How ESG works
An experienced endoscopist passes a flexible endoscope through the mouth and into the stomach. Using the FDA-cleared Apollo OverStitch suturing system, a series of full-thickness sutures are placed along the greater curvature of the stomach. These sutures fold the stomach inward, reducing its functional volume by roughly 70% and creating a tubular, sleeve-like shape — similar in effect to a surgical sleeve gastrectomy, but without removing tissue and without external incisions.
Why it can support weight loss
- Reduced functional stomach volume promotes earlier satiety with smaller portions.
- Slower gastric emptying may help maintain fullness between meals.
- Mechanical restriction provides structural support to behavioral and nutritional changes.
What ESG is not
- It is not a surgical sleeve gastrectomy — no stomach tissue is removed.
- It is not a gastric bypass — the digestive tract is not rerouted.
- It is not an intragastric balloon — sutures are durable and not removed at a set interval.
- It is not a substitute for lifestyle change, follow-up, or medical supervision.
Who may benefit
ESG is generally discussed for adults with a BMI in the range of approximately 30-40 who have not achieved sustained results through medically supervised lifestyle therapy and who prefer a less invasive alternative to traditional bariatric surgery. Candidacy must be confirmed by a qualified physician after an individual evaluation. See full candidacy guide.
Typical expected outcomes
Published cohorts report average total body weight loss of approximately 15-20% at 12-24 months in well-selected patients with appropriate follow-up. Individual outcomes vary and depend on starting weight, nutrition, activity, follow-up adherence, and medical conditions. See the evidence base.
Risks
As with any endoscopic procedure, ESG carries risks including nausea, abdominal pain, bleeding, and rare serious adverse events such as perforation. Reported rates of serious adverse events in published series are approximately 1-2%. All risks should be reviewed in detail during informed consent with the clinical team.
Recovery
Most patients are discharged the same day or after one night of observation, follow a staged liquid-to-solid diet over several weeks, and return to most normal activities within 1-2 weeks. See the full recovery guide.
FAQ
Is ESG a surgery?
ESG is an endoscopic procedure — performed through the mouth without external incisions. It is not a surgical sleeve gastrectomy and removes no stomach tissue.
Is ESG reversible?
The internal sutures placed during ESG can typically be revised or removed by an experienced endoscopist, although individual anatomy varies. Discuss reversibility with the clinical team.
How long does the procedure take?
ESG is generally performed in approximately 45-90 minutes under general anesthesia. Most patients go home the same day or the following morning.
How much weight can I lose with ESG?
Published series report average total body weight loss of approximately 15-20% at 12-24 months. Outcomes vary based on starting weight, adherence to nutrition and activity plans, and follow-up. No specific result is guaranteed.