Association for Bariatric Endoscopy systematic review and meta-analysis assessing the American Society for Gastrointestinal Endoscopy preservation and incorporation of valuable endoscopic innovations thresholds for transoral outlet reduction.

Roux-en-Y gastric bypass is a bariatric surgery associated with durable long-term weight loss in most, but not all, patients. Transoral outlet reduction (TORe) is an endoscopic procedure that reduces the gastrojejunostomy diameter and gastric pouch volume to promote weight loss in patients with recurrent weight gain after Roux-en-Y gastric bypass. This systematic review and meta-analysis, conducted by the Association for Bariatric Endoscopy in collaboration with the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee, aimed to evaluate whether TORe meets the performance thresholds outlined in the ASGE preservation and incorporation of valuable endoscopic innovations (PIVI) document for the clinical adoption of endoscopic bariatric therapies.

Comparison of a novel endoscopic suturing device to conventional endoscopic suturing device in a validated simulator: a randomized, crossover study (with video).

Background And Aims: Endoscopic suturing using a conventional suturing device has a steep learning curve. This study assesses the ease of use of a novel endoscopic suturing system compared to the conventional device using a validated simulator.

Methods: This randomized, crossover study included suturing experts and novices performing pursestring suturing on a transoral outlet reduction simulator.

The Impact of Endoscopic Gastric Remodeling on Gastroesophageal Reflux Disease.

Introduction: Sleeve gastrectomy is associated with an increased incidence of gastroesophageal reflux disease (GERD). By contrast, the impact of endoscopic gastric remodeling (EGR) on GERD symptoms remains unclear.

Methods: This prospective study included patients who underwent EGR and completed validated GERD-related patient-reported outcome questionnaires at baseline and 12 months postprocedure.

Establishing standards of practice for endoscopic sleeve gastroplasty: a global expert consensus using a modified Delphi method.

Background And Aims: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive treatment for obesity with established efficacy and safety. However, procedural techniques vary. In this study, our aim was to develop a standardized ESG approach.

Tolerability and Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists in Patients with Inflammatory Bowel Disease.

Purpose: Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have transformed obesity management, but their safety and efficacy in patients with inflammatory bowel disease (IBD) warrants further evaluation.

Methods: This retrospective cohort study included adults with obesity and a diagnosis of IBD who were treated with GLP-1 RA within a large healthcare network. Primary outcomes were ≥ 5% total weight loss (TWL) at 12-months post initiation, and IBD flares, comparing 12-months pre- and post-GLP-1 RA initiation.

Endoscopic Weight Loss Options.

Endoscopic therapies for obesity have emerged as safe, effective, and minimally-invasive alternatives to traditional approaches, including lifestyle modification, anti-obesity medications, and bariatric surgery. Currently, in the United States, 2 types of endoscopic weight loss therapies are Food and Drug Administration (FDA)-approved and are commercially available-intragastric balloons and endoscopic gastric remodeling. These devices and procedures are associated with approximately 10% to 20% total weight loss at 1 year and have distinct technical features, benefits, and risks that providers should be familiar with.

Glucagon-like peptide-1 receptor agonists and upper endoscopy: a real-world experience.

Objective: Increased use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has raised safety concerns during endoscopy due to their mechanism of delaying gastric emptying. This study aims to evaluate the impact of GLP-1RAs on technical success and safety of esophagogastroduodenoscopy (EGD).

Methods: This was a retrospective study of bariatric patients who underwent EGD between January 2022 and December 2023.

Efficacy of anti-obesity medication (AOM) and endoscopic gastric remodeling (EGR): Analysis of combination therapy with optimal timing and agents.

Endoscopic gastric remodeling (EGR) and anti-obesity medications (AOMs) are effective weight loss therapies. While the efficacy of EGR and AOMs has been established, the effect of combination therapy and its optimal approach remain unknown. This was a single-center retrospective review of prospectively collected data from patients who underwent EGR.

Endoscopic management of obesity and metabolic diseases.

Obesity has become a global pandemic that is associated with a range of metabolic disorders. Traditional treatment options, such as lifestyle modification and anti-obesity medications, often exhibit limited efficacy and can lead to long-term weight gain, especially upon discontinuation of the medication. Although bariatric surgery is effective, its accessibility is constrained, and only a small percentage of eligible patients receive this intervention.

EUS-guided gastroenterostomy for malignant gastric outlet obstruction: impact of clinical and demographic factors on outcomes.

Background And Aims: EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to surgical gastrojejunostomy and endoluminal stenting for malignant gastric outlet obstruction (MGOO). Studies regarding factors associated with the EUS-GE outcomes are limited.

Methods: A retrospective observational study was conducted with consecutive patients who underwent EUS-GE for MGOO from January 2016 to November 2023.

EUS-guided shear wave elastography for fibrosis screening in patients with obesity and metabolic dysfunction-associated steatotic liver disease: a pilot study (with video).

Background And Aims: Liver fibrosis staging is challenging in patients with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). Liver biopsies are invasive, whereas noninvasive tests such as vibration-controlled transient elastography (VCTE) can be inaccurate in patients with obesity. We hypothesized that EUS-guided shear wave elastography (EUS-SWE) is more accurate for liver fibrosis staging in patients with MASLD and obesity; the aim of this pilot study was to test this hypothesis and establish optimal fibrosis stage cutoffs for EUS-SWE.

Endoscopic Management of Weight Regain After Bariatric Surgery.

Weight regain, also known as recurrent weight gain, is common following bariatric surgeries. While anti-obesity medications and surgical revisions offer effective treatment options, they are not without their challenges and limitations. Over the last few decades, there have been significant advancements in endoscopic interventions to address weight regain following bariatric surgery.

Autonomic and Enteric Profiling May Help Predict Response to Diverse Obesity Therapies.

Purpose: Changes in autonomic (ANS) and enteric nervous systems (ENS) may be involved in pathogenesis of obesity. We hypothesized that baseline autonomic and enteric parameters may predict outcomes of diverse obesity therapies.

Material And Methods: We studied ANS and ENS physiology in 37 patients (8 male, 29 female, age 45 years, weight 129.

Safe Continuation of Glucagon-like Peptide 1 Receptor Agonists at Endoscopy: A Case Series of 57 Adults Undergoing Endoscopic Sleeve Gastroplasty.

Purpose: Glucagon-like receptor agonists (GLP1-RAs) have raised peri-procedural concerns due to their potential to delay gastric emptying. The American Association of Anesthesiologists has advised pausing a single dose before elective endoscopy. However, a subsequent directive from multiple gastroenterology societies underscored the need for further assessment to substantiate this practice.

Early Successful Experiences of Surgical Conversion of Endoscopic Gastric Plication to Roux-en-Y Gastric Bypass.

Background: The primary obesity surgery endoluminal (POSE) procedure is an innovative incision-less endoscopic bariatric procedure that is increasingly used. However, variable weight loss response and recurrence post-endoscopic bariatric procedures have at times necessitated laparoscopic bariatric conversion. The safety and approach of conversion to laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB), however, have been an active point of discussion within revisional bariatric surgery.

Bariatric endoscopic antral myotomy: a pilot study assessing technical feasibility, physiologic changes, and preliminary efficacy.

Background And Aims: Gastric balloons and endoscopic sleeve gastroplasty appear to work by delaying gastric emptying. We hypothesized that pylorus-sparing antral myotomy would inhibit the antral pump, inducing gastric retention and similarly resulting in weight loss.

Methods: In this single-center pilot study, we assessed bariatric endoscopic antral myotomy (BEAM) using submucosal tunneling.

American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity.

This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development.

Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting.

Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous.

Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss.

Importance: Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their efficacy.

Endoscopic sleeve gastroplasty: the identification of the key procedural steps through a modified Delphi method.

Background: Endoscopic sleeve gastroplasty (ESG) is an innovative, minimally invasive bariatric procedure with an excellent safety and efficacy profile in adults with obesity. The purpose of the procedure is to shorten and tubularize the stomach along its greater curvature. Nevertheless, there are some heterogeneities in the approach to ESG, which will be important to address as the procedure sees increasingly widespread clinical adoption.

Combination Therapy of Endoscopic Gastric Remodeling with GLP-1RA for the Treatment of MASLD.

Purpose: The mainstay of treatment for metabolic dysfunction-associated steatotic liver disease (MASLD) is weight loss. Endoscopic gastric remodeling (EGR) and glucagon-like peptide-1 receptor agonist (GLP-1RA) are effective weight loss therapies. This study aims to assess the effect of combining EGR with GLP-1RA on liver-related outcomes and weight profile.