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EndoSleeve vs GLP-1 Medications
Which Weight-Loss Option Is Right for You?
Both EndoSleeve, also known as endoscopic sleeve gastroplasty, or ESG, and GLP-1 medications can help patients lose weight. They work differently, and the best option depends on your medical history, weight-loss goals, medication tolerance, insurance coverage, and long-term plan.
EndoSleeve is an incisionless endoscopic procedure that reduces stomach size from the inside. GLP-1 medications are injectable or oral medications that work on appetite, fullness, and metabolism.
What the Evidence Shows
In the MERIT randomized trial, ESG produced significantly greater weight loss than lifestyle therapy alone, with about 13.6% total body weight loss at 52 weeks compared with 0.8% in the control group. The same trial reported that 80% of patients with ESG improved at least one metabolic comorbidity at 52 weeks.
Lancet. 2022 Aug 6;400(10350):441-451]
For GLP-1 medications, semaglutide 2.4 mg produced about 15% mean weight loss at two years in the STEP 5 trial, while tirzepatide produced approximately 15.0%, 19.5%, and 20.9% mean weight loss at 72 weeks depending on dose in the SURMOUNT-1 trial.
Nat Med. 2022 Oct;28(10):2083-2091
The major practical difference is maintenance. After stopping semaglutide, participants in one extension study regained about two-thirds of the weight they had lost within one year, supporting the idea that ongoing medication is often needed to maintain results.
Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725
EndoSleeve may be a good option for patients who want a procedural approach to weight loss, patients who do not tolerate GLP-1 medications, or patients looking for an alternative to traditional bariatric surgery. In some cases, EndoSleeve and GLP-1 medications may also be used together as part of a comprehensive medical weight-loss strategy.
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