Endoscopic sleeve gastroplasty outperforms oral semaglutide in short-term weight loss

A comparative study, presented at ESGE Days 2026, has found that endoscopic sleeve gastroplasty (ESG) is associated with significantly greater short-term weight loss than oral semaglutide in adults with obesity.

The retrospective cohort study included 150 patients treated in routine clinical practice and evaluated outcomes at six months.

Patients undergoing ESG achieved a mean total body weight loss of 12.7 %, compared with 8.7 % in those receiving 14 mg of oral semaglutide, corresponding to a mean difference of approximately 4.0 % (p=0.0001). This difference remained significant after adjustment for baseline characteristics, including age, sex, body mass index, and diabetes status, and was supported by multiple sensitivity analyses.

Endoscopic sleeve gastroplasty is a minimally invasive endoscopic procedure that reduces gastric 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, particularly for oral formulations.

Patients undergoing ESG were also more likely to achieve clinically meaningful weight loss. At six months, 70 % of patients in the ESG group achieved at least 10 % total body weight loss compared with 43 % in the semaglutide group, while 36 % achieved at least 15 % weight loss compared with 7%, respectively. Adverse event rates were comparable between groups and were predominantly mild gastrointestinal symptoms, with no serious complications or mortality reported.

Dr Nitin G. Jagtap, lead author of the study, said the findings address a common clinical question.

In real-world practice, patients often ask whether they should choose a procedure or a medicine, but there has been very little comparative data to guide that decision. We focused on oral semaglutide because it was the most commonly available option during the study period, so this reflects a real-world clinical decision, not an artificial comparison."

Dr Nitin G. Jagtap, Study Lead Author and Medical Gastroenterologist, AIG Hospital

He added, "The approximately 4 % greater weight loss with ESG is meaningful and may translate into improved control of obesity-related conditions such as diabetes and fatty liver disease, although these outcomes were not directly assessed in this study."

Dr Jagtap emphasized that treatment choice should remain individualized, taking into account patient preference, access, and long-term adherence. "A daily oral therapy requires sustained commitment, whereas ESG is a one-time intervention associated with more rapid weight loss. These approaches should be viewed as complementary," he explained.

"Our results suggest ESG should be considered alongside pharmacological therapies as a mainstream option in obesity management," Dr Jagtap concluded. "The future of care lies in personalized treatment selection – matching the right approach to the right patient."