Research Article
Volume 9 Issue 7 - 2022
Endoscopic Sleeve Gastroplasty Plus Semaglutide Versus Endoscopic Sleeve Gastroplasty Alone for Weight Loss: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
Anna Carolina Hoff1*, Zadid Haq2, Abdellah Hedjoudje2, Manoel Galvao Neto3, Luiz Gustavo de Quadros4, Sergio Alexandre Barrichello5, Gabriel Cairo Nunes5 and Dilhana Badurdeen6
1Angioskope Clinic, Department of Endobariatrics, São José dos Campos, SP, Brazil
2Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
3Head of Bariatric Endoscopy of Mohak, Indore, India
4Kaiser Hospital, São Paulo, Brazil
5Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paolo, Brazil
6Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA
*Corresponding Author: Anna Carolina Hoff, Clinical Director, Division of Endobariatrics, Angioskope Sao Jose dos Campos and São Paulo, Sao Jose dos Campos, SP, Brazil.
Received: June 03, 2022; Published: June 29, 2022


Endoscopic sleeve gastroplasty (ESG) is effective for inducing weight loss and treating metabolic co-morbidities of obesity. Semaglutide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1), produces significant weight loss when combined with lifestyle intervention. In this study, we aim to assess whether adults with overweight and obesity can achieve superior weight loss and metabolic improvement with ESG and semaglutide (ESG-S) compared to ESG alone.

Methods: In this prospective randomized, double-blind, placebo-controlled trial, we enrolled 61 patients with overweight or obesity undergoing ESG at three outpatient clinics in Brazil between June to October 2019. Patients were randomly assigned to treatment with once-weekly injectable semaglutide or an identical placebo pen within 1-month after ESG. 58 patients completed the study. The primary outcome was percent total body weight loss (%TBWL) 12 M after ESG (11 M after initiation of semaglutide). Secondary outcomes were change in percent body fat and hemoglobin A1c (HbA1c) 11 M after initiation of semaglutide.

Results: Comparisons between the two groups showed that patients who received injectable semaglutide within one month of ESG had a superior mean% TBWL at 12 m compared to those who received placebo, 25.21% (SD 2.14%) versus 18.65% (SD 1.44%) (p < 0.001). Additionally, the ESG-S group had a significantly greater reduction in percent body fat mass, 12.69% (SD 4.84%) vs. 9.04% (SD 6.38%), p < 0.001), and lower mean hemoglobin A1c, (4.93 [SD 0.45] vs. 5.33 [SD 0.60]), compared to the ESG group at 12 M.

Conclusion: Combination therapy utilizing injectable semaglutide at 1-month following ESG results in superior weight loss and comorbidities compared to ESG alone, as demonstrated by the decrease in%TBWL, percent body fat and HbA1c at 12m. 

Key points

  • Endoscopic bariatric therapies, while effective, have not achieved bariatric surgery outcomes on their own.
  • Endoscopic sleeve gastroplasty and semaglutide (ESG-S) approached bariatric surgery weight loss outcomes at 12 months.
  • Combination therapy has potential as a less-invasive alternative to bariatric surgery for managing obesity and its complications.

Keywords: Weight Loss; Metabolic Endoscopy; Combination Therapy; Bariatric Endoscopy; Diabetes; Obesity


  1. Apovian CM. “The Obesity Epidemic--Understanding the Disease and the Treatment”. The New England Journal of Medicine2 (2016): 177-179.
  2. Sharaiha RZ., et al. “Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity”. Clinical Gastroenterology and Hepatology5 (2021): 1051-1057.e1052.
  3. Sharaiha RZ., et al. “Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients”. Clinical Gastroenterology and Hepatology4 (2017): 504-510.
  4. Sartoretto A., et al. “Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study”. Obesity Surgery7 (2018): 1812-1821.
  5. Hedjoudje A., et al. “Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis”. Clinical Gastroenterology and Hepatology5 (2020): 1043-1053.e1044.
  6. Badurdeen D., et al. “Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss”. Gastrointestinal Endoscopy (2020).
  7. Gardner H and Hamdy O. “Oral GLP1 Analog: Where Does the Tide Go?” Clinical Medicine Insights: Endocrinology and Diabetes 13 (2020): 1179551420984130.
  8. Wilding JPH., et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity”. The New England Journal of Medicine (2021).
  9. Polonsky WH., et al. “Patient perspectives on once-weekly medications for diabetes”. Diabetes, Obesity and Metabolism2 (2011): 144-149.
  10. Witkowski M., et al. “A Systematic Literature Review and Network Meta-Analysis Comparing Once-Weekly Semaglutide with Other GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Previously Receiving Basal Insulin”. Diabetes Therapy3 (2018): 1233-1251.
  11. Kahn J. FDA Approves New Drug Treatment for Chronic Weight Management, First Since (2014).
  12. Ling CH., et al. “Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population”. Clinical Nutrition5 (2011): 610-615.
  13. Barrichello S., et al. “Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study”. Gastrointestinal Endoscopy5 (2019): 770-780.
  14. Ozempic®. Ozempic® (semaglutide) injection 0.5 mg or 1 mg | GLP-1 RA HCP (2021).
  15. Müller-Stich BP., et al. “Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis”. Annals of Surgery3 (2015): 421-429.
  16. Sjöström L. “Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery”. Journal of Internal Medicine3 (2013): 219-234.
  17. Wing RR., et al. “Long-term effects of modest weight loss in type II diabetic patients”. Archives of Internal Medicine10 (1987): 1749-1753.
  18. “2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults”. Journal of the American Pharmacists Association 54.1 (2014): e3.
  19. Adams KF., et al. “Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old”. The New England Journal of Medicine8 (2006): 763-778.
  20. Wing RR., et al. “Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes”. Diabetes Care7 (2011): 1481-1486.
  21. Magkos F., et al. “Effects of Moderate and Subsequent Progressive Weight Loss on Metabolic Function and Adipose Tissue Biology in Humans with Obesity”. Cell Metabolism4 (2016): 591-601.
  22. Gregg EW., et al. “Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial”. The Lancet Diabetes and Endocrinology11 (2016): 913-921.
  23. Abu Dayyeh BK., et al. “Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals”. Clinical Gastroenterology and Hepatology1 (2017): 37-43.e31.
  24. Lopez-Nava G., et al. “Gut and Metabolic Hormones Changes After Endoscopic Sleeve Gastroplasty (ESG) Vs. Laparoscopic Sleeve Gastrectomy (LSG)”. Obesity Surgery7 (2020): 2642-2651.
  25. Cheskin LJ., et al. “Endoscopic sleeve gastroplasty versus high-intensity diet and lifestyle therapy: a case-matched study”. Gastrointestinal Endoscopy2 (2020): 342-349.e341.
  26. Fayad L., et al. “Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study”. Gastrointestinal Endoscopy4 (2019): 782-788.
  27. Novikov AA., et al. “Endoscopic Sleeve Gastroplasty, Laparoscopic Sleeve Gastrectomy, and Laparoscopic Band for Weight Loss: How Do They Compare?” Journal of Gastrointestinal Surgery2 (2018): 267-273.
  28. Peterli R., et al. “Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial”. Obesity Surgery5 (2012): 740-748.
  29. Gu L., et al. “Differences in the effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass on gut hormones: systematic and meta-analysis”. Surgery for Obesity and Related Diseases2 (2021): 444-455.
  30. Alqahtani A., et al. “Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients”. Gastrointestinal Endoscopy6 (2019): 1132-1138.
  31. Fayad L., et al. “Gastric mucosal devitalization (GMD): translation to a novel endoscopic metabolic therapy”. Endoscopy International Open12 (2019): E1640-e1645.
  32. Oberbach A., et al. “Gastric mucosal devitalization improves blood pressure, renin and cardiovascular lipid deposition in a rat model of obesity”. Endoscopy International Open12 (2019): E1605-e1615.
  33. Kumbhari V., et al. “Gastric mucosal devitalization is safe and effective in reducing body weight and visceral adiposity in a porcine model”. Gastrointestinal Endoscopy1 (2018): 175-184.e171.
  34. Oberbach A., et al. “Gastric mucosal devitalization reduces adiposity and improves lipid and glucose metabolism in obese rats”. Gastrointestinal Endoscopy1 (2018): 288-299.e286.
  35. Espinet-Coll E., et al. “Suture pattern does not influence outcomes of endoscopic sleeve gastroplasty in obese patients”. Endoscopy International Open10 (2020): E1349-e1358.
  36. Itani MI., et al. “Endoscopic sleeve gastroplasty with argon plasma coagulation: A novel technique”. Journal of Digestive Diseases11 (2020): 664-667.
  37. Farha J., et al. “Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit”. Endoscopy (2020).
  38. Johansen P., et al. “Evaluating the Long-Term Cost-Effectiveness of Once-Weekly Semaglutide Versus Once-Daily Liraglutide for the Treatment of Type 2 Diabetes in the UK”. Advances in Therapy5 (2020): 2427-2441.
  39. O'Neil PM., et al. “Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial”. Lancet10148 (2018): 637-649.
  40. Lopez-Nava G., et al. “Endoscopic Sleeve Gastroplasty for Obesity: a Multicenter Study of 248 Patients with 24 Months Follow-Up”. Obesity Surgery10 (2017): 2649-2655.
  41. Kumbhari V. “The Endoscopic Sleeve Gastroplasty (ESG)”. Bariatric Surgery Source (2021).
  42. Lopez-Nava G., et al. “Personalization of Endoscopic Bariatric and Metabolic Therapies Based on Physiology: a Prospective Feasibility Study with a Single Fluid-Filled Intragastric Balloon”. Obesity Surgery9 (2020): 3347-3353.
  43. Gomez V., et al. “Rejuvenate and repopulate: renaissance of the duodenum”. Gastrointestinal Endoscopy1 (2021): 121-123.
Citation: Anna Carolina Hoff., et al. “Endoscopic Sleeve Gastroplasty Plus Semaglutide Versus Endoscopic Sleeve Gastroplasty Alone for Weight Loss: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study”. EC Gastroenterology and Digestive System 9.7 (2022): 54-65.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 21, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.