Gastric Sleeve Surgery vs. Endoscopic Sleeve Gastroplasty
Morbid obesity is a worldwide disease in pandemic proportion. Laparoscopic surgical treatment, such as Vertical Sleeve Gastrectomy (VSG), helps patients with weight problems and comorbidities like hypertension and diabetes type 2. Newer incision-less procedures, like Endoscopic Sleeve Gastroplasty (ESG), offer a less invasive approach for overweight individuals, producing comparable results with faster recovery.
In the traditional gastric sleeve procedure, a large portion of the stomach is cut and removed laparoscopically. However, Endo-Sleeve reduces the size of the stomach by folding and suturing it endoscopically without removing any tissues.
In this definitive guide, Mexico Bariatric Center® is shining a light on VSG and ESG procedures by examining their similarities and differences. Contact us to see which bariatric procedure is best for you to achieve a durable weight reduction and live a healthier and longer life.
What is VSG?
Vertical Sleeve Gastrectomy (VSG), or gastric sleeve, is a surgical solution for obese and super-obese subjects around the globe. The sleeve gastrectomy utilizes laparoscopic instrumentation that makes tiny incisions on the abdominal wall to gain access to the gastric cavity. The surgeon then resects a significant part of the stomach along its greater curvature.
The majority of Ghrelin hunger hormones (70%) residing in the upper part of the stomach is removed. As a result, food cravings and appetite are drastically suppressed.
The new smaller banana-shaped pouch restricts the amount of food you can eat. An additional benefit of this operation is the restoration of the body’s sensitivity to insulin and leptin hormones.
What is ESG?
Endoscopic Sleeve Gastroplasty (ESG), also known as the accordion procedure, is an innovative procedure in the gastroenterology field developed to replicate the effects of gastric sleeve surgery without the invasive repercussions. ESG mimics gastric restriction by reducing pouch volume internally while keeping it whole and intact.
Gastric emptying is delayed due to shrinkage of the stomach pouch. Therefore, patients are not getting as hungry.
An endoscopic suturing probe, the Overstitch, creates the smaller pouch. The instrument folds the stomach body with a triangular stitching pattern producing a tubular shape. The sewing and folding methods are much the same as the obsolete gastric plication surgery.
The Pros and Cons of VSG vs. ESG
Vertical Sleeve Gastrectomy (VSG) is a minimally invasive surgery that uses 3-5 small incisions, leaving tiny scars on the abdomen. Endoscopic Sleeve Gastroplasty (ESG) is a “scarless” procedure. The surgeon performs the procedure through the mouth and esophagus, leaving no external scars or internal adhesions.
Both methods effectively promote long-term health by reducing stomach capacity, though they cater to different patient profiles:
- The surgical sleeve is a permanent, high-potency tool for those with higher BMIs (30+)
- The endoscopic sleeve is an effective intervention for those with lower BMIs (28-35).
Unlike the well-established gastric sleeve, the endoscopic sleeve is a newer technique, and long-term data are still being gathered. However, early clinical trials show promising success for weight reduction.
Differential Effects of Gastric Sleeve vs. Endoscopic Sleeve Gastrectomy?
The notable difference between these two procedures is that the surgical gastric sleeve (VSG) typically provides higher expected excess weight loss (%EWL) and is better suited for the resolution of obesity-related health problems than the endoscopic sleeve gastroplasty (ESG).
While both aim to reduce stomach volume, the surgical sleeve has a slightly higher risk of complications as it involves the permanent removal of a large portion of the stomach through laparoscopic incisions. In contrast, the endoscopic sleeve is less invasive because it is performed via the mouth with no external incisions and no removal of tissue; instead, the stomach is folded and sutured.
Because neither procedure involves rerouting or bypassing the intestines, the risk of malabsorption is lower than with a gastric bypass, though maintaining proper vitamin intake remains important for surgical patients. Furthermore, there are more established revision surgery options for surgical sleeve patients. In contrast, the endoscopic sleeve offers the unique advantage of being potentially reversible or adjustable since the stomach anatomy remains intact.
Key VSG differences
- 4/5 of stomach excised (holds 200 ml)
- Hormones are severed and removed
- More weight loss reported
- Laparoscopic procedure
- Single-incision (SILS)
- Long-term data available
Key ESG differences
- 2/3 of stomach folded/sutured (holds 250 ml)
- Hormones remain intact
- No incisions are required
- Less hospital stay
- Fastest recovery rate
- No long-term data is available
Similarities
- The stomach is a very slim sleeve
- Lowers the amount of food intake
- Rapid weight loss
- Cures obesity-related comorbidities
Which Procedure is Best for Me?
For patients with significant scar tissue from prior abdominal procedures, the surgical gastric sleeve is often the ideal choice because it requires far less internal dissection and bowel manipulation than a bypass. It is also well-suited for those with a history of ulcers, patients who must continue taking aspirin or NSAIDs, and individuals who smoke, as it avoids the specific risk of marginal ulcers associated with intestinal rerouting.
In contrast, the endoscopic sleeve gastroplasty (ESG) is uniquely beneficial for patients who wish to avoid abdominal surgery entirely or those who are not surgical candidates due to high BMI or other health risks.
Do I Qualify for Gastric Sleeve?
- BMI 30+
- Existing Abdominal Scarring
- Previous Ulcer
- Sleeve is Easily Revised
Do I Qualify for Endoscopic Sleeve Gastroplasty?
- BMI between 28-39
- No history of large hiatal hernias or gastrointestinal bleeding.
- No prior abdominal surgeries (scar-free abdomen)
- Reversible (on certain conditions)
Consult with MBC’s top-rated weight loss surgeons in finding out the best option for you!
Comparing Costs and Insurance Coverage
In the United States, Endoscopic Sleeve Gastroplasty (ESG) typically costs between $10,000 and $15,000; however, because it is classified as a nonsurgical procedure, it is rarely covered by insurance. The vertical gastric sleeve (VSG) is generally more expensive, with self-pay prices ranging from $14,000 to $25,000, yet it has the advantage of being partially or fully covered by many insurance providers for patients who meet specific medical qualifications.
For those seeking more affordable options, medical tourism in border cities like Tijuana, Mexico, has become a popular alternative. In Mexico, these same procedures are often 50% to 75% less expensive, with VSG packages starting around $4,000 and ESG starting near $6,000, typically including all-inclusive hospital stays and local transportation.
Mexico Bariatric Center® offers all-inclusive packages for gastric sleeve in Mexico starting at $4,495* and endoscopic sleeve gastroplasty in Mexico starting around $6,695*.
Revision of ESG & VSG
Take Away
Conventional sleeve gastrectomy is a popular stand-alone surgery efficacious for obese and super-obese patients. Only 1% of the population who are qualified for bariatric surgeries like the gastric sleeve receive this life-changing operation due to several factors, including;
- Hesitation to go under the knife
- Low BMI around the 30s
- Insufficient insurance coverage
The recent advancement in endobariatric therapies, such as Endoscopic Sleeve Gastroplasty, has filled the gap between surgical and non-surgical weight loss procedures. Therefore, a greater percentage of patients can access incisionless obesity intervention tools, such as ESG, with minimal downtime.
The end-sleeve is a suitable therapy for overweight persons with less risk and faster recovery. Informing people about the pros and cons of ESG and VSG is crucial for a positive outcome.
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