Introduction
The management of obesity is often complicated by associated comorbidities such as type 2 diabetes, hypertension and hyperlipidaemia—all of which contribute to significant polypharmacy. High pill burden is linked to reduced adherence, increased healthcare costs, and lower quality of life. While Endoscopic Sleeve Gastroplasty (ESG) has been established as a minimally invasive intervention for weight loss, its impact on medication use remains underexplored. This study aims to evaluate changes in medication burden following ESG in a real-world cohort, with a focus on the potential for pharmacological de-escalation alongside weight loss.
Aims & Methods
We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. The primary outcome was change in medication burden, defined as the total number of prescribed medications at baseline, 6 months, and 12 months following ESG. Data on medication count were collected from electronic medical records, including all chronic medications prescribed for obesity-related comorbidities.
Results
At baseline, 17.8% of patients were on one or more oral anti-diabetic medications, 2.6% were on insulin, 30.9% were taking antihypertensives, and 22% were on lipid-lowering therapy. At 6 months post-ESG, the proportion of patients on anti-diabetic medications decreased to 15.2%, and insulin use dropped slightly to 2.1%. Anti-hypertensive use declined to 20.8%, and lipid-lowering therapy was reduced to 17.1%. By 12 months, further reductions were observed: 12.7% of patients remained on anti-diabetic medications, only 1.4% were on insulin, and use of anti-hypertensives and lipid-lowering agents fell to 20.8% and 18.8%, respectively.
The total number of medications per patient decreased significantly over time. At baseline, patients were on an average of 1.36 medications targeting diabetes, hypertension, and hyperlipidemia. This declined to 0.61 medications at 6 months and 0.59 at 12 months, corresponding to mean reductions of 0.75 (95% CI: 0.42–1.07, p < 0.001) and 0.77 (95% CI: 0.46–1.08, p < 0.001), respectively. These reductions were consistent across all major cardiometabolic drug classes.
Conclusion
In addition to driving meaningful weight loss, ESG contributes to a measurable reduction in medication burden for obesity-related comorbidities. These findings support the broader role of ESG in promoting pharmacologic de-escalation, potentially improving long-term adherence and quality of life in patients with obesity.
Disclosure
NIL
