ESG · EndoSleeve · OverStitch · POSE · IFSO surgeon · İzmir
Endoscopic sleeve gastroplasty failure: what a surgeon finds after an EndoSleeve failed
I do not offer endoscopic sleeve gastroplasty (ESG). It costs more than a gastric sleeve, and in my experience the result does not last. I have operated on more than 30 people after an ESG, EndoSleeve or POSE procedure stopped working. This page covers endoscopic sleeve gastroplasty failure from the operating table: what NICE says, why the stitches give way, what I find in theatre, what it costs in the UK and what your options are now.
Send your height, weight, the type and date of your procedure (ESG, EndoSleeve, OverStitch or POSE) and your symptoms. I reply personally, usually the same day. Flights are not included.
The short answer
Endoscopic sleeve gastroplasty failure: the short answer
Endoscopic sleeve gastroplasty narrows the stomach from the inside. An endoscope passed through the mouth places stitches that fold the stomach wall into a tube. There are no cuts, but it is done under general anaesthetic. Most people feel full very quickly in the first weeks. The patients I see are the ones for whom that feeling faded.
- 1
The restriction often fades
In the patients who come to me, normal appetite usually returned within weeks to months, and the weight followed.
- 2
The stomach is not the same afterwards
A thickened wall, an irregular surface and stitches grown into the tissue make any later operation more demanding.
- 3
It is expensive
UK private clinics publish prices of roughly £9,000 to £13,500, several times the cost of a gastric sleeve with us.
- 4
We do not offer it
We do not offer endoscopic sleeve gastroplasty: it costs more than a sleeve and, in our experience, the result does not last. If yours has failed, there are good options, set out below.
Where I stand: my view is not neutral. The people who reach me are those whose procedure did not work; anyone happy with their ESG has no reason to write to a revision surgeon. That is why this page sets my experience side by side with NICE and the published studies.
The procedures
ESG, EndoSleeve, OverStitch and POSE: what the names mean
EndoSleeve is not a medical term but an everyday name for endoscopic sleeve gastroplasty. In the UK, ESG is usually done with the OverStitch system; POSE is a different device that works with anchors. Both leave the whole stomach in place and fold it from the inside.
| Name | How it works | What stays in the stomach |
|---|---|---|
| ESG with OverStitch (Boston Scientific) | Running full-thickness stitches along the stomach, tightened into a narrower tube. | Stitches and the small fasteners that hold them |
| POSE / POSE 2 (USGI Medical) | Tissue anchors gather the stomach wall into folds, mainly in the body of the stomach. | Anchors and stitches |
| POSE 3 ("Double Helix") | A newer version: according to providers, fewer anchors that each hold two layers of folds. To my knowledge, independent long-term data are not yet available. | Anchors and stitches |
Endoscopic sleeve gastroplasty and related systems. Technical details from manufacturer and clinic information, September 2026.
Whichever system was used, the principle and the weak point are the same: the result depends on stitches holding in an organ that stretches and contracts with every meal.
What NICE and the NHS say
Is ESG approved in the UK? What NICE says, and why we still do not offer it
It is only fair to start with the official position. In February 2024 NICE said endoscopic sleeve gastroplasty can be used to treat obesity in adults with standard arrangements for clinical governance, consent and audit. It should be done in specialist weight management centres by trained clinicians, and every procedure should be recorded in the National Bariatric Surgery Registry. The committee concluded that the evidence shows the procedure is safe in the short and long term, and that people with a BMI over 30 lose weight when it is combined with lifestyle changes.
The numbers behind that are real. In the randomised MERIT trial (Abu Dayyeh and colleagues, The Lancet, 2022), people who had ESG lost on average 13.6% of their body weight after one year, against 0.8% with lifestyle changes alone. One NHS trust's patient leaflet quotes an average loss of 49% of excess weight at 12 months. For POSE 2, a 2025 meta-analysis in Obesity Surgery (Farooque and colleagues) reported 13.23% total weight loss at three months and 16.22% at six months.
So why do we not offer it? Approval means a procedure is acceptable, not that it is the best choice. After a gastric sleeve, large studies typically report losses of around a quarter to a third of body weight. ESG costs more than that operation in the UK, and in my experience the effect does not last: most of the patients I operate on had regained the weight within months. Trial averages also rarely include the people who later have surgery somewhere else, and those are exactly the people I see.
Study results are averages, not a promise for any individual. That applies to every procedure, including the ones we offer.
Recognising it
Signs of endoscopic sleeve gastroplasty failure
The people who come to me after an ESG, EndoSleeve or POSE were treated in different countries and clinics, yet their stories follow the same pattern:
- 1
The first days: nausea, cramps, very small portions
After the procedure they could eat very little, often with nausea and stomach pain.
- 2
A few weeks later: the appetite returns
In my experience the stitches start to loosen in many patients within the first week. It usually becomes noticeable a few weeks later, when portions start to grow again.
- 3
Follow-up: give it time
At the check-up they are told the effect needs time. Months pass, and the weight stalls or climbs back.
- 4
In the end: the same question as before
Surgery is back on the table, only now on a stomach that is harder to operate on, and after a five-figure sum has been spent.
If this is you: it is not a lack of willpower. When stitches give way, that is a mechanical limit of the procedure, not a personal failing.
Why it happens
Why ESG fails: stitches in a stomach that never stops moving
The stomach is not a static organ. It stretches with every meal and contracts with every wave of digestion. The stitches placed during endoscopic sleeve gastroplasty sit under that load all day, every day. As they lose tension, the folds flatten and the stomach gradually regains its volume. In the patients I have operated on, this is the most common mechanism of endoscopic sleeve gastroplasty failure.
I am not the only surgeon who has seen it. A 2019 case report in the Journal of Surgical Case Reports (Alhayo and Devadas) describes two women with persistent obesity despite repeated ESG. At revision, the stitches had come apart completely, and stitches and titanium clips had passed through the full thickness of the stomach wall, with adhesions around the stomach. The authors quote failure rates of between 50 and 90 per cent from earlier reports.
In theatre
What I find in theatre after a failed ESG
When I operate on a stomach that has had an endoscopic sleeve gastroplasty, I see from the outside what was stitched from the inside. Three findings come up again and again:
A thickened, scarred stomach wall
The stitches trigger inflammation that turns into scar tissue over weeks and months. In the treated area the wall is clearly thicker and stiffer than healthy tissue.
An irregular, puckered outer surface
Instead of a smooth surface there are dents and bulges. In some patients stitch material can be seen through the outer wall, a sign that it has passed through its full thickness.
Retained stitches and fasteners
Stitches, anchors and fasteners do not dissolve. They sit embedded in scar tissue, and exactly where cannot be fully mapped before the operation.
Why this matters for the staple line: a gastric sleeve is made with a stapler that divides and seals the stomach along a line, and it is designed for healthy, even tissue. A thick, scarred wall and embedded material make a secure staple line harder to achieve, and an insecure staple line raises the risk of a leak, the most serious complication after a sleeve. The warning signs are explained under gastric sleeve leak symptoms.
That is why I plan these operations as revisions rather than first operations: an endoscopy beforehand, an oversewn staple line and a leak test during the operation.
Durability
Is endoscopic sleeve gastroplasty permanent?
The stitches are designed to stay, and ESG is marketed as a long-lasting procedure. In practice the question is not whether the stitches remain in the stomach, but whether they keep holding the folds together. In the patients I see, they did not.
Can it be redone? Some centres offer a repeat procedure, and a published report describes a repeat ESG after a failed POSE as technically feasible. In my view, repeating the same mechanism in a stomach that has already stretched it once rarely changes the long-term result, and each round adds scar tissue for any future surgeon.
If your appetite has come back, it is worth having an endoscopy to see what is left of the folds before deciding anything.
Comparison
ESG vs gastric sleeve: the differences at a glance
Many people choose ESG because they want to avoid an operation. That is understandable. Here is the honest comparison, based on the studies and on what I see after ESG:
| ESG | Gastric sleeve | Mini gastric bypass | |
|---|---|---|---|
| Access | endoscope through the mouth | keyhole surgery, small incisions | keyhole surgery, small incisions |
| Anaesthetic | general | general | general |
| The stomach | folded and stitched from inside | most of the stomach is removed | small stomach pouch, part of the small intestine bypassed |
| What stays | stitches and fasteners in the wall | fine staples along the staple line | fine staples along the staple line |
| Stay | often same day or one night | 4 nights in hospital, no hotel | 4 nights in hospital, no hotel |
| Lasting effect | limited in our experience | permanent reduction; regain is possible later | permanent, with an added metabolic effect; often better with reflux |
| Price | about £9,000–£13,500 (UK private) | from £3,000 | from £3,500 |
ESG vs gastric sleeve and mini gastric bypass. Which option suits you depends on your weight, your health and whether you have reflux.
How the operation itself works and what your stay looks like are explained on gastric sleeve Turkey, and how we approach safety is set out in how safe gastric sleeve surgery in Turkey is.
Cost
Endoscopic sleeve gastroplasty cost in the UK and Turkey
UK private clinics publish prices for endoscopic sleeve gastroplasty of roughly £9,000 to £13,500, depending on what the package includes. NHS access depends on local commissioning, so many people look at private clinics or abroad.
If you are comparing ESG prices in Turkey, you will find offers. You will not get one from us: we do not offer ESG, because it costs more than a gastric sleeve and in our experience the result does not last. What we can quote are the operations that do last:
| Procedure | Where | Price | Note |
|---|---|---|---|
| ESG (OverStitch, POSE) | UK private | about £9,000–£13,500 | varies by clinic; not offered by us |
| Gastric sleeve (first operation) | İzmir | from £3,000 | all-inclusive, 4 nights in hospital |
| Gastric sleeve after ESG or mini gastric bypass after ESG | İzmir | from £3,500 | all-inclusive, 4 nights in hospital |
Endoscopic sleeve gastroplasty cost in UK private clinics (published prices, September 2026) compared with our prices. Flights are not included.
Included in our prices: surgery and anaesthetic, all tests including endoscopy, four nights in hospital with a companion in your room, airport transfers and twelve months of follow-up by video call and WhatsApp. You pay on the day of surgery, with no deposit and no instalment plans, and there is no extra charge if a complication needs treatment. Full details are on gastric sleeve surgery price in Turkey.
If yours has failed
My EndoSleeve failed: what are my options?
A failed endoscopic sleeve gastroplasty does not rule out effective treatment. It changes the planning. This is how we approach it:
- 1
Assessment on WhatsApp
Send your height, weight, the type and date of your procedure, your symptoms and, if you have it, the report. I will tell you honestly what is possible and what is not.
- 2
Endoscopy on arrival
It shows how much of the folding is left, where stitches and fasteners sit, and whether there is reflux or inflammation.
- 3
Gastric sleeve after ESG
Without significant reflux, a sleeve is often the natural route. After ESG it is more demanding than a first operation, but feasible with a surgeon experienced in this anatomy.
- 4
Mini gastric bypass after ESG
With heartburn, acid-blocking tablets or marked reflux, a mini gastric bypass is often the better choice. It adds a metabolic effect, and deficiencies are clearly less common than after a classic Roux-en-Y bypass.
- 5
Medication as support
GLP-1 medication such as Mounjaro or Wegovy can help before or after surgery, but it does not change a scarred stomach. More on bariatric surgery after GLP-1.
The decision is made together: I do not commit to a procedure on WhatsApp. The endoscopy in İzmir confirms or changes the plan before anything is fixed.
Other revision routes, such as re-sleeve or sleeve to bypass, are summarised under gastric revision surgery in Turkey.
Your stay in İzmir
Gastric sleeve after ESG in İzmir: five days, four nights in hospital
- 1
Day 1: arrival and tests
VIP transfer from İzmir airport straight to the hospital. Blood tests, ultrasound, a heart scan and assessment by cardiology, chest medicine and anaesthesia, plus the endoscopy. You spend the first night on the ward.
- 2
Day 2: surgery
Keyhole surgery under general anaesthetic. You are up and walking within hours. I do not place a routine drain.
- 3
Nights 1 to 4: hospital, not hotel
Hospital stay until discharge, with no hotel transfer. Doctors and nurses are there around the clock, which matters most in the first days after an operation on a previously treated stomach. A companion can stay in your room, with meals included.
- 4
Day 5: discharge and flight home
You leave with your diet plan and a report for your GP, and you are driven straight to the airport. Follow-up continues for twelve months by video call and WhatsApp.
Before you travel: there is no liver-shrinking diet. If you use Mounjaro, Wegovy or Ozempic, you do not need to stop weeks in advance; ideally your last dose is about one week before surgery. After surgery come two weeks of liquids, two weeks of soft purée and solid food from the first month.
Without surgery
Not ready for surgery? Alternatives to ESG
Not everyone wants or needs an operation. If you have not had ESG yet and are still deciding, these are the alternatives I can recommend honestly, with their limits:
- 1
Gastric balloon for six months
Placed by endoscopy and removed after six months. It leaves no stitches and nothing behind in the stomach wall. The first three days are often unpleasant, with nausea and cramps. With us it costs £1,200, plus £250 for removal; details under gastric balloon Turkey.
- 2
Weight loss injections
GLP-1 medication works for as long as you take it. After stopping, many people regain weight.
- 3
A diet and activity programme
The foundation of every treatment, though on its own rarely enough for severe obesity.
None of these reduces the stomach for good. The difference from ESG: after a balloon your stomach is as it was before, and any later operation remains a straightforward first operation.
Who operates
Op. Dr. Volkan Arayıcı: revision surgery after ESG as everyday work
I have worked exclusively in bariatric and metabolic surgery since 2014, I am a member of IFSO and I have performed more than 5,000 operations at a JCI- and TEMOS-accredited hospital in İzmir. Revisions after ESG, gastric bands and sleeves are a regular part of my work, and I have operated on more than 30 patients after an endoscopic sleeve gastroplasty.
I operate on every patient myself and answer WhatsApp enquiries personally. What patients write about their treatment with us is collected under gastric sleeve Turkey experiences, my background is on Op. Dr. Volkan Arayıcı, bariatric surgeon in Izmir, and if the weight returns after a sleeve, weight regain after gastric sleeve explains what helps. For a band that has stopped working, see gastric band revision to sleeve.
Frequently asked questions
Endoscopic sleeve gastroplasty failure: your questions answered
What are the signs of endoscopic sleeve gastroplasty failure?
The typical signs of endoscopic sleeve gastroplasty failure are portions that grow again, hunger that returns and weight that stalls or comes back within months. In the patients I see, the stitches had loosened. An endoscopy shows how much of the folding is left and is the first step before deciding on anything else.
Is endoscopic sleeve gastroplasty permanent?
The stitches are meant to stay, and ESG is promoted as long-lasting. Whether the folds keep holding is another matter: in the patients who come to me, the stitches had loosened and the stomach had regained its volume. NICE considers the procedure effective on average; my experience covers the people for whom it did not last.
Can I have a gastric sleeve after ESG?
Yes. A gastric sleeve after ESG is more demanding than a first operation because the wall is thickened and stitches or fasteners are embedded in it, but it is feasible. With significant reflux a mini gastric bypass is often the better choice. The decision follows an endoscopy. With us it costs from £3,500, all-inclusive.
How much does endoscopic sleeve gastroplasty cost in the UK?
UK private clinics publish prices of roughly £9,000 to £13,500, depending on what the package includes. NHS access depends on local commissioning. We do not offer ESG; a gastric sleeve with us costs from £3,000 and a gastric sleeve after ESG from £3,500, flights not included.
Is ESG safer than a gastric sleeve?
ESG has no incisions and a shorter recovery, and NICE considers it safe. A gastric sleeve is a bigger operation with surgical risks such as bleeding or a leak. The trade-off is durability: in my experience ESG often does not last, and a later operation on a stomach treated with ESG is more demanding than a first sleeve.
Which is better, ESG or gastric sleeve?
In an ESG vs gastric sleeve comparison, ESG is less invasive, while a sleeve gives substantially more weight loss in large studies. For someone with severe obesity who wants a result that lasts, I recommend a sleeve or a mini gastric bypass rather than ESG. The right choice depends on your weight, your health and whether you have reflux.
Does the NHS offer endoscopic sleeve gastroplasty?
NICE allows ESG in specialist weight management centres, and some NHS hospitals provide it. Whether it is available to you depends on local commissioning and eligibility criteria, which is why many people look at private clinics.
Is EndoSleeve the same as ESG or POSE?
EndoSleeve is an everyday name for endoscopic sleeve gastroplasty. In the UK it is usually done with the OverStitch system, which uses running stitches. POSE is a different device that folds the stomach with anchors. The principle, and the weak point, are the same.
Do you offer endoscopic sleeve gastroplasty in Turkey?
No. We do not offer ESG, EndoSleeve or POSE: they cost more than a gastric sleeve, and in our experience the results do not last. We treat people whose EndoSleeve failed, and we offer gastric sleeve, mini gastric bypass and gastric balloon.
My EndoSleeve failed. Is it my fault?
No. When stitches loosen in a stomach that stretches with every meal, that is a mechanical limit of the procedure, not a lack of willpower. What matters now is an honest assessment of your stomach and your options.
Has your ESG failed? Ask before you decide.
Send me your height, weight, the type and date of your procedure, your symptoms and, if you have it, the report. You will get an honest first assessment of your endoscopic sleeve gastroplasty failure: gastric sleeve, mini gastric bypass, or no operation for now.
WhatsApp: +90 532 466 67 67This page is for information and does not replace a medical consultation. Results are individual and no outcome is guaranteed. Information on other providers' procedures and prices comes from publicly available sources, September 2026.
Op. Dr. Volkan Arayıcı
Specialist in Bariatric & Metabolic Surgery · Izmir, Turkey
This article was written and medically reviewed by Op. Dr. Volkan Arayıcı. Dr. Arayıcı has been exclusively specialising in bariatric surgery since 2014 and has performed over 5,000 procedures at a JCI- and TEMOS-accredited hospital in Izmir.
✍ Published: June 18, 2026 · 🔄 Updated: September 12, 2026 · About the author →
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