Endoscopic Sleeve Gastroplasty Outperforms Oral Semaglutide 14mg for Short-Term Weight Loss in Adults with Obesity
Background
Managing obesity effectively remains a critical challenge, with many individuals struggling to achieve and maintain significant weight loss through lifestyle interventions alone. While bariatric surgery offers substantial results, its invasiveness and associated risks limit broader adoption. Less invasive options like Endoscopic Sleeve Gastroplasty (ESG) and pharmacological agents such as GLP-1 receptor agonists like semaglutide have emerged as promising alternatives. However, real-world comparative data directly assessing the effectiveness and safety of ESG against oral semaglutide, particularly regarding short-term and sustained weight loss, have been scarce, making it difficult to guide treatment selection.
Study Design
Researchers conducted a retrospective comparative cohort study between January 2024 and April 2025, including 150 adults (ESG=50; semaglutide=100) aged 18-65 years with BMI ≥30 kg/m2 or ≥27 kg/m2 with obesity-related comorbidity. Patients received either ESG or oral semaglutide 14mg daily. The primary endpoint was percentage total body weight loss (%TBWL) at 6 months. Secondary outcomes included responder rates (≥10% and ≥15% TBWL), adverse events, and 12-month weight outcomes. Statistical analyses included Welch's two-sample t-tests, ANCOVA adjusted for covariates, inverse probability of treatment weighting (IPTW), and 1:1 propensity score matching.
Results
At 6 months, mean %TBWL was significantly higher in the ESG group compared to the oral semaglutide group (12.72±5.67% vs. 8.67±3.84%; p=0.0001). This significant difference persisted after covariate adjustment (adjusted mean difference = -4.04%; p=0.0001), IPTW analysis (p<0.001), and propensity-matched analysis (p=0.021). Responder rates for ≥10% TBWL were achieved by 70% of ESG patients versus 43% of semaglutide patients (RR 0.62; 95% CI; 0.46-0.82; p=0.0009).
Key Findings
- ESG achieved significantly higher mean %TBWL at 6 months (12.72%) compared to oral semaglutide 14mg (8.67%; p=0.0001).
- The difference in %TBWL at 6 months remained significant after covariate adjustment (-4.04%; p=0.0001).
- Responder rates for ≥10% TBWL were higher with ESG (70%) vs. semaglutide (43%; p=0.0009).
- Responder rates for ≥15% TBWL were substantially higher with ESG (36%) vs. semaglutide (7%; p=0.0006).
- At 12 months, mean %TBWL was sustained in both groups (11.92% for ESG, 10.91% for semaglutide) with no significant between-group difference (p=0.41).
Why It Matters
This real-world comparison provides valuable insights for clinicians and patients weighing options for obesity management. ESG offers a more rapid and pronounced initial weight loss effect compared to oral semaglutide 14mg, particularly within the first six months. This could be crucial for patients needing a quicker metabolic improvement or those who have struggled with pharmacological interventions. While ESG showed superior short-term efficacy, the sustained weight loss at 12 months for both groups, without a significant difference, suggests that oral semaglutide remains a potent long-term option, especially for individuals preferring a non-invasive approach. The findings highlight that treatment selection should consider patient preferences, desired speed of weight loss, and tolerance for procedural interventions versus daily oral medication.
obesity
semaglutide
endoscopic sleeve gastroplasty
weight loss
real-world
cohort study