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A groundbreaking study conducted by AIG Hospitals has revealed that Endoscopic Sleeve Gastroplasty (ESG)—a minimally invasive, 45-minute procedure—offers significantly better short-term weight loss compared to standard oral anti-obesity medication.
The study, titled “Endoscopic Sleeve Gastroplasty Versus Oral Semaglutide for Obesity: A Real-World Comparative Cohort Study,” was published in the prestigious medical journal Endoscopy. It evaluated 150 adults with obesity between January 2024 and April 2025, tracking 50 patients who underwent ESG and 100 who took a daily 14 mg dose of oral semaglutide. Both groups maintained a calorie-restricted diet and exercise regime.
The findings highlight a clear short-term advantage for the endoscopic intervention:
- Higher Total Weight Loss: At the six-month mark, ESG patients achieved an average total body weight loss of 12.72%, compared to 8.67% in the oral semaglutide group.
- Superior Hit Rates: Approximately 70% of ESG patients successfully shed at least 10% of their body weight, whereas only 43% of the medication group achieved the same.
- Milestone Success: An impressive 36% of the ESG group lost 15% or more of their total body weight, compared to a mere 7% of those relying on the oral pill.
Mechanistic Differences and Safety
ESG is entirely non-surgical, performed through the mouth using an endoscope. Doctors use full-thickness sutures to reshape and reduce the stomach’s capacity from the inside, helping patients feel full faster. Conversely, oral semaglutide is a GLP-1 receptor agonist that chemically suppresses appetite but demands strict, long-term adherence and can be restricted by high costs or patient tolerance.
While ESG provides a more powerful initial weight-loss push, the gap narrowed at the 12-month follow-up, with ESG patients averaging an 11.92% loss compared to semaglutide’s 10.91%. No major adverse events were reported in either group, with side effects limited to mild gastrointestinal discomfort.
Medical experts emphasize that obesity should be viewed as a chronic metabolic disease. Rather than treating these methods as competing options, healthcare professionals view ESG and pharmacotherapy as complementary tools that must be paired with permanent lifestyle modifications.