ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One) | March 2026-SESSION B: Bariatric and Endoluminal Interventions- What APPs Should Know

Video Transcription

Video Summary

The speaker reviews obesity as a chronic, relapsing disease requiring multiple “tools in the toolbox,” noting a treatment gap between medications and bariatric surgery. Lifestyle changes yield ~5% total body weight loss, older medications ~10–12%, newer agents like tirzepatide ~17–20%, while bariatric surgery can achieve ~30–40%. Because few eligible patients undergo surgery and many discontinue GLP-1/GIP drugs, endoluminal (endobariatric) options help bridge the gap (FDA-approved for BMI 30–50). Key surgeries include sleeve gastrectomy and Roux-en-Y gastric bypass; clinicians must watch for post-op red flags (tachycardia/leak, epigastric pain/internal hernia, persistent vomiting/stricture) and manage long-term micronutrient needs and NSAID avoidance. Endoscopic options include the intragastric balloon (temporary, less used) and endoscopic sleeve gastroplasty (ESG), a same-day suturing procedure producing ~13–20% loss at 12 months, with specific contraindications and leak/bleed red flags. Combination therapy (ESG + GLP-1s) is increasingly common. A case highlights taking post-procedure symptoms seriously, as abdominal pain revealed a large benign mass.

Asset Subtitle

Sarah Kosinski, DNP, APRN, FNP-BC

Keywords

obesity chronic relapsing disease

tirzepatide GLP-1 GIP weight loss medications

bariatric surgery sleeve gastrectomy Roux-en-Y gastric bypass

endobariatric endoscopic sleeve gastroplasty ESG

postoperative red flags micronutrient management NSAID avoidance