GIs should incorporate obesity management into their practice as part of a multi–disciplinary care team.

Endoscopic bariatric therapies (EBTs) can be used effectively as adjunctive therapy that fills an important gap in the management of obesity and metabolic disease, according to a new AGA Clinical Practice Update.

Writing in the journal Gastroenterology, Barham K. Abu Dayyeh and colleagues provide seven pieces of practice advice based on a review of the available literature, current practice patterns, and their general knowledge and experience in using endoscopic bariatric therapies in clinical trials and practice:

• EBTs should be considered in patients with obesity who have been unsuccessful in losing or maintaining weight loss with lifestyle interventions.
• EBTs can be used in patients with severe obesity as a bridge to traditional bariatric surgery or as a bridge to allow unrelated interventions that are unable to be performed because of weight limits.
• Clinicians should use EBTs as part of a structured weight loss program that includes dietary intervention, exercise therapy and behavior modification, in both the active weight loss phase and the long–term maintenance phase.
• Clinicians should screen all potential EBT candidates with a comprehensive evaluation for medical conditions, comorbidities, and psychosocial or behavioral patterns that contribute to their condition before enrolling patients in a weight loss program that includes EBTs.
• Clinicians incorporating EBTs into their clinical practice should follow up with patients prospectively to capture the impact of the program on weight and weight–related comorbidities, and all related adverse outcomes. Poor responders should be identified and offered a detailed evaluation and alternative therapy.
• Clinicians embarking on incorporating EBTs into their clinical practice should have a comprehensive knowledge of the indications, contraindications, risks, benefits and outcomes of individual EBTs, as well as a practical knowledge of the risks and benefits of alternative therapies for obesity.
• Institutions should establish specific guidelines that are applied consistently across disciplines for granting privileges in EBTs that reflect the necessary knowledge and technical skill a clinician must achieve before being granted privileges to perform these procedures.

The authors suggest that GIs who want to incorporate EBTs into their clinical practice should develop expertise in managing obesity as a disease in conjunction with a multi–disciplinary team taking care of patients with obesity.