Endoscopic Sleeve Gastroplasty in Turkey

Endoscopic Sleeve Gastroplasty (ESG) in Turkey is an endoscopic weight-management procedure that reduces the functional volume of the stomach using internal sutures placed through an endoscope.

Unlike surgical Sleeve Gastrectomy, ESG does not remove a large portion of the stomach and does not require external abdominal surgical incisions. However, it is still an invasive medical procedure that requires appropriate medical assessment, endoscopic equipment, anesthesia or sedation, and clinical follow-up.

ESG may be considered for selected adults with obesity as part of a broader weight-management programme that includes nutrition, lifestyle modification and medical follow-up.

It should not be presented as a guaranteed alternative to bariatric surgery or as a treatment that produces the same amount of weight loss in every patient.

For information about other weight-management procedures, see our Bariatric Surgery in Turkey section.

What Is Endoscopic Sleeve Gastroplasty?

Endoscopic Sleeve Gastroplasty, commonly abbreviated as ESG, is an endoscopic bariatric and metabolic therapy used for weight management in selected patients.

During the procedure, a flexible endoscope is passed through the mouth and into the stomach. A specialized endoscopic suturing system is then used to place full-thickness sutures in the stomach wall.

These sutures change the shape and functional capacity of the stomach without surgically removing stomach tissue.

The treatment is intended to support:

• earlier satiety;
• smaller meal portions;
• structured dietary change;
• long-term weight management.

ESG should be considered part of a complete obesity-treatment strategy rather than a stand-alone procedure that removes the need for nutrition and lifestyle follow-up.

How Does ESG Work?

ESG changes the shape and functional volume of the stomach using internal sutures.

The altered stomach configuration can help patients feel full after eating smaller portions and may influence how food moves through the stomach.

Weight loss after ESG is not caused by one mechanism alone. Outcomes can also be influenced by:

• energy intake;
• food choices;
• physical activity;
• obesity-related medications;
• metabolic health;
• behavioural factors;
• long-term follow-up;
• individual biological response.

Is ESG the Same as Gastric Sleeve Surgery?

No.

Endoscopic Sleeve Gastroplasty and surgical Sleeve Gastrectomy are different procedures.

Patients should not choose between ESG and surgical Sleeve Gastrectomy based only on whether abdominal incisions are used.

Factors such as BMI, obesity-related conditions, previous treatment, reflux, required amount of weight reduction, anesthesia risk and long-term treatment goals should also be considered.

For more information about the surgical option, see our Gastric Sleeve in Turkey guide.

Does ESG Remove Part of the Stomach?

No.

ESG does not involve surgical removal of a large part of the stomach.

The stomach remains in place and its internal configuration is changed using endoscopic sutures.

This is one of the main anatomical differences between ESG and surgical Sleeve Gastrectomy.

Does ESG Require Abdominal Incisions?

Routine ESG is performed through the mouth using an endoscope, so external abdominal surgical incisions are not normally required.

It is therefore more accurate to describe ESG as an endoscopic procedure without external abdominal incisions rather than using phrases such as “scarless surgery.”

Patients still undergo an invasive therapeutic endoscopic procedure requiring appropriate anesthesia, monitoring and aftercare.

Who May Be Considered for ESG?

Current professional guidance supports considering endoscopic bariatric and metabolic therapies together with lifestyle modification in selected adults with:

• a BMI of 30 kg/m² or higher; or
• a BMI between 27 and 29.9 kg/m² with at least one obesity-related medical condition.

These criteria do not mean that everyone within these BMI ranges is automatically suitable for ESG.

Individual assessment may also consider:

• weight and BMI history;
• previous attempts at weight management;
• type 2 diabetes;
• high blood pressure;
• sleep apnea;
• fatty liver disease;
• reflux symptoms;
• previous stomach surgery;
• eating behaviour;
• current medications;
• anesthesia risk;
• ability to participate in long-term nutritional and lifestyle follow-up.

Is ESG Only for Patients With BMI 30–35?

No.

A fixed BMI range of 30–35 should not be presented as the universal definition of an ideal ESG candidate.

Endoscopic bariatric therapies may be considered across a broader range of appropriately selected patients.

At higher BMI levels, ESG may still be discussed in selected individuals, including patients who do not wish to undergo bariatric surgery or who require another treatment approach.

However, patients who require substantial weight reduction should also discuss other options such as:

• anti-obesity medication;
• Gastric Sleeve;
• Gastric Bypass;
• other metabolic and bariatric procedures.

Who May Not Be Suitable for ESG?

ESG is not appropriate for every patient.

Depending on the individual case, another treatment or further investigation may be required when there are factors such as:

• certain previous stomach operations;
• important structural abnormalities of the stomach;
• active gastric ulcer disease;
• significant gastrointestinal bleeding;
• some large hiatal hernias;
• certain coagulation disorders;
• medical conditions that significantly increase anesthesia or endoscopy risk;
• pregnancy;
• inability to participate in the required dietary and medical follow-up.

The final eligibility decision should be made by the treating healthcare professional after individual assessment.

How Is Endoscopic Sleeve Gastroplasty Performed?

The exact technique can vary between treatment centres and endoscopists.

In general, ESG may involve:

1. medical assessment and pre-procedure preparation;
2. administration of appropriate anesthesia or sedation;
3. insertion of an endoscope through the mouth;
4. inspection of the stomach;
5. placement of full-thickness endoscopic sutures;
6. creation of a narrower gastric configuration;
7. final endoscopic assessment.

The exact suture pattern, number of sutures and treatment technique should be determined by the healthcare professional performing the procedure.

Does ESG Reduce the Stomach by a Fixed Percentage?

No fixed percentage should be guaranteed.

ESG changes stomach geometry and functional capacity, but the final configuration can depend on:

• baseline stomach anatomy;
• endoscopic technique;
• suture pattern;
• individual tissue characteristics;
• changes that occur during healing and longer-term follow-up.

Treatment success should therefore be evaluated according to overall clinical and weight-management outcomes rather than an exact promised percentage reduction in stomach volume.

How Much Weight Can You Lose After ESG?

Clinical research shows that ESG can result in meaningful weight loss when combined with structured lifestyle modification.

In the MERIT randomized clinical trial, patients treated with ESG plus lifestyle modification achieved an average 13.6% total body weight loss at approximately one year.

Systematic reviews and meta-analyses have also reported average total body weight-loss results generally in the mid-teens during follow-up.

These figures describe averages from study populations and are not guarantees for an individual patient.

Individual results can be influenced by:

• starting weight and BMI;
• dietary habits;
• physical activity;
• metabolic health;
• medications;
• behavioural factors;
• participation in follow-up;
• individual biological response.

Will Everyone Lose the Same Percentage of Weight?

No.

Published percentages represent averages across groups of patients.

Some individuals lose more weight and others lose less.

Therefore, claims such as “ESG guarantees 15–20% weight loss” should not be used.

Is ESG More Effective Than Lifestyle Changes Alone?

Randomized clinical evidence has shown greater average weight loss with ESG combined with lifestyle modification than with lifestyle modification alone in selected patients with obesity.

However, ESG does not replace lifestyle treatment.

Long-term care should continue to address:

• nutrition;
• physical activity;
• eating behaviour;
• obesity-related medical conditions;
• long-term weight maintenance.

Is ESG Better Than Gastric Sleeve?

Not for every patient.

ESG involves less anatomical alteration because stomach tissue is not surgically removed.

Surgical Sleeve Gastrectomy generally results in greater average weight loss but also involves abdominal surgery and permanent removal of part of the stomach.

A comparative meta-analysis found greater average weight loss after laparoscopic Sleeve Gastrectomy than ESG, while the procedures also had different adverse-event and reflux profiles.

The appropriate treatment depends on factors such as:

• BMI;
• weight-loss requirements;
• obesity-related medical conditions;
• previous treatments;
• surgical and anesthesia risk;
• patient preferences;
• long-term follow-up requirements.

Is ESG Completely Reversible?

ESG should not simply be described as a completely reversible procedure.

In selected circumstances, endoscopic sutures may be revised, removed or additional treatment may be performed.

However, tissue remodeling and scarring can occur over time.

Changing the gastroplasty may therefore require another endoscopic procedure and cannot be assumed to be simple or appropriate in every patient.

Can ESG Sutures Break or Loosen?

The stomach configuration and the effect of the sutures can change over time.

Weight recurrence should not automatically be blamed on the patient or explained simply by saying that the patient “broke the stitches.”

Long-term outcomes can be influenced by:

• tissue remodeling;
• suture durability;
• stomach adaptation;
• dietary behaviour;
• medications;
• metabolic changes;
• individual biological response.

Can ESG Be Revised or Repeated?

Repeat or revision endoscopic treatment may be considered in selected patients.

Before deciding on additional treatment, the healthcare team may assess:

• current stomach anatomy;
• the original ESG configuration;
• weight-loss history;
• weight recurrence;
• dietary intake;
• medications;
• behavioural factors;
• alternative obesity treatments.

Not every patient with weight recurrence needs another ESG procedure.

Can You Have Bariatric Surgery After ESG?

Potentially, yes.

Previous ESG does not automatically prevent a patient from later being considered for bariatric surgery.

Depending on the individual case, future options may include:

• Gastric Sleeve;
• Roux-en-Y Gastric Bypass;
• another metabolic or bariatric procedure.

Previous endoscopic suturing and tissue remodeling should be taken into account during future surgical planning.

Does ESG Cause Gastric Leaks?

ESG does not create the long surgical staple line used in Sleeve Gastrectomy and does not require surgical removal of stomach tissue.

This gives ESG a different complication profile from surgical Sleeve Gastrectomy.

However, it is incorrect to say that leakage, stomach-wall injury or serious complications are impossible.

Published ESG studies have reported serious adverse events including:

• gastrointestinal bleeding;
• perigastric fluid collection;
• significant abdominal symptoms requiring medical care;
• other procedure-related complications.

Systematic reviews have generally reported a low rate of serious adverse events, but low risk does not mean zero risk.

What Are the Possible Risks of ESG?

Common short-term symptoms may include:

• abdominal discomfort;
• cramping;
• nausea;
• vomiting;
• bloating;
• temporary difficulty tolerating food or fluids.

Less common but potentially more serious complications may include:

• gastrointestinal bleeding;
• dehydration;
• infection;
• perigastric fluid collection;
• gastric-wall injury;
• anesthesia-related complications;
• need for hospital treatment;
• need for additional endoscopic or surgical intervention.

The individual risk profile should be discussed before treatment.

Does ESG Require General Anesthesia?

ESG is generally performed with anesthesia appropriate for a complex therapeutic upper gastrointestinal endoscopic procedure.

The exact anesthesia plan can depend on:

• the medical facility;
• treatment protocol;
• patient medical history;
• airway assessment;
• anesthesia risk;
• the treating anesthesia team’s decision.

Patients should not assume that ESG is performed without anesthesia simply because it does not involve abdominal incisions.

Is ESG Painful?

Abdominal discomfort, cramping and nausea can occur during early recovery.

The intensity and duration vary between patients.

It is therefore inappropriate to promise that ESG will be painless or that everyone will experience the same recovery.

Severe, persistent or worsening pain should be medically assessed.

How Long Does ESG Take?

There is no single procedure time that applies to every patient.

Duration may depend on:

• patient anatomy;
• endoscopic technique;
• suture pattern;
• technical complexity;
• additional endoscopic findings;
• anesthesia and recovery requirements.

Recovery After ESG

Recovery is generally less extensive than recovery after laparoscopic bariatric surgery, but individual experiences vary.

During the early recovery period, patients may experience:

• nausea;
• abdominal discomfort;
• cramping;
• fatigue;
• temporary changes in food tolerance.

The time required to return to work or normal activity depends on symptoms, occupation and individual recovery.

A fixed recovery period should not be guaranteed for every patient.

What Is the Diet After ESG?

Patients generally follow a staged nutritional programme while the stomach adapts and tissues heal.

Depending on the treating team’s protocol, progression may include:

• appropriate liquids;
• thicker liquids or puréed foods;
• soft foods;
• gradual progression toward a structured long-term diet.

The exact schedule should be provided by the treating healthcare and nutrition team.

A generic online diet should not replace the patient’s individual treatment instructions.

When Can You Exercise After ESG?

Light movement may be appropriate during early recovery.

Return to more strenuous exercise should be individualized according to:

• pain;
• nausea;
• hydration;
• food tolerance;
• general medical condition;
• the treating team’s instructions.

ESG and Acid Reflux

ESG changes stomach anatomy differently from surgical Sleeve Gastrectomy.

Comparative studies have reported lower rates of new reflux after ESG than after surgical Sleeve Gastrectomy.

However, ESG should not be promoted as a treatment that guarantees prevention or cure of GERD.

Patients with significant heartburn, regurgitation, difficulty swallowing, hiatal hernia or known esophageal disease may require additional evaluation before treatment.

Can ESG Cause or Worsen Reflux?

Reflux outcomes vary between patients.

The reflux profile of ESG appears different from that of surgical Sleeve Gastrectomy, but no patient should be guaranteed that reflux symptoms will remain unchanged or improve.

ESG vs Gastric Balloon

ESG and intragastric balloon treatment are different endoscopic approaches to weight management.

A Gastric Balloon involves placement of a temporary space-occupying device inside the stomach.

ESG instead uses internal sutures to change stomach configuration.

The appropriate option depends on individual medical assessment and treatment goals.

Can Weight Return After ESG?

Yes.

Weight recurrence can occur after any obesity treatment.

Possible contributors can include:

• changes in eating behaviour;
• reduced physical activity;
• medications;
• metabolic adaptation;
• changes in stomach configuration;
• individual biological factors.

Obesity is a chronic disease and long-term management remains important after ESG.

Can Weight-Loss Medication Be Used With ESG?

Anti-obesity medication may be appropriate for selected patients before or after ESG.

The decision depends on factors such as:

• weight response;
• medical history;
• obesity-related conditions;
• medication contraindications;
• possible adverse effects;
• long-term treatment goals.

Medication should be prescribed and monitored by an appropriate healthcare professional.

How Much Does Endoscopic Sleeve Gastroplasty Cost in Turkey?

The cost of ESG can depend on the individual treatment plan, endoscopic equipment, anesthesia, medical assessment, medical facility and follow-up services.

Clinic Care Center does not currently publish a universal fixed ESG price on this page.

A written quotation should be provided after treatment availability and individual medical eligibility have been confirmed.

Patients should check whether the quotation includes:

• medical consultation;
• the ESG procedure;
• endoscopic suturing equipment;
• anesthesia;
• medical facility charges;
• pre-treatment investigations;
• prescribed medication;
• initial postoperative follow-up;
• nutrition support when specifically included;
• accommodation when specifically included;
• transfers when specifically included.

All included and excluded services should be confirmed in writing before travel.

Who Provides Endoscopic Sleeve Gastroplasty Treatment?

Clinic Care Center is a medical tourism provider and does not independently perform Endoscopic Sleeve Gastroplasty.

Medical assessment, confirmation of eligibility, endoscopic treatment, anesthesia, prescriptions and clinical follow-up must be provided by appropriately qualified healthcare professionals at a suitable medical facility.

The exact treating physician, medical facility and ESG system should be confirmed in the patient’s individual treatment plan before travel.

Clinic Care Center coordinates communication, appointments, treatment information and travel-related services for international patients.

What Should You Ask Before ESG?

Before proceeding with treatment, patients should understand:

• why ESG is being recommended;
• who will perform the procedure;
• where the procedure will be performed;
• which endoscopic suturing system will be used;
• what type of anesthesia is planned;
• which risks are most relevant to the individual patient;
• the expected range of weight loss rather than a guaranteed result;
• the nutritional follow-up programme;
• what happens if significant weight recurrence occurs;
• which services are included in the written quotation.

Frequently Asked Questions About Endoscopic Sleeve Gastroplasty

Is ESG bariatric surgery?

ESG is an invasive therapeutic endoscopic bariatric and metabolic procedure rather than conventional laparoscopic bariatric surgery. It is performed through the mouth and does not require surgical removal of stomach tissue.

Is ESG the same as Gastric Sleeve?

No. Sleeve Gastrectomy permanently removes a substantial portion of the stomach. ESG changes stomach configuration using internal endoscopic sutures.

Does ESG leave abdominal scars?

Routine ESG does not require external abdominal incisions, so it does not create the typical small abdominal scars associated with laparoscopic surgery.

How much weight can I lose with ESG?

Clinical studies show meaningful average weight loss, often in the mid-teens as a percentage of total body weight during follow-up. Results vary substantially between individuals and should not be guaranteed.

Is ESG safer than surgical Gastric Sleeve?

The two procedures have different risk profiles. ESG avoids surgical stomach resection but still has potential endoscopic and anesthesia-related complications. One treatment should not be described as universally safer for every patient.

Can ESG cause serious complications?

Yes. Serious complications are uncommon in published studies but can occur. Reported problems include gastrointestinal bleeding, perigastric fluid collections and other procedure-related adverse events.

Is ESG reversible?

Endoscopic revision or suture removal may be possible in selected situations, but ESG should not be described as completely or effortlessly reversible.

Can ESG be repeated?

Repeat or revision endoscopic treatment may be considered after medical and anatomical assessment in selected patients.

Can I have bariatric surgery after ESG?

Potentially yes. Previous ESG does not automatically prevent future bariatric surgery, but the previous gastroplasty should be considered during surgical planning.

Does ESG cure acid reflux?

No. ESG should not be presented as a guaranteed treatment for GERD. Patients with clinically significant reflux require individual assessment.

Is weight loss guaranteed?

No. Weight response varies according to patient characteristics, nutrition, physical activity, medical treatment, follow-up and individual biological response.

Medical References

• ASGE–ESGE Guideline on Endoscopic Bariatric and Metabolic Therapies for Adults With Obesity
• MERIT Randomized Trial – Endoscopic Sleeve Gastroplasty With Lifestyle Modification
• Systematic Review and Meta-Analysis – Efficacy and Safety of Endoscopic Sleeve Gastroplasty
• Meta-Analysis – Endoscopic Sleeve Gastroplasty Compared With Laparoscopic Sleeve Gastrectomy
• Systematic Review and Meta-Analysis – Worldwide Safety and Weight-Loss Outcomes of ESG

Request Information About Endoscopic Sleeve Gastroplasty

The Clinic Care Center international patient coordination team can provide information about ESG availability, consultation arrangements, treatment quotations and treatment coordination in Istanbul.

For an initial review, patients may be asked to provide information about:

• height and weight;
• weight history;
• medical conditions;
• current medications;
• previous obesity treatments;
• previous stomach or abdominal procedures;
• reflux or gastrointestinal symptoms;
• relevant medical reports when available.

An initial remote review may help determine the next steps but does not confirm eligibility for ESG and does not replace individual medical assessment.

Medical Disclaimer

This page provides general educational information and does not replace individual medical assessment, diagnosis or treatment advice.

Eligibility for ESG, expected weight loss, anesthesia requirements, possible risks, recovery and long-term follow-up vary between patients. Final medical decisions should be made by the treating healthcare professional after individual assessment.