★★★★★ 4.9 from 850+ reviews
Pros and cons · Renew Bariatrics
The gastric sleeve (VSG) and endoscopic sleeve gastroplasty (ESG) both make the stomach smaller. The sleeve is surgery that removes most of the stomach. ESG is done through the mouth with sutures, with no incisions. Here’s how they compare on weight loss, risks, recovery and cost.
Renew offers both. ESG is performed by Dr. Héctor Pérez.
Free, no-obligation review
A coordinator will contact you about your options and quote, with no commitment.
Prefer to talk? Call (844) 736-3963, available 24/7.
Prefer to talk? Call 24/7 (844) 736-3963
Quick pros and cons
The best choice depends on your BMI, how much weight you want to lose and whether you want to avoid surgery.
About 9.6 percentage points more body weight lost than ESG across 13 studies (meta-analysis).
Done through the mouth, with no incisions and nothing removed.
1.6% were readmitted after the sleeve vs 3.8% after ESG in matched US patients (ACS).
New reflux in 1.9% after ESG vs 14.5% after the sleeve in a matched study (Fayad et al.).
At Renew, ESG is for a BMI of 29.5 to 40. The sleeve goes up to 65.
$4,899 at Renew. ESG is a custom quote.
How they work
Both are restrictive: a smaller stomach holds less food, so you feel full sooner. The sleeve removes about 80% of the stomach. ESG uses an endoscope passed through the mouth to stitch the stomach into a narrower tube, so nothing is removed.
Side by side
| Gastric sleeveSurgery | ESGEndoscopic, no incisions | |
|---|---|---|
| How it’s done | Laparoscopic surgery through small incisions | Through the mouth with an endoscope, under general anesthesia |
| Stomach removed | About 80% | None |
| Surgeon at Renew | Our bariatric surgeons | Dr. Héctor Pérez |
| Your stay at Renew | 2 hospital nights, 1 hotel night | 2 hospital nights, 1 hotel night |
| BMI range at Renew | 29.5 to 65 | 29.5 to 40 |
| Body weight lost at 6 months | 23.6% | 17.1% |
| Body weight lost at 5 years | 18.8% | 15.9% |
| Readmitted within 30 days | 1.6% | 3.8% |
| New reflux | 14.5% | 1.9% |
| Cost with Renew Bariatrics | $4,899, all-inclusive | Custom quote |
6-month weight loss and new reflux from Fayad et al., Gastrointestinal Endoscopy, 2019, which matched 54 ESG and 83 sleeve patients. 5-year results come from two different sources: the PCORnet Bariatric Study, Annals of Internal Medicine, 2018 for the sleeve and Sharaiha et al., 5-year ESG outcomes, 2021 for ESG, so compare them with care. Readmissions from the American College of Surgeons, 2026. These are averages from studies. Your results will be different.
Results
The gastric sleeve led to more weight loss than ESG in the studies that compared them. ESG still leads to meaningful weight loss that can last for years.
Health conditions
Both can improve type 2 diabetes, high blood pressure and sleep apnea. In the MERIT trial, 80% of ESG patients had improvement in at least one of these conditions at 1 year (MERIT randomized trial, Lancet, 2022). In the 2026 review, diabetes remission was more likely after the sleeve (meta-analysis of 13 studies, Obesity Surgery, 2026).
Complications
Both procedures are low risk. After the sleeve, the main risks are leaks, bleeding and reflux. After ESG, nausea and stomach pain are common for the first few days, and serious problems such as bleeding or a leak are rare. In matched US patients, ESG had more readmissions and reoperations within 30 days, while a smaller study found fewer adverse events after ESG.
Which is right for you?
You have a BMI of 29.5 to 65.
You want the most weight loss from a restrictive procedure.
You’re comfortable with surgery and lifelong vitamins.
You have a BMI of 29.5 to 40.
You want to avoid incisions and keep your whole stomach.
You have reflux, or a sleeve isn’t a good fit for you.
Another non-surgical option is the gastric balloon, which is temporary. You can also compare all 11 procedures we offer.
Cost
At Renew, the gastric sleeve is $4,899, all-inclusive except airfare. ESG is a custom quote after Dr. Pérez reviews your health history. HSA and FSA are accepted, with financing available.
Send your health history and our team will review your options. Virtual consultations are available.
5-star Google reviews. Want to talk with a past patient? Ask your coordinator.
“Loved the doctors and staff, would recommend this surgery center in TJ. My gastric sleeve procedure was so seamless. Thank you guys so much for such a great experience.”
“Had a Gastric Sleeve on 4/18/24 in Tijuana Mexico. The hospital was very clean all of the staff were very polite and professional. I would 100% recommend.”
“Absolutely wonderful from the coordinators being on top of everything and efficiently to the transportation. I had Dr. Perez and he was phenomenal. The nurses are so adorably sweet and attentive to their patients. I 10/10 recommend Renew Bariatrics to anyone!”
“Dr. Hector Perez and his team were absolutely amazing! I highly recommend using Renew Bariatrics. You can tell they honestly love what they do and make you feel at home.”
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Neither is better for everyone. The sleeve leads to more weight loss and works for a wider BMI range. ESG avoids incisions, keeps your whole stomach and causes less new reflux. Our team will recommend one after reviewing your health history.
In a matched study, patients lost 17.1% of their body weight 6 months after ESG vs 23.6% after the sleeve. A 2026 review of 13 studies found about 9.6 percentage points more weight loss after the sleeve.
Both are low risk. In matched US patients, ESG had more readmissions within 30 days (3.8% vs 1.6%). A smaller study found fewer adverse events and less new reflux after ESG.
ESG at Renew is for a BMI of 29.5 to 40. It’s performed by Dr. Héctor Pérez.
Yes. Because ESG doesn’t remove any of the stomach, a sleeve or another surgery is still possible later. Ask our team about timing.
The gastric sleeve is $4,899, all-inclusive except airfare. ESG is a custom quote after Dr. Pérez reviews your health history. HSA and FSA are accepted.
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Double board-certified surgeons with 9,000+ surgeries.
Prefer to talk? Call 24/7 (844) 736-3963
Free, no-obligation review
Form loading. Prefer to talk? Call (844) 736-3963, available 24/7.
No commitment. A coordinator will contact you.
