A new study suggests that an endoscopic procedure called endoscopic sleeve gastroplasty (ESG) may lead to greater short-term weight loss in adults with obesity compared to oral semaglutide. The findings, presented at ESGE Days 2026, come from a retrospective analysis of 150 patients treated in routine clinical settings.
Patients who underwent ESG lost an average of 12.7% of their body weight after six months, while those taking 14mg of oral semaglutide lost 8.7%. The difference of about 4% remained significant even after adjusting for factors like age, sex, and diabetes status. Sensitivity analyses confirmed the results.
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ESG works by reducing gastric volume through an endoscopic technique. Semaglutide, a glucagon-like peptide-1 receptor agonist, helps control weight by affecting appetite. Few real-world studies have compared these two approaches, especially for oral medications.
At six months, 70% of ESG patients reached a 10% weight loss threshold, compared to 43% on semaglutide. Thirty-six percent of ESG patients achieved 15% weight loss, versus 7% on the drug. Adverse events were similar in both groups, with mostly mild gastrointestinal issues reported.
Dr. Nitin G. Jagtap, lead author of the study, said the results address a common clinical question. “Patients often ask whether to choose a procedure or medicine, but there’s been little data to guide that decision,” he explained. The study focused on semaglutide because it was widely available during the research period.
Dr. Jagtap noted the 4% weight loss difference could help manage obesity-related conditions like diabetes. However, the study did not directly assess these outcomes. He emphasized that treatment choices should be individualized, considering patient preferences, access, and long-term adherence.
“ESG is a one-time intervention with rapid weight loss, while semaglutide requires daily commitment,” Dr. Jagtap said. He called for viewing the two options as complementary rather than competing. The study suggests ESG could be a mainstream option in obesity management, alongside drugs.
The future of obesity care, according to Dr. Jagtap, depends on matching the right approach to each patient. “Personalized treatment selection is key,” he added. The study highlights the need for more real-world comparisons between procedural and pharmacological methods.
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