Endoscopic Sleeve Gastroplasty vs Oral Semaglutide

Obesity management in India is evolving rapidly with the introduction of novel therapies. Specifically, a landmark study from AIG Hospitals in Hyderabad recently compared endoscopic sleeve gastroplasty with oral semaglutide. This research provides crucial, real-world Indian evidence for clinicians. Consequently, these findings offer a clearer roadmap for personalising obesity care based on clinical timelines.

Endoscopic Sleeve Gastroplasty Outperforms Pills Initially

In this retrospective study, researchers analyzed 150 adults with obesity between January 2024 and April 2025. Specifically, fifty patients underwent endoscopic sleeve gastroplasty while one hundred received daily oral semaglutide (14 mg). At six months, the procedural group demonstrated a significant advantage. These patients achieved an average weight loss of 12.72%. In contrast, those taking oral semaglutide achieved an average weight loss of 8.67%.

Furthermore, responder rates were much higher in the procedural group. Approximately 70% of those undergoing the endoscopic technique lost at least 10% of their body weight. Meanwhile, only 43% of the medication group reached this threshold. Therefore, the endoscopic option provides a stronger initial push for patients requiring rapid weight reduction.

Long-Term Outcomes and Cost Considerations

The therapeutic gap narrowed significantly by the twelfth month. At one year, average weight loss stood at 11.92% for the procedure group and 10.91% for the medication group. Indeed, this catching-up effect occurs because oral tablets work through gradual hormonal pathways. Conversely, the procedural approach produces immediate anatomical restriction. Thus, both strategies are highly effective for long-term weight maintenance.

To begin with, the upfront cost of the procedure is around Rs 1.5 lakh. Although oral semaglutide is cheaper initially, it requires long-term use. Consequently, the cumulative costs of both treatments become comparable over time. Ultimately, both methods serve as bridge therapies. Therefore, dietary changes and regular exercise remain the foundation of obesity management.

Frequently Asked Questions

Q1: Why does endoscopic sleeve gastroplasty lead to faster early weight loss?

This minimally invasive procedure uses an endoscope to place sutures inside the stomach, immediately reducing its size. Consequently, patients feel full much faster, leading to rapid early weight loss.

Q2: Who is the ideal candidate for each treatment based on this study?

The procedure is excellent for patients who need rapid weight loss before major surgeries. Conversely, oral medications are highly suitable for patients seeking a non-invasive option who can maintain long-term compliance.

References

1. ESG helps faster short-term weight loss than oral meds: AIG study – ETHealthworld
2. Jagtap N, Golchha A, Katrevula A, et al. Endoscopic Sleeve Gastroplasty Versus Oral Semaglutide for Obesity: A Real-World Comparative Cohort Study. Endoscopy. 2026. doi:10.1055/a-2891-4165.

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