Advanced Endoscopy Fellows Program | September 2024-ASGE ESGE EBMT Guideline 2024

ASGE ESGE EBMT Guideline 2024

Pdf Summary

The joint ASGE-ESGE guideline provides an evidence-based summary and recommendations for the use of endoscopic bariatric and metabolic therapies (EBMTs) in managing obesity. Developed using the GRADE framework, it examines the efficacy and safety of FDA-approved or CE-marked EBMT devices and procedures approved within five years of the guideline’s development. The guideline suggests using EBMTs plus lifestyle modification (LM) in patients with a BMI ≥30 kg/m², or a BMI of 27-29.9 kg/m² with at least one obesity-related comorbidity. This includes using intragastric balloons (IGBs) and endoscopic gastric remodeling (EGR).<br /><br />Obesity, a growing global health issue, significantly increases the risk of mortality due to cardiovascular diseases and cancer. Traditional obesity treatments include LM, antiobesity medications (AOMs), and bariatric surgery. However, LM often results in minimal long-term weight loss, and barriers like cost and time commitment limit its effectiveness. Newer AOMs, although more effective, face issues like cost, drug shortages, and potential safety concerns. Bariatric surgery, while highly effective, is chosen by less than 2% of eligible patients annually due to cost, accessibility, and perceived invasiveness.<br /><br />EBMTs, developed over the past three decades, are increasingly popular and are classified into gastric and small-bowel devices. Gastric devices focus on weight loss with secondary metabolic benefits, while small-bowel interventions primarily address metabolic conditions. Despite their popularity, a comprehensive guideline was lacking until this document, which addresses efficacy, safety, and periprocedural care for these therapies.<br /><br />For EGR, the primary efficacy endpoint is weight loss, and a pooled total weight loss (TWL) of 5% is deemed clinically significant. Cardiometabolic improvements were inferred from an average TWL of 5-10%. Recommendations include treating obesity with IGBs plus LM, emphasizing periprocedural care involving antiemetics, pain medications, and PPIs.<br /><br />Ultimately, EBMTs are conditionally recommended for various BMI categories, with emphasis on individualized treatment strategies. The guideline highlights the need for further studies on long-term outcomes, combination therapies, and periprocedural care to optimize and expand EBMT use.

Keywords

endoscopic bariatric therapies

metabolic therapies

obesity management

GRADE framework

intragastric balloons

endoscopic gastric remodeling

lifestyle modification

antiobesity medications

bariatric surgery

periprocedural care