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.
The retrospective cohort study included 150 patients treated in routine clinical practice and evaluated outcomes at six months.
Patients who underwent ESG achieved a mean total body weight loss of 12.7%, compared to 8.7% in those who received 14 mg of oral semaglutide, 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 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 who underwent ESG were also more likely to achieve clinically significant 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 mainly 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 drug, but there is 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 clinical decision and not an artificial comparison.”
Dr Nitin G. Jagtap, Lead Study Author and Medical Gastroenterologist, AIG Hospital
He added, “The approximately 4% greater weight loss with ESG is significant and may translate into improved control of obesity-related conditions such as diabetes and fatty liver disease, although these effects were not directly assessed in this study.”
Dr. Jagtap emphasized that the choice of treatment should remain individualized, taking into account patient preference, access and long-term compliance. “A daily oral treatment requires ongoing commitment, whereas ESG is a one-time intervention associated with more rapid weight loss. These approaches should be considered complementary,” he explained.
“Our results suggest that ESG should be considered alongside pharmacological therapies as a primary option in the management of obesity,” concluded Dr. Jagtap. “The future of care lies in personalized treatment choice – matching the right approach to the right patient.”
