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Endoscopic Sleeve and Surgical Gastric Sleeve are two popular weight loss options that have helped many people achieve their weight loss goals. Endoscopic Sleeve is an out patient, non-surgical procedure in which the size of the stomach is reduced by approximately 70% by way of an endoscope. On the other hand, Surgical Gastric Sleeve, otherwise known as the Laparoscopic Sleeve Gastrectomy (LSG), is a surgical weight loss procedure that involves removing a portion of the stomach and creating a sleeve-like shape.

Both surgeries have their pros and cons, and the choice between the two ultimately depends on the individual's specific needs and goals. Endoscopic Sleeve is less invasive and has a shorter recovery time, but it may not be as effective for those with a higher BMI or those who have previously undergone weight loss surgery. Surgical Gastric Sleeve has a higher success rate for long-term weight loss and can also improve conditions such as heart disease and high blood pressure, but it carries a higher risk of complications and requires a longer recovery time.

Definition of Endoscopic Sleeve and Surgical Gastric Sleeve

Endoscopic Sleeve, also known as Endoscopic Sleeve Gastroplasty (ESG), is an out-patient, non-surgical treatment in which an endoscope is used to taper the size of the stomach. The procedure is performed under general anesthesia and involves inserting a small camera through the mouth into the stomach. The camera is used to guide the placement of sutures that reduce the size of the stomach, creating a sleeve-like shape. The procedure typically takes 60-90 minutes, and patients can usually go home the same day.

Surgical gastric sleeve, also known as vertical sleeve gastrectomy, is a weight loss treatment in which a portion of the stomach is extracted to make it smaller. This procedure is usually carried out laparoscopically, meaning that small incisions are made in the midsection, and a camera and surgical tools are inserted through them. The practitioner then removes approximately 80% of the stomach, leaving behind a narrow sleeve-shaped stomach.

Procedure and Recovery

Endoscopic Sleeve Procedure and Recovery

During an endoscopic sleeve procedure, the patient is sedated, and a flexible tube with a camera is inserted through the mouth and into the stomach. The surgeon then uses special tools to place sutures in the stomach, reducing its size by up to 70%. The whole treatment can be completed in as little as an hour. 

Recovery time for an endoscopic sleeve procedure is relatively quick, with most patients able to return to normal activities within a day or two. However, patients are advised to follow a liquid diet for the first few days after the procedure and then gradually transition to solid foods over the course of several weeks.

Surgical Gastric Sleeve Procedure and Recovery

Surgical gastric sleeve is a more invasive procedure that involves making several incisions in the abdomen. The surgeon then removes a portion of the stomach, leaving a sleeve-shaped tube. This protocol is effective at reducing the size of the patient's stomach while helping them feel full faster.

As a more invasive procedure, Surgical Gastric Sleeve generally comes with a longer recovery period than Endoscopic Sleeve. Patients may need to stay in the hospital for a few days after the procedure and may need to take several weeks off work and other normal activities.

During the recovery period, patients will need to take special care to avoid complications such as blood clots, infections, and leaks. They will also need to attend follow-up appointments with their surgeon to monitor their progress and make any necessary adjustments to their diet or medication regimen.

Benefits and Risks

Endoscopic Sleeve Benefits and Risks

Some of the benefits of ESG include:

  • No incisions or scars
  • Shorter recovery time compared to traditional surgery
  • A decreased risk of complications, such as infections and bleeding
  • Lower risk of malnutrition compared to other weight loss surgeries
  • Potential improvement in obesity-related health conditions such as diabetes, high blood pressure, and sleep apnea

However, there are also some risks associated with ESG, such as:

  • Potential for stomach perforation during the procedure
  • Nausea, vomiting, and abdominal pain after the procedure
  • Possible weight regain over time
  • Limited data on long-term efficacy and safety

Surgical Gastric Sleeve Benefits and Risks

Some of the benefits of Surgical Gastric Sleeve include:

  • Significant and sustained weight loss (around 50 - 60%)
  • An improvement in obesity-related health conditions, such as diabetes, sleep apnea, and high blood pressure
  • Potential reduction in mortality and overall health risks associated with obesity

However, there are also some risks associated with Surgical Gastric Sleeve, such as:

  • Longer recovery time compared to ESG
  • Higher risk of complications such as infections, bleeding, and blood clots
  • Higher risk of malnutrition and vitamin deficiencies
  • Potential for long-term complications such as gallstones 

Overall, both ESG and Surgical Gastric Sleeve come with their own sets of benefits and risks, and patients should refer to an experienced practitioner before making a final decision on their treatment. 

Effectiveness and Results

Endoscopic Sleeve Effectiveness and Results

A study published in the Journal of Clinical Gastroenterology found that patients who underwent ESG lost an average of 16.3% of their excess weight after one year. Another study found that ESG resulted in an average weight loss of 15.9% at six months and 19.7% at one year.

ESG is also associated with improvements in comorbidities, including type 2 diabetes, sleep apnea, and high blood pressure. Studies have found that ESG can lead to a significant reduction in HbA1c levels in diabetes patients.

Surgical Gastric Sleeve Effectiveness and Results

Data from the American Society for Metabolic and Bariatric Surgery indicates that, on average, Surgical Gastric Sleeve patients lose around 60-80% of their excess weight within the first year after surgery. 

Surgical Gastric Sleeve is also associated with major reductions in comorbidities, including type 2 diabetes, high blood pressure, and sleep apnea. Data shows that this procedure is much more effective at treating Type 2 Diabetes than when it is addressed with medical therapy alone. 


The price of these procedures will vary depending on many factors, such as the location of the practice or hospital, the practitioner's experience, the type of anesthesia used, and the length of the hospital stay. In general, endoscopic sleeve procedures tend to be less expensive than surgical gastric sleeve procedures because they are less invasive and require less time in the hospital. That said, it's essential that patients consult with an experienced healthcare professional to determine the best course of action based on their needs and budget before moving forward. 

Summary of Endoscopic Sleeve vs Gastric Sleeve

Overall, patients should carefully consider the cost and benefits of both procedures before making a decision. Both treatments come with their pros and cons, and these must be carefully weighed before going forward with either one. Above all, it is vital that patients refer to a well-versed practitioner in order to ensure that they make an informed decision on their treatment. 

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