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Comparative Study
. 2025 Jun;15(3):e70001.
doi: 10.1111/cob.70001. Epub 2025 Feb 5.

Revisional endoscopic sleeve gastroplasty versus semaglutide and tirzepatide for weight recidivism after sleeve gastrectomy

Firas Bahdi  1 , Sagar Shah  2 , Fadi Dahoud  3 , Maryam Farooq  3 , Philip Kozan  1 , Stephen Kim  1 , Alireza Sedarat  1 , Na Shen  4 , Adarsh Thaker  1 , Jennifer M Kolb  1 , Erik Dutson  5 , V Raman Muthusamy  1 , Danny Issa  1
Affiliations
Comparative Study

Revisional endoscopic sleeve gastroplasty versus semaglutide and tirzepatide for weight recidivism after sleeve gastrectomy

Firas Bahdi et al. Clin Obes. 2025 Jun.

Abstract

Background and aims: Weight recidivism following sleeve gastrectomy (SG) is common. Adjuvant treatments include new glucagon-like peptide 1 and glucose-dependent insulinotropic peptide receptor agonists (GLP1/GIP-RA) or revisional endoscopic sleeve gastroplasty (R-ESG). We here compare the outcomes of these treatments.

Methods: A retrospective study of patients ≥18 years with prior SG treated with semaglutide, tirzepatide or R-ESG for weight recidivism between January 2019 and 2023 at large academic centre. Primary outcomes were total body weight loss (TBWL) and adverse events (AEs). Secondary outcomes were changes in metabolic parameters. Tertiary outcome was to compare GLP1/GIP-RA outcomes in SG patients to matched patients with intact stomach.

Results: Our study included 68 (prior SG + GLP1/GIP-RA) and 22 (prior SG + R-ESG). R-ESG offered higher TBWL% than GLP1/GIP-RA at 3 (11.2% vs. 4.3%, p < .001), 6 (13.5% vs. 6.8%, p < .001) and 12 months (13.4% vs. 9.2%, p = .07) with no significant difference in AEs or change in metabolic parameters. On subgroup analysis, tirzepatide achieved similar 12-months TBWL% as R-ESG (13.2% vs. 13.4%, p = .9) and significantly more than semaglutide (13.2% vs. 8.1%, p = .04). Compared to patients with intact stomach (n = 87), GLP1/GIP-RA achieved significantly lower TBWL% in patients with prior SG at 3 (4.3% vs. 5.7%, p = .02), 6 (6.8% vs. 9.2%, p = .02) and 12 months (9.2% vs. 12.7%, p = .03). Medication refills were difficult in 41.3% of patients.

Conclusions: In a single-centre real-world experience study, R-ESG and tirzepatide appear to offer more weight loss than semaglutide in SG patients with weight recidivism although GLP1/GIP-RA were underdosed. GLP1/GIP-RA achieved higher weight loss in patients with intact stomach than those with prior SG.

Keywords: endoscopic sleeve gastroplasty; semaglutide; sleeve gastrectomy; tirzepatide.

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References

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