Endoscopic sleeve gastroplasty in Medellín
From COP 14,000,000 to 32,000,000, performed by endoscopy with no incisions
Endoscopic sleeve gastroplasty, also known as the endoscopic sleeve, ESG or the Apollo method, reduces the stomach with sutures placed from the inside, through the mouth, without cutting the abdomen or removing any part of the stomach. At MDE Care we help you compare it with the surgical sleeve and the gastric balloon, tell you the price before you decide, and coordinate your assessment with a bariatric endoscopy specialist and, if you are traveling from abroad, your stay in Medellín.
0
abdominal incisions
60 to 90
minutes, under general anesthesia
1 night
of observation, for most people
13.6%
of total body weight at one year
USD 8,000 to 15,000
is the cost in the United States
Endoscopic sleeve, surgical sleeve or gastric balloon: which one fits you?
With your height, your weight and three answers, we show you the option that usually fits cases like yours, why, and what each one costs.
Your BMI
34.9
Do you want to avoid abdominal incisions?
Are you looking for something temporary or long-lasting?
Do you have type 2 diabetes, high blood pressure, sleep apnea or another weight-related condition?
It changes the guideline criteria for surgery and for endoscopy.
How they differ, in numbers
15.2% vs 29.3%
of total body weight at one year, endoscopic versus surgical sleeve, in a comparative study (Clinical Endoscopy 2021)
17.5% vs 10.4%
of total body weight at one year, endoscopic sleeve versus balloon, in a meta-analysis of 28 studies
1.3% vs 17.9%
new-onset reflux: endoscopic versus surgical sleeve
2%
serious adverse events with the endoscopic sleeve in the MERIT trial
Your guidance
Answer the questions
Your result
Pending
What is missing
- Tell us whether you want to avoid abdominal incisions to see the option that usually fits your case.
In the United States, endoscopic sleeve gastroplasty costs between USD 8,000 and 15,000 when paid out of pocket.
* Guidance only, based on published guidelines and studies. It does not replace the judgment of the bariatric endoscopy specialist or the bariatric surgeon, who determine the option at the assessment based on your medical history and test results. Reference prices; the final quote is provided after the assessment.
Your weight over time with the endoscopic sleeve
We apply the published averages at 1, 2 and 5 years to your weight and compare them with what diet and exercise alone achieve.
Your BMI is 34.9. This is what the published averages mean for your weight:
At one year, in the MERIT trial
With endoscopic sleeve
13 kg
Diet and exercise only
1 kg
In MERIT, the average loss was 49.2% of excess weight.
Estimated weight, in kilograms
82.3%
achieve at least 10% weight loss at one year
61%
maintain at least 10% at 5 years
68%
maintained at least 25% of excess weight loss at 2 years
Each point comes from a different study: 1 year, the MERIT trial (The Lancet 2022); 2 years, an IFSO meta-analysis of 44 studies; 5 years, a cohort of 216 patients. Because they come from different groups, the curve is not that of a single person; over the long term some weight may be regained. Each patient’s result depends on adherence to diet, physical activity and follow-up. This is an estimate for guidance only, not a promise of results, and it does not replace the specialist’s judgment.
What endoscopic sleeve gastroplasty is and how it works
The specialist passes an endoscope through the mouth into the stomach and, with a suturing device, places full-thickness stitches along the greater curvature. The stitched folds turn the stomach into a tube similar to that of the surgical sleeve, at about 30% of its original size, so you feel full with less food.
Unlike the surgical sleeve, the abdomen is not cut and no part of the stomach is removed, and the stitches can be adjusted or removed if necessary.
The Apollo method and international endorsement
- In July 2022, the US FDA authorized the Apollo ESG system, the first approved for this technique, in adults with a BMI of 30 to 50.
- It is performed by gastroenterologists or surgeons with specific training in bariatric endoscopy.
- The UK’s NICE has accepted it as an option for adults with obesity since 2024, and the International Federation for the Surgery of Obesity (IFSO) endorses it as an effective and valuable intervention after reviewing 44 studies.
Less volume
The stomach is left at about 30% of its original size.
No incisions
Everything is done through the mouth, with no abdominal scars.
The stomach is preserved
No tissue is removed; it is folded and stitched from the inside.
Adjustable stitches
They can be adjusted or removed if needed.
Evidence reviewed by IFSO
15,714
patients in 44 studies: an average total body weight loss of 17.6% at 12 months.
From the procedure to solid food
What usually happens at each stage, according to published references.
Day 0
60 to 90 minute endoscopy
Under general anesthesia. There are no wounds to care for.
The first night
Observation
Some people go home the same day; most stay one night to be monitored.
The first week
Back to work
Mild pain, nausea and heartburn usually ease, and most people return to work.
About one month
Solid food
After the liquid diet and then the soft diet, the stomach has healed enough to eat solids.
Who is a candidate for endoscopic sleeve gastroplasty?
It is usually indicated when
- Your BMI is between 30 and 50 and diet, exercise or medication have not been enough to lose or maintain weight.
- Your BMI is between 30 and 40, the range with the most evidence and the best documented results.
- Your BMI is between 27 and 29.9 with at least one associated condition: the ASGE and ESGE guidelines suggest it as a conditional recommendation and the case is evaluated individually.
- Your BMI is 40 or more and bariatric surgery is not an option for you.
- You are committed to lifelong healthy eating and to follow-up care.
It may be contraindicated by
- Previous stomach, esophageal or bariatric surgery.
- A hiatal hernia larger than 4 cm or severe reflux.
- A gastric or duodenal ulcer, esophagitis or Barrett’s esophagus.
- Severe clotting disorders or daily use of anticoagulants.
- A previous intragastric balloon, which can thicken the stomach wall.
- Pregnancy, breastfeeding or an eating disorder.
These are criteria from the main trial of this technique; the specialist reviews them in your case. If you have already had bariatric surgery, learn about revision surgery.
What the MERIT trial showed
The main randomized trial of the technique, published in The Lancet in 2022: 209 people with a BMI of 30 to 40, at nine centers in the United States, compared the endoscopic sleeve plus diet and exercise with diet and exercise alone.
Excess weight loss at one year
Total body weight loss at one year
Achieved at least 25% excess weight loss
Improved at least one metabolic condition
At 2 years, 68% of the endoscopic sleeve group maintained at least 25% excess weight loss. In a cohort followed for 5 years, the average loss was 15.9% of total body weight.
Recovery and eating
The most common experience is mild pain while the stitches heal, with temporary nausea and heartburn that are controlled with medication. In some people, pain and nausea are more pronounced for a few days.
The three phases of eating
First
Liquid diet
Then
Soft diet
Around one month
Solid foods
The exact timing of each phase, physical activity and supplements are defined by the specialist together with nutrition, based on your case.
Risks of endoscopic sleeve gastroplasty
It is a procedure with a low rate of serious complications, but it is not risk-free. The specialist reviews the risks with you at the assessment.
MERIT trial
2%
serious adverse events (3 of 131), with no deaths and no need for intensive care or surgery.
IFSO meta-analysis
1.25%
serious adverse events in 15,398 procedures.
Versus the surgical sleeve
1.3%
new-onset reflux, versus 17.9% with the surgical sleeve.
Discomfort in the first days
The most common are mild pain, nausea and temporary heartburn; in some people they are more pronounced for a few days.
Gastrointestinal bleeding and fluid collection
These were the most frequently reported serious events in a meta-analysis of 1,859 patients, each below 1%.
Weight regain
Over the long term, some weight may be regained. The stitches can be adjusted and treatment can be complemented with medication.
Future surgery
The ASMBS warns that the stitches may leave permanent anchors that complicate a later surgical revision.
Endoscopic sleeve, surgical sleeve and gastric balloon, side by side
| Endoscopic sleeve | Surgical sleeve | Gastric balloon | |
|---|---|---|---|
| How it works | Folds and stitches the stomach from the inside | Removes 75 to 80% of the stomach | Takes up space in the stomach |
| Incisions | None | 4 to 6, laparoscopic | None |
| Duration | 60 to 90 minutes | 1 to 2 hours | 20 to 30 minutes |
| Hospital stay | Most people, one night | About one day | Outpatient |
| Total body weight loss at one year, versus the surgical sleeveComparative study, Clinical Endoscopy 2021 | 15.2% | 29.3% | Not included |
| Total body weight loss at one year, versus the balloonMeta-analysis of 28 studies | 17.5% | Not included | 10.4% |
| New-onset reflux | 1.3% | 17.9% | Reviewed at the assessment |
| Permanence | Long-lasting; the stitches can be removed | Permanent, not reversible | Temporary; the Orbera balloon is removed at 6 months |
| Price in Medellín | COP 14,000,000 to COP 32,000,000 | From COP 23,000,000 | COP 12,000,000 to COP 18,000,000 |
Learn more about the surgical gastric sleeve and the gastric balloon.
Your endoscopic sleeve in Medellín, step by step
Most people spend one night under observation and resume their activities within the first week. How many days you should stay in Medellín before flying is determined by the specialist based on your case.
Step 1
Contact us on WhatsApp
Tell us about your case, your height, your weight and whether you have had stomach surgery.
Step 2
Video call with the specialist
Initial assessment without traveling.
Step 3
Preliminary tests
Those the specialist indicates for your case.
Step 4
Quote in US dollars
With a breakdown of what is included.
Step 5
Procedure and recovery
With the option of a recovery house with nursing care: USD 270 per night in a standard room.
Step 6
Remote follow-up
Telehealth visits with the specialist and with nutrition during the diet transition.
About endoscopic sleeve gastroplasty in Medellín
How much does endoscopic sleeve gastroplasty cost in Medellín?
How much weight do you lose with endoscopic sleeve gastroplasty?
Is endoscopic sleeve gastroplasty surgery? Does it leave scars?
How many days in the hospital does it require, and when can I return to work?
What is the Apollo method?
Which is better, the endoscopic sleeve or the surgical sleeve?
Which is more effective, the gastric balloon or the endoscopic sleeve?
Can the weight come back? Is endoscopic sleeve gastroplasty reversible?
Would you like to compare all the options?
The bariatric surgery guide compares your case with every technique, with and without surgery.
Other weight loss options
Request your endoscopic sleeve quote in Medellín
Tell us your height, your weight and where you are traveling from. We will send you the cost of your process and coordinate your assessment with the specialist.