During Endoscopic Sleeve Gastroplasty (ESG), a gastroenterologist passes an endoscope through the mouth and places sutures inside the stomach. This creates a smaller, tube-like shape that can support earlier fullness and smaller portions.

There are no abdominal incisions, and unlike surgical sleeve gastrectomy, no part of the stomach is removed. ESG is still a medical procedure, so preparation, recovery guidance, diet progression, and follow-up matter.

Anti-obesity medications can influence appetite, satiety, food intake, or related metabolic pathways. The review included several medications, including semaglutide, liraglutide, tirzepatide, topiramate, and others.

That means “ESG plus medication” does not describe one identical treatment plan. Different drugs, doses, timing, and patient populations can produce different outcomes.

Learn more about semaglutide treatment and tirzepatide treatment.

Across 10 studies involving 578 participants, patients receiving ESG plus anti-obesity medication showed an average advantage of about 1.9 percentage points in total weight loss at approximately seven months.

The review found no consistent long-term weight-loss advantage for ESG plus medication over ESG alone. It also found no meaningful overall HbA1c improvement from adding medication to ESG compared with ESG alone.

A well-matched plan matters more than simply adding another therapy. Cost, side effects, medication tolerance, treatment burden, and the patient’s goals all matter.

Some patients start medication around the time of ESG. Others add it later when weight loss slows, hunger increases, or weight regain develops.

These differences in timing and medication choice contributed to variation across the studies. Your gastroenterologist should evaluate prior weight-loss attempts, metabolic health, appetite patterns, medication response, and goals before deciding when medication fits.

ESG and medication are tools within comprehensive obesity care. Neither replaces nutrition, movement, sleep, muscle preservation, behavior change, or ongoing medical monitoring.

Regular follow-up helps identify plateaus, side effects, or weight regain early—before those issues become harder to address.

The researchers concluded that combination treatment deserves selective use rather than routine use for everyone. The evidence base also had limitations, including variation among studies and relatively limited full-text data.

The practical lesson is simple: the newest or most intensive treatment is not automatically the best one for every patient.