Obesity treatment: Endoscopic gastric reduction and modern medications working together
Being overweight is not simply a lifestyle problem, but the result of a complex biological interaction. Hormonal imbalances, a changed gut-brain axis, genetic predispositions, and psychological factors cause the body not only to store weight, but to actively defend it. In many cases, conventional measures such as dieting or exercise alone are not enough to lose weight permanently.
At our gastroenterology practice in Bern, we therefore take an innovative, holistic approach: we combine modern endoscopic procedures for stomach reduction with the latest generation of drug therapy, in particular GLP-1 analogues such as semaglutide or the newly approved, even more effective tirzepatide.
NEJM study 2025: Tirzepatide is more effective than semaglutide – even without diabetes
In May 2025, the renowned New England Journal of Medicine (NEJM) published a groundbreaking study that examined for the first time the direct comparison of tirzepatide and semaglutide in adults with obesity without diabetes. In the randomized study, 751 non-diabetic participants received either tirzepatide (10 mg or 15 mg) or semaglutide (1.7 mg or 2.4 mg) as a weekly injection over 72 weeks. The results were clear: participants who received tirzepatide lost an average of 20.2% of their body weight, while those who received semaglutide lost "only" 13.7%. Waist circumference also decreased significantly more with tirzepatide.
This study confirms what many experts have suspected: tirzepatide, which acts on two hormone axes simultaneously (GLP-1 and GIP), is the new gold standard in the pharmacological treatment of obesity—even in people without type 2 diabetes mellitus.
Endoscopic sleeve gastrectomy (ESG): A minimally invasive option with a big effect
In parallel with drug therapy, we rely on an innovative endoscopic procedure that does not require surgical incisions: endoscopic sleeve gastrectomy, also known as endoscopic sleeve gastroplasty (ESG). In this procedure, the stomach is reduced in size from the inside using special sutures during a gastroscopy. This creates a tube-shaped stomach structure that reduces the amount of food consumed and makes you feel full sooner – without the need for a scalpel or hospital stay.
ESG can be performed on its own, but shows its maximum effect in combination with GLP-1 analogues. Experience shows that those who simultaneously reduce the size of their stomach and influence the hormonal hunger and satiety signals benefit the most – often with a weight loss of 20% or more.
The theory of "neuro-enteral synergy"
A new hypothesis is increasingly being discussed among experts: the so-called "neuro-enteral synergy." This refers to the amplification of natural satiety signals through a combined effect on the stomach, intestines, and brain. While GLP-1 receptors primarily inhibit the appetite center in the hypothalamus, GIP receptors also influence insulin release and possibly also neural plasticity in the reward system. Tirzepatide utilizes precisely this dual target and could thus stabilize not only weight but also eating behavior in the long term.
If, at the same time, the stomach is reduced endoscopically and the amount of food is limited, a multimodal therapeutic effect is created that acts both mechanically and hormonally. From a medical point of view, we are talking about synergistic agonization of enterohormonal signaling pathways – which translates as: the interaction of mechanics and biochemistry changes the body's system in a lasting way.
Who is this combination therapy suitable for?
Our offer is aimed at people with a body mass index (BMI) of 30 kg/m² or above, or 27 kg/m² or above with additional health risk factors such as high blood pressure, fatty liver, insulin resistance, or joint problems. Patients who have already tried many diets but have not been able to achieve stable long-term results will benefit particularly.
We provide individual advice, assess your medical requirements in an initial consultation, and accompany you throughout the entire process—from endoscopic gastric reduction to drug therapy and dietary changes.
Conclusion:
Evidence-based medicine meets modern endoscopy
The latest studies impressively demonstrate how effective the combination of endoscopic gastric reduction and modern GLP-1/GIP medications can be. While semaglutide has already shown great success in weight loss, tirzepatide is setting new standards – with an average weight loss of over 20% in the current NEJM study. ESG offers a minimally invasive, reversible option that mechanically supports this therapeutic concept.
At our practice in Bern, we offer you exactly this combination: modern, scientifically based obesity therapy – individually tailored, professionally supervised, and without any surgical intervention. Please feel free to make an appointment for a personal consultation.