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.

Efficacy of VSG vs. ESG

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.

VSG vs ESG side by side comparison

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.


Vertical Sleeve Gastrectomy is commonly referred to as a “minimally invasive” surgery with minimal scarring. Endoscopic Sleeve Gastroplasty, known as “scarless,” is without abrasions and adhesions.

Both procedures have restrictive components to limit the amount of food intake. However, weight loss after sleeve gastrectomy is mainly caused by appetite suppression due to changes in fasting and postprandial Ghrelin, Glucagon-Like Peptide-1 (GLP-1), and Peptide-YY (PYY) Levels.

VSG VS ESG differences and similarities

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


  • The stomach is a very slim sleeve
  • Lowers the amount of food intake
  • Rapid weight loss
  • Cures obesity-related comorbidities

laparoscopic vs endoscopic procedures - Mexico Bariatric Center

Vertical Sleeve Gastrectomy (VSG)Endoscopic Sleeve Gastroplasty (ESG)
Method3-5 cuts (1 cut in SILS)No cuts
Stomach80-84% removal of the greater curvature64-72% reduction in gastric volume
AnatomyGut and metabolic hormones altered & gastric nerves severedGastric fundus intact
Duration45 min40 min
Hospital1 to 2 daysOut-patient (1 day)
Time off1 to 2 weeks5 – 10 days
Recovery3 – 4 weeks2 – 3 weeks
AdvantageMost common
Low risk
More weight loss
Higher safety profile
Reduced complication rate
Recovery expedited
DisadvantageTemporary hair loss
Hormonal imbalance
May increase GERD/reflux
No long-term safety or efficacy data
Less %EWL
Weight Loss65 – 85%  excess weight loss30 – 50% excess weight loss
Post-Op3 to 5 meals/day
800 – 1200 Cal
3 to 5 Meals/Day
800-1200 Cal
CriteriaBMI 30+
‘1st” Procedure
BMI of 28 to 35
“1st” Procedure

VSG vs ESG cost difference between US and Mexico

VSG Cost vs. ESG Cost

ESG therapy is roughly between $12,000 to $15,000 in the US and is typically not covered by insurance since it’s classified as a nonsurgical procedure. On the other hand, VSG can be more expensive as it can range between $20,000 to $25,000.

VSG can be partially covered by insurance, depending on your coverage qualifications. Both procedures are more expensive in U.S. and Cannada than in Mexico. The border city of Tijuana offers the same procedures for about 50% to 75% less than the total price.

Is ESG Better for Me?

Both procedures provide adequate weight loss results that lead to improved health long-term by trimming the gut. A vertical sleeve gastrectomy is an excellent option for those with higher BMIs (30+) looking for a more permanent weight loss tool. The endoscopic sleeve is a weight loss kickstart for those with lower BMIs (28 to 35).

Sleeve gastrectomy is a well-established bariatric procedure. There is no extended data available for Endo Sleeve; however, early on indications show patients’ success.

Revision of ESG & VSG

ESG to VSG Revision

Following a nutritional and exercise program is crucial for long-term success. If ESG yields undesirable results, patients have the option of revision surgery. Revisional operation is also necessary if sutures are loosened, come undone, or are incorrectly placed. Typically, the next viable option is switching ESG to VSG.

In most cases, the ESG to VSG conversion is feasible and not very complicated. The bariatric surgeon needs to undo the sutures endoscopically and perform the sleeve gastrectomy laparoscopically.

VSG to ESG Revision

Vertical sleeve gastrectomy has excellent success in curing obesity and its associated diseases. However, failures happen as patients fail to reach their goal weight in less than 20% of the cases due to:

  • Pouch Dilation
  • Hormonal Adaption
  • Improper Eating & Living Habits

If unsuccessful patients do not experience acid reflux/GERD, the restriction can be recreated with ESG. Endo-bariatric surgeons can perform a re-sleeve endoscopically to restore the sleeve and promote weight loss. Check other sleeve gastrectomy revision options.

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 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 endobariatrics therapies, such as Endoscopic Sleeve Gastroplasty, has filled the gap between surgical and non-surgical weight loss procedures. Therefore, a higher percentage of patients can acquire incision-less obesity intervention tools, like ESG, without much 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.