after their procedure, and are back to work in 2-3 days.

The other big difference between the two procedures is related to the manner in which the stomach size is reduced. In a sleeve gastrectomy, the surgeon uses the laparoscope to actually cut and remove a sizable portion of stomach tissue along the greater curvature of the stomach. This stomach tissue, which represents about 80%-85% of total stomach volume, is totally removed from the body, and the remaining stomach tissue is formed into a banana-shaped gastric sleeve.

In an endoscopic sleeve gastroplasty bariatric procedure, we aim for a similar reduction in the volume of the stomach (70%-80%), but this reduction is achieved without removing stomach tissue. Instead, we use a specialized suturing tool mounted to the endoscope to plicate (another word for fold or corrugate) the excess stomach tissue from inside the stomach itself. In essence, a large portion of the stomach is partitioned off by sewing it shut along the greater curvature. The end result is a smaller-shaped stomach but without the need for any incisions. With ESG, we are also able to shorten the stomach. So instead of a banana-shaped tube, the stomach has a scrunched-up, pouch-like shape. This leads to slower emptying of food, and a prolonged sense of fullness.

How Much Weight Can You Lose?

One of the reasons both of these weight loss options have been gaining popularity in recent years is because of how effective they are, especially when compared to traditional methods of weight loss. Patients undergoing sleeve gastrectomy surgery can expect a total body weight loss (TBWL) of around 25%-30%; another way of looking at it is that you can lose 60%-70% of excess weight, which is defined as weight over and above what is considered normal for a person’s height and sex. A patient having an endoscopic sleeve gastroplasty can expect to lose a similar amount: 20% of total weight or 70% of excess weight.

What are the Pros and Cons of a Laparoscopic Sleeve Gastrectomy (LSG)?


  • Rapid Results: Compared to diet and exercise-based regimens (which people can languish with for years), LSG patients have reported losing as much as 70% of total weight loss within the first year. 
  • Simple Surgery: Unlike gastric bypass, where a complicated reformation of the stomach and small intestine is required, LSG is relatively simple and thus has less risk for complications.
  • Short Recovery: Patients recovering from the procedure usually only need to stay in the hospital for a couple days before they’re ready to return home.


  • Permanent: Once completed, the procedure is irreversible, so getting the surgery requires a lifelong commitment to living with reduced stomach capacity.
  • Complications: Even though the surgery is relatively safe compared to other types of surgery, the fact that abdominal incisions and significant tissue removal are necessary means that there is a higher risk of complications like internal bleeding, infection, or even death.
  • Possible Nutrient Deficiency: Restricting stomach capacity means that potentially fewer important bodily nutrients are actually absorbed by the digestive system; vitamin supplements may be necessary depending on the person.

What are the Pros and Cons of an Endoscopic Sleeve Gastrectomy (ESG)?


  • Non-Surgical: The best thing about ESG is that no actual surgery is necessary because the procedure is completely enodscopic. In fact, the only interaction with the stomach wall is the minuscule suturing device used to bind together the two sides of the stomach.
  • Quick Recovery: Even compared to LSG, which is already a rapid recovery, recovering from the ESG procedure is amazingly fast. Not only is an overnight hospital stay not even required, but the procedure is so mild that most people will be able to go back to work in about two days.
  • Fewer Complications: In general, any kind of surgery has risks related to the incisions themselves, typically leading to bleeding or infection. With ESG, the lack of incisions means that it is very unlikely to have such complications; in fact, there is a less than 1% chance of getting a complication.


  • Permanent: Like with LSG, ESG is irreversible.
  • Possible Nutrient Deficiency: Also like LSG, having the ESG procedure can potentially cause a deficiency in nutrients that may require dietary supplements. The good news is that after the first 1-2 months patients will eat a completely balanced, healthy diet, and are no longer at risk of deficiency.

Speak to A Weight Loss Professional

Many people seek a weight loss procedure for aesthetic reasons, but the truth is that overweight and obesity bring with them the possibility of different health concerns. So even though it feels great to have the body you’ve always wanted to have, losing weight can also rectify or improve a number of adverse health conditions: high blood pressure, heart disease, type 2 diabetes, and sleep apnea, just to name a few.

If you have a body mass index (BMI) over 30 and have been struggling to lose weight, it might be time to consider a new approach to weight loss. If you’re interested in learning more about weight loss procedures, request a consultation at True You Weight Loss. Our highly experienced staff can discuss the various non-surgical weight loss procedures we offer and which might be best for you.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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