A comparative study presented at ESGE Days 2026 found that endoscopic sleeve gastroplasty (ESG) was associated with significantly greater short-term weight loss than oral semaglutide in obese adults.
This retrospective cohort study included 150 patients treated in routine clinical practice and assessed 6-month outcomes.
Patients receiving ESG achieved a mean total weight loss of 12.7% compared to 8.7% for patients receiving oral semaglutide 14 mg, corresponding to a mean difference of approximately 4.0% (p=0.0001). This difference remained significant after adjusting for baseline characteristics such as age, gender, BMI, and diabetes status and was supported by multiple sensitivity analyses.
Endoscopic sleeve gastroplasty is a minimally invasive endoscopic surgery that reduces stomach volume, while semaglutide is a glucagon-like peptide-1 receptor agonist that promotes weight loss through appetite regulation. Direct real-world comparisons between procedural and pharmacological approaches remain limited, especially for oral formulations.
Patients receiving ESG were also more likely to achieve clinically meaningful weight loss. At 6 months, 70% of patients in the ESG group achieved at least 10% total weight loss, compared with 43% and 36% in the semaglutide group (compared with 7%). The incidence of adverse events was similar between groups, mainly mild gastrointestinal symptoms, with no serious complications or mortality reported.
Dr. Nitin G. Jagtap, lead author of the study, said the results address a common clinical question.
In clinical practice, patients often ask whether they should choose surgery or drugs, but there is little comparative data to help make that decision. We focused on oral semaglutide because it was the most commonly available option during the study period. Therefore, this is not an artificial comparison and reflects actual clinical decisions. ”
Dr. Nitin G. Jagtap, lead study author and gastroenterologist, AIG Hospital
He added: “While the significant weight loss of approximately 4% with ESG is meaningful and may lead to improved management of obesity-related conditions such as diabetes and fatty liver disease, these results were not directly evaluated in this study.”
Dr. Jagtap emphasized that treatment choices should be individualized, taking into account patient preferences, access, and long-term compliance. “While daily oral therapy requires ongoing commitment, ESG is a one-time intervention with more rapid weight loss. These approaches should be considered complementary,” he explained.
“Our results suggest that ESG should be considered alongside pharmacotherapy as a mainstream option in obesity management,” concluded Dr. Jagtap. “The future of care lies in personalized treatment selection, matching the right approach to the right patient.”
sauce:
European Society of Gastrointestinal Endoscopy
