Hyderabad: At a time when weight loss medicines have become a rage, a new study by the Asian Institute of Gastroenterology has found that Endoscopic Sleeve Gastroplasty (ESG), a non-surgical procedure, helped patients lose weight faster than oral semaglutide tablets in the short term. After a year, though, the difference narrowed.The AIG Hospitals study has been published in the peer-reviewed journal Endoscopy.As part of the study, researchers Dr D Nageshwar Reddy, Dr Nitin Jagtap, and Dr Rakesh Kalpala, compared 150 adults with obesity treated between January 2024 and April 2025. Around 50 patients underwent ESG, while 100 received oral semaglutide 14 mg along with standard lifestyle modification. At six months, patients who underwent ESG achieved an average total body weight loss of 12.72%, compared with 8.67% among those taking oral semaglutide. Around 70% of ESG patients lost at least 10% of their body weight, compared with 43% in the medication group.“Patients frequently ask whether they should opt for an endoscopic procedure or medication for weight loss. We undertook this study to generate Indian evidence that would help answer that question,” said Dr D Nageshwar Reddy, chairman, AIG Hospitals, and the first Indian doctor to receive all the three Padma awards — Padma Vibhushan, Padma Bhushan and Padma Shri.He said India is among the few countries where oral semaglutide is available, making such a comparison possible.ESG is a 45-minute minimally invasive procedure performed through the mouth using an endoscope. Doctors place sutures or medical threads inside the stomach to reduce its functional size, helping patients feel full sooner without surgically removing any part of the stomach. Oral semaglutide, on the other hand, is a tablet that works through hormonal pathways to reduce appetite and food intake. While the medication is less invasive, it requires regular use under medical supervision.However, by 12 months, the average total body weight loss difference between patients of both the procedures becomes the same – 11.92% in the ESG group and 10.91% in the semaglutide group – as per the study.“ESG produces an immediate effect because the stomach size is reduced, whereas the tablets work through hormonal mechanisms and take time to modify the body’s metabolism. That’s why the medication group catches up over time,” Dr Reddy said, explaining why the difference narrows down after 12 months.Dr Reddy said ESG may be particularly useful for patients who require rapid weight loss before knee or cardiac surgery or for those seeking quicker results. “The one-time procedure currently costs around Rs 1.5 lakh, while semaglutide tablets are cheaper initially but require long-term use, making overall costs more comparable, he said, adding that neither treatment should replace diet and exercise.“These are bridge therapies. Diet, physical activity and long-term behavioural changes remain the foundation of obesity management,” he said.The researchers cautioned that the study was a single-centre, retrospective analysis, not a randomised clinical trial, and compared only oral semaglutide 14 mg. The findings should therefore not be extrapolated to injectable GLP-1 drugs or newer dual-incretin therapies.Dr Nageshwar Reddy said the team is now planning a similar study comparing ESG with injectable weight-loss medications.
