A procedure is paid for once and a drug is paid for monthly, which makes the shape of the weight-loss curve a financial question as much as a clinical one. The same arithmetic run against surgery is in how long the drug takes to cost more. A retrospective cohort put 50 endoscopic sleeve gastroplasty patients beside 100 taking oral semaglutide 14 mg and followed both [1].
At six months the procedure won comfortably. Mean total body weight loss was 12.72% against 8.67%, a difference that survived covariate adjustment, inverse probability weighting and propensity matching. Response rates told the same story: 70% of the procedure group reached 10% or more against 43% on the tablet, and 36% reached 15% or more against 7%.
That trajectory difference is worth more than the final numbers. A gastroplasty does its work immediately and then the patient lives with it; a titrated drug takes months to reach a maintenance dose, which is why its curve is still rising when the procedure's has turned. Any comparison between the two that stops before a year is measuring the schedule rather than the treatment — the same issue that makes early response figures hard to read, as in slow responders at week eight.
Three things stop this settling the question. Nobody was randomized, so whatever led 50 people to choose a procedure and 100 to choose a tablet is also in the result. Eighteen of the hundred tablet patients discontinued during follow-up and five of the fifty procedure patients started semaglutide, which blurs the arms in the direction that helps the procedure's twelve-month figure. And 150 patients at one center is small for a comparison this consequential.
The dose matters too, and is easy to miss. Oral semaglutide 14 mg is a diabetes-dose tablet, not the higher oral doses licensed for weight management and not the injection, so this is not a verdict on semaglutide generally. What the tablet costs relative to the injection is the subject of the tablet usually costs more, the dose question itself is in oral dose against injection, and the odds of still being on either at a year are in two thirds stop within a year.