ESG is a non-surgical, minimally invasive procedure that does not leave scars and is different from bariatric surgery. A specially trained doctor—sometimes a gastroenterologist or bariatric surgeon—gently passes a small, flexible scope called an endoscope down your mouth to place internal sutures that reduce your stomach capacity. Unlike a traditional surgical sleeve procedure (like LSG or VSG), ESG is performed without any incisions, and no part of your stomach is removed. You will be under anesthesia or sedation throughout the ESG procedure. Explore ESG procedure
Potential side effects of ESG
The most common side effects of an ESG procedure are nausea, abdominal pain, vomiting and abdominal discomfort—especially during the first week. Other symptoms like constipation, heartburn, or bloating may occur but usually go away within 30–60 days. Your doctor can help you understand what’s typical and when to check in if something feels off.
How ESG differs from GLP-1 medications
For many people on the path to weight loss, the treatment conversation will likely include GLP-1 medications, such as Wegovy®*. GLP-1s are prescription injections or pills that must be taken on a regular basis, and many people regain weight if they discontinue use.4
ESG is different. Coupled with diet and lifestyle changes, ESG has been shown to provide lasting weight loss without requiring ongoing weight loss medications
Understanding ESG costs and insurance coverage
As of May 2026, more than 100 million individuals may have access to ESG through their health insurance.† While multiple insurance companies include the procedure as a covered benefit, costs and insurance coverage can vary.
Our cost and coverage page reviews key considerations, explores how coverage works—including FSA and HSA eligibility—and outlines questions to ask your provider during your first conversation about ESG.
As seen in...
Read the journeys of real people who chose Endura Weight Loss Solutions and the ESG procedure.
Is ESG right for you?
If you're looking for a less-invasive weight loss alternative to surgery and have tried diet and exercise without lasting results, then ESG may be a good fit. The best way to know for sure is to speak with a local ESG provider who can help you understand your options.
This patient testimonial is sponsored by Boston Scientific. Results are from individual customer testimonials. Results in other cases may vary. In a study, patients with class 1 (BMI 30 to <35 kg/m²) or class 2 (BMI 35 to <40 kg/m²) obesity who underwent ESG in conjunction with prescribed diet and exercise counseling achieved an average of 13.6% total body weight loss at year one.
ESG FAQs
The ESG weight loss procedure usually takes 60–90 minutes, and studies have shown that most people typically went home the same day and returned to routine daily activities in 2–3 days.2,3 Like any other weight loss option, ESG requires a lasting commitment. To keep weight off, it’s important to live a healthy lifestyle, including eating well and staying active. Explore ESG recovery
Everyone experiences different results. In a clinical study, people lost an average of 13.6% of their total body weight 12 months after undergoing the ESG procedure and following a prescribed diet and exercise program.1 Diet and lifestyle changes after the ESG procedure can help support your weight loss goals. However, every person’s body and recovery experience are unique, so it’s important to follow your doctor’s specific instructions. Explore ESG recovery
No. In a clinical study, people lost an average of 13.6% of their total body weight 12 months after undergoing the ESG procedure and following a prescribed diet and exercise program.1 These results were achieved without taking GLP-1 medications. See how ESG and GLP-1s differ
The most common side effects of the ESG procedure are gastrointestinal symptoms such as nausea, abdominal pain, vomiting, constipation, burping, or diarrhea. These symptoms typically resolve within 30–60 days. All procedures have risks. Talk with an ESG provider about whether the weight loss procedure is right for you. Find a doctor
The ESG procedure is for adults with obesity who:
- Have a body mass index (BMI) of 30–50 kg/m2
- Prefer a non-surgical weight loss option
- Are not eligible for weight loss surgery
- Have not been able to lose weight or maintain weight loss through diet and exercise alone
Talk with an ESG provider about whether the weight loss procedure is right for you. Find a doctor
Your weight loss goals are within reach
Connect with an ESG provider to learn more about Endura Weight Loss Solutions and the ESG procedure.
Important OverStitch Endoscopic Suturing System Safety Information
ESG is performed using a suturing device called OverStitch. Learn about the risks of the OverStitch Endoscopic Suturing System & OverStitch NXT
Endoscopic Suturing System (“OverStitch”) for bariatric surgery:
Talk with your doctor to fully understand all the risks and benefits associated with using this device. Ask your doctor whether this device is right for you.
Indications for Use:
OverStitch is for adult patients with obesity with BMI between 30-50 kg/m2. OverStitch can reduce the size of the stomach by stitching the inside. It can also fix the stomach outlet from previous bypass surgery.
When OverStitch is used to help with weight loss, you need to follow a healthy diet and exercise program. You may not lose weight if you do not adopt healthy habits.
Contraindications:
Your doctor will ask you about your medical history and perform a physical exam to decide if OverStitch is right for you. At the time of your procedure, the doctor may detect internal issues that prevent you from receiving OverStitch. For example, stomach ulcers or inflammation in the stomach may impact device placement.
You should not receive OverStitch if you: have a large hiatal hernia; have a history of bleeding in your stomach or food pipe; have a history of eating disorders; are pregnant; have bleeding disorders or are on blood thinners.
Warnings:
Talk to your doctor if you develop major, continued upper abdominal or back pain with difficulty breathing at any time after getting OverStitch.
OverStitch contains nickel. Nickel may cause an allergic reaction in people with nickel sensitivity.
Potential Risks:
Breathing any foreign object or substance such as food, saliva, or stomach contents into your lungs; Intestine blockage; Switching to a different type of surgery; Nausea, vomiting, dehydration; Bleeding; Infection; Swelling, redness, and pain in tissues caused by injury or damage; Damage to or a hole through the tissue around the stomach, food pipe or surrounding organs; Unintended transfer of fluid or gas from one area of the body to another; Pain; Feeling pins and needles; Buildup of fluid around the stomach; Air leaking from the lungs; Difficulty breathing; Narrowing or tightening in the stomach; Wound opening; Death
MRI Safety Information:
OverStitch can be MRI scanned under certain conditions. Scanning under other conditions may result in injury or device malfunction. Inform your doctor or MRI technician of the device before undergoing an MRI scan. This allows them to take any needed precautions.
Individual weight loss may vary.
*All trademarks are the property of their respective owners. Any use of third-party trademarks, logos, or brand names is for identification purposes only and does not imply endorsement or affiliation.
†Covered lives are estimates based on data from Clarivate and Policy Reporter. Policies are subject to change or discontinuation.
For the OverStitch Endoscopic Suturing System you need to follow a healthy diet and exercise program to lose weight. You may not lose weight if you do not adopt healthy habits. Your doctor’s clinical team, including dietitians, nutritionists and/or exercise trainers, should help you on your weight loss journey.
1. Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): A prospective, multicentre, randomised trial. Lancet. 2022;400:441–451.
2. Kumar N, Abu Dayyeh BK, Lopez-Nava Breviere G, et al. Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique. Surg Endosc. Apr 2018;32(4):2159-2164.
3. Abu Dayyeh BK, Acosta A, Camilleri M, Mundi MS, Rajan E, Topazian MD, Gostout CJ. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clinical Gastroenterology and Hepatology. 2017;15(1):37-43.e1.
4. Budini B, Luo S, Tam M, et al. Trajectory of weight regain after cessation of GLP-1 receptor agonists: a systematic review and nonlinear meta-regression. eClinicalMedicine, 2026; 93
CAUTION: U.S. Federal law restricts this device to sale by or on the order of a physician.
All photographs taken by Boston Scientific.