Study: Combining Minimally Invasive Bariatric Surgery With Semaglutide Increases Weight Loss


Pairing semaglutide, a drug used to treat diabetes, with a minimally invasive endoscopic sleeve gastroplasty (ESG) can provide significant weight loss benefits for patients who are not candidates for invasive weight loss surgery, according to a study presented at Digestive Disease Week 2021.

For the double-blind study, the researchers randomized 61 patients undergoing ESG into 2 groups: 1 receiving semaglutide—an injectable glucagon-like peptide-1 receptor that has been found to stimulate weight loss—1 month after the procedure, and the other receiving a placebo administered through look-alike injector pens. Participants were monitored each month for body weight and body composition, with blood panels taken every 3 months.

According to the authors of the study, patients receiving semaglutide lost 26.7% of their total body weight on average, compared to 19.6% in the control group. The semaglutide group lost 86.3% of their excess weight (the amount of weight the participants needed to lose to reach normal BMI) compared to 60.4% for the control group. Additionally, body fat by weight decreased by 12.7% in the semaglutide group versus 9% in the control group, and glycated hemoglobin levels fell 0.95 for the semaglutide group and 0.61 for the controls.

“As the worldwide obesity rate continues to climb, so do the number of people seeking bariatric surgery to treat their condition,” said Anna Carolina Hoff, MD, lead researcher on the study and founder and clinical director of Angioskope Brazil, São José dos Campos, in a press release. “Surgical procedures are some of the most successful ways to help patients lose weight, but they can eventually come with complications. Our study shows that patients may not have to undergo invasive surgery to get similar results.”

More invasive surgical procedures, such as laparoscopic sleeve gastrectomy, come with increased costs and a higher risk for complications, such as gastroesophageal reflux disease. These procedures are normally restricted to patients with a BMI of at least 35 with comorbidities, or a BMI above 40.

ESG can be performed at an earlier stage of disease and at a lower BMI, allowing more patients to get the treatment they need before their disease progresses. Providing earlier treatment to patients with obesity can reduce the risk of mortality and comorbidities, as well as lower costs associated with treatment.

“ESG has been available to patients for years, but it has not always been as successful as surgical options in helping patients lose weight,” Hoff said in the release. “We now have a minimally invasive procedure that can be just as successful when combined with semaglutide and can be made available to even more people looking to lose a significant amount of weight.”

ESG is performed through guiding a device through the patient’s throat into the stomach, where an endoscopist uses sutures to decrease the size of the stomach. This assists in weight loss by limiting the amount that a patient can eat. Patients are candidates for ESG if they have a BMI at or above 30, and diet and exercise have not helped them lose weight, or if they are not a candidate for surgery, or do not wish to pursue surgery.

Long-term durability of the treatment still has yet to be determined, according to the researchers.


Pairing bariatric procedure with diabetes drug increases weight loss [news release]. EurekAlert; May 14, 2021. Accessed May 17, 2021.

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