Endoscopic Stomach Procedure vs Liraglutide: Which Works Better for Weight Loss at 12 Months? | Research

The takeaway

Endoscopic sleeve gastroplasty produced faster weight loss than liraglutide in the first 6 months, but by 12 months the difference disappeared as ESG patients began regaining weight while liraglutide users kept losing steadily.

Converged at 12 months
ESG significantly outperformed liraglutide at 3-6 months (P=0.001), but by 12 months there was no difference — ESG patients were regaining while liraglutide patients continued losing

What the researchers found

In 43 randomized patients (23 ESG, 20 liraglutide) with class I-II obesity:

• At 3 and 6 months: ESG significantly outperformed liraglutide for both %EWL and %TWL (P=0.001)

• At 12 months: No statistically significant difference between groups — the ESG advantage had disappeared

• ESG pattern: rapid initial weight loss followed by some weight regain after 6 months

• Liraglutide pattern: slower but more consistent weight loss that continued beyond 6 months

• Resolution of obesity-related comorbidities: no significant differences between groups at any time point (3, 6, or 12 months)

• Safety: no major complications or significant side effects in either group

Why it matters

Patients with moderate obesity face a choice between procedures and medications, but until now there were no head-to-head trials comparing them. This study reveals a crucial insight: the procedure wins early but the drug wins late, and they converge at 12 months. This trajectory pattern — fast surgical loss with regain vs slow pharmacological loss with persistence — has major implications for patient counseling and treatment selection.

How the study worked

Prospective, randomized controlled, single-center study. 43 patients with class I and II obesity were randomized to ESG (n=23) or liraglutide (n=20). All participants received standardized follow-up with both surgeon and nutritionist assessments. Outcomes measured at 3, 6, and 12 months included %EWL, %TWL, and resolution of obesity-related comorbidities.

What this study cannot tell us

Very small sample size (43 patients) limits statistical power and generalizability. Single-center study. Only liraglutide (the least potent currently available GLP-1 agonist) was tested — semaglutide or tirzepatide might perform differently. Only 12-month follow-up; longer data are needed. The ESG weight regain trend at 12 months needs longer follow-up to characterize. Class I-II obesity only; may not apply to severe obesity. The authors acknowledge larger studies with longer follow-up are needed.

How to read the evidence

This is a prospective randomized controlled trial — a strong study design. However, the very small sample size (43 patients), single-center design, and 12-month follow-up limit the strength of conclusions. It is best viewed as a pilot study generating hypotheses about the comparative trajectories of procedural vs pharmacological obesity treatment.

When this study was published

Published in 2025, this is a very current trial addressing one of the most relevant questions in obesity medicine. As the first RCT comparing ESG to a GLP-1 agonist, it sets the stage for larger definitive trials.

The bigger picture

This trial captures a defining question in obesity medicine: procedure vs peptide. As GLP-1 drugs have grown more potent (semaglutide, tirzepatide) and endoscopic techniques have refined, understanding their comparative trajectories is essential. The finding that liraglutide's slower but persistent weight loss catches up to the procedure's rapid but fading effect at 12 months suggests that newer, more potent GLP-1 drugs might surpass endoscopic procedures at longer follow-up.

Questions still open

Would more potent GLP-1 drugs like semaglutide or tirzepatide outperform ESG even at early time points?
Does the ESG weight regain trend continue beyond 12 months, and would adding a GLP-1 drug prevent it?
Is combining ESG with GLP-1 therapy the optimal approach for sustained weight loss?

Common questions

Is a stomach procedure or a GLP-1 drug better for weight loss?

This study suggests it depends on the timeline. The endoscopic procedure (ESG) produced faster weight loss in the first 6 months, but patients started regaining afterward. Liraglutide caused slower weight loss that continued steadily, and by 12 months the two approaches were equivalent. Neither had major side effects, and both equally resolved obesity-related health conditions. The choice may depend on whether you prefer fast results or steady progress.

Why did ESG patients start regaining weight?

Weight regain after bariatric procedures is common as the stomach gradually adapts and stretches. ESG reduces stomach volume but doesn't change the hormonal signals that drive hunger. GLP-1 drugs like liraglutide, in contrast, continuously suppress appetite through hormonal pathways, which may explain their more sustained effect. Combining a procedure with a GLP-1 drug might offer the best of both worlds.

Read the original research

Comparative Efficacy of Endoscopic Sleeve Gastroplasty (Esg) Versus Liraglutide in Weight Loss and Remission Of Obesity-Related Comorbidities: Twelve Months Follow-Up Results.

Obesity surgery, 35(9), 3531-3539

View on PubMed ↗Publisher’s paper ↗

Citation

Nigro, Stefania; Vinciguerra, Federica; Guccione, Fabio; Alibrandi, Angela; Filannino, Ruggiero; Navarra, Giuseppe. (2025). Comparative Efficacy of Endoscopic Sleeve Gastroplasty (Esg) Versus Liraglutide in Weight Loss and Remission Of Obesity-Related Comorbidities: Twelve Months Follow-Up Results.. Obesity surgery, 35(9), 3531-3539. https://doi.org/10.1007/s11695-025-08155-2