Endoscopic sleeve gastroplasty (ESG) in Turkey: what it is and how it works
Endoscopic sleeve gastroplasty (ESG) is a weight-loss procedure that reduces the size of the stomach from the inside, without any cuts in the skin and without removing any of the stomach. A flexible endoscope with a suturing device on its tip is passed through the mouth into the stomach, and the surgeon places a series of stitches along the stomach wall, pulling it together into a narrower, tube-like shape that resembles the sleeve created by gastric sleeve surgery. The smaller stomach fills sooner, and the new shape also slows emptying, so you feel full on smaller portions. It is also called endoscopic sleeve or non-surgical sleeve, but it is an operation under general anaesthesia and needs a proper follow-up programme.
This guide explains how endoscopic sleeve gastroplasty (ESG) works, what the evidence says, what it costs compared with the UK, US and Germany, who qualifies, recovery, risks and how to check a team. For the wider choice of weight-loss procedures see our bariatric treatments in Turkey.
How is endoscopic sleeve gastroplasty (ESG) done, step by step?
The procedure takes about 60 to 90 minutes under general anaesthesia. The endoscope is passed through the mouth and the stomach is inspected. The suturing device then places full-thickness stitches in a pattern, usually along the greater curvature and the front and back walls, and the stitches are tightened to fold the stomach into a tube that is roughly 60 to 70 percent smaller. No tissue is cut or removed and no staples are used. Most people stay in hospital for one night for observation, fluids and anti-nausea medicine. Because nothing is cut from the outside, there are no scars and no hernia risk from incisions.
Does endoscopic sleeve gastroplasty (ESG) work? What the evidence says
Yes, within limits. A randomised controlled trial known as MERIT, published in The Lancet, found average total body weight loss of around 13 to 14 percent at one year in people who had ESG with lifestyle support, against less than 1 percent in the lifestyle-only group, with most people keeping weight off at two years. Other studies report similar numbers over longer periods, and improvements in blood sugar, blood pressure and fatty liver. This is less weight loss than after a laparoscopic gastric sleeve or gastric bypass, which typically reach about 25 to 30 percent. Long-term data over many years are still more limited than for surgery. ESG is not a one-off fix; it works when combined with a diet and exercise programme and regular reviews. A reliable hospital will give you ranges, not guarantees.
Endoscopic sleeve gastroplasty (ESG) cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for the procedure and the hospital stay, not hospital quotes. Each hospital confirms its own price in a written quote after reviewing your medical history.
| Country | Approximate cost range |
|---|---|
| Turkey | €3,500 – €8,000 |
| United Kingdom | €6,500 – €12,000 |
| United States | €9,000 – €17,000 |
| Germany | €6,000 – €12,000 |
What changes the price: the endoscopist's experience, the number of sutures, the length of stay, pre-operative tests such as blood tests, ECG and gastroscopy, and the dietitian and follow-up programme. A package normally includes the consultation, tests, the procedure, anaesthesia, one or two nights, medicines, a diet plan and airport transfers. Ask whether remote follow-up with a dietitian is included.
ESG, gastric sleeve, balloon or band: how do the options compare?
ESG sits between a temporary balloon and a surgical sleeve in both effect and invasiveness. The table shows typical positions, and your bariatric team should explain which one fits your BMI and health.
| Option | Suited to | Typical limits |
|---|---|---|
| ESG | BMI roughly 30 to 40 who want no incisions and no stomach removal | Less weight loss than surgery; stitches can loosen and weight can return |
| Gastric sleeve | BMI about 35 and above, larger weight-loss goals | Permanent; part of the stomach is removed |
| Gastric balloon | Lower BMI, short-term support | Temporary; removed after about six months |
| Gastric band | Patients who want an adjustable, reversible device | Implant remains; requires frequent adjustments |
There is no single right answer. People with severe obesity, or diabetes that needs strong weight loss, are often advised to have surgery because it gives larger and more durable results.
Who qualifies for endoscopic sleeve gastroplasty (ESG)?
ESG is usually offered to adults with a body mass index of about 30 to 40 who have not lost weight with diet and exercise, and in some centres to people with a lower BMI and obesity-related conditions. Professional societies such as the American Society for Gastrointestinal Endoscopy and the American Society for Metabolic and Bariatric Surgery describe it as an option for this group. You are less suited if you have a very high BMI, a large hiatus hernia, active stomach ulcers, severe reflux, a previous stomach operation that changed the anatomy, bleeding disorders, or untreated eating disorders, or if you are pregnant. A gastroscopy before the procedure checks the stomach.
What does the diet look like after ESG?
The procedure only works with eating changes. Most programmes follow stages: clear and full liquids for the first one to two weeks, then pureed food for about two weeks, soft food for two to four weeks, and then normal textures in small portions from about six to eight weeks. You need around 60 to 80 grams of protein daily, slow eating, small bites and no drinking with meals. Vitamin and mineral supplements may be advised. Alcohol and fizzy drinks are usually avoided, and snacking in the evening undermines the stomach reduction. A dietitian should follow you for at least a year, including from home by video.
Your trip to Turkey and endoscopic sleeve gastroplasty (ESG) recovery
Plan three to five nights in Turkey: pre-operative tests on the first day, the procedure on the second, a night of observation and a review before you travel. Nausea, stomach cramps, a sore throat and bloating are common for several days, and are usually controlled with medicines. Most people walk the same evening and go back to desk work after about three to seven days. Avoid heavy lifting and intense exercise for around two weeks. Because there are no wounds, long flights are usually fine if you walk and drink fluids; the team will advise on blood-thinning measures. A written diet plan and contacts for questions are part of a good package. See how our process works for how coordination continues after you return.
Endoscopic sleeve gastroplasty (ESG) results: what happens to your weight over time?
Weight loss is fastest in the first three to six months and levels off by 12 to 18 months. For many people the result is a drop of about 10 to 20 percent of body weight, though individual results vary widely with diet, activity and adherence. Photographs are less dramatic than after bypass surgery; improvements in blood sugar, joint pain and sleep apnoea often appear before large visual changes. Weight can return if portion sizes increase or if the stitches loosen, and a few patients need a repeat endoscopic procedure or conversion to surgery. Ask the hospital what percentage of its patients keep their weight off at two years.
Risks and complications of endoscopic sleeve gastroplasty (ESG)
Common effects in the first days are nausea, vomiting, abdominal pain, a sore throat and bloating. Less common risks are bleeding, infection, a leak or perforation of the stomach wall, fluid around the lung, a blood clot, a narrowing that makes swallowing difficult and reactions to anaesthesia. Serious complications are uncommon but may need hospital treatment or surgery. Long-term, weight regain and reflux can occur. Information on bariatric procedures is available from the NHS, the American Society for Metabolic and Bariatric Surgery and the American Society for Gastrointestinal Endoscopy. Ask the team what its complication rate is and what emergency facilities exist.
How to choose an ESG team and hospital, and questions to ask
Look for a hospital with an experienced bariatric endoscopist who performs ESG regularly, an anaesthetist, an intensive-care unit and the ability to convert to surgery if needed, plus a dietitian and psychologist. Red flags include promises of a set weight loss, a quote without pre-operative tests, no named doctor, no follow-up plan and pressure to book quickly. You can start with our free quote page, sending your height, weight and history. Questions to ask:
- How many ESG procedures do you perform each year?
- Do I qualify for ESG or would surgery suit me better?
- What weight loss do your patients reach at 12 and 24 months?
- Who follows me up, and for how long, after I return home?
- What happens if the stitches loosen or I regain weight?
Hospitals with Bariatric Surgery in Turkey
Frequently asked questions
ESG is a weight-loss procedure in which stitches placed through the mouth with an endoscope reduce the stomach to a narrow tube. There are no skin incisions and no part of the stomach is removed.
A randomised trial reported average total body weight loss of about 13 to 14 percent at one year with lifestyle support. It works when combined with diet changes and follow-up, and gives less weight loss than gastric sleeve surgery.
Approximate ranges are €3,500 to €8,000 in Turkey, against about €6,500 to €12,000 in the UK. The hospital confirms its price in a written quote that states what the package includes.
ESG tightens the stomach with stitches and removes nothing, while gastric sleeve surgery removes about 80 percent of the stomach with staples. Sleeve surgery typically gives larger and more durable weight loss.
Adults with a BMI of about 30 to 40 who have not succeeded with diet and exercise are the usual candidates. A large hiatus hernia, active ulcers or a prior stomach operation can rule it out.
Most people go back to desk work after three to seven days and avoid heavy lifting for about two weeks. Nausea and cramps are common for a few days and are managed with medicines.
You are under general anaesthesia during the procedure. Afterwards most people have stomach cramps, nausea and a sore throat for a few days, which can be controlled with medicines.
Yes. Weight can return if portions grow or if the stitches loosen. A diet plan, regular reviews and sometimes a repeat procedure help; ask the hospital how it handles regain.
Serious complications such as bleeding, a leak or an infection are uncommon but possible. Safety depends on a trained endoscopist, a hospital with intensive care and a clear follow-up plan.
Three to five nights is usual: tests, the procedure, a night of observation and a review before you fly. The hospital will set the schedule after reviewing your history.