A Pair of Shoes

Prospects for Pairing Endoscopy with Semaglutide

The big meeting of gastroenterology – DDW – happens online this weekend. It’s doesn’t typically offer a lot on obesity science and clinical care. But this year, the meeting has a fascinating peek at the potential for pairing endoscopy with semaglutide. News in advance of the meeting suggests this pairing might produce clinical results that come close matching more invasive surgical procedures for obesity.

Naturally, though, we advise taking this early report with a grain of salt.

ESG: Endoscopic Sleeve Gastroplasty

The ESG procedure is minimally invasive compared to a gastric sleeve or bypass. There are no incisions, just a scope that goes in down the throat to the stomach. A special device places sutures in the stomach to make it smaller. Because this procedure is less invasive, it is generally even safer than a gastric sleeve. Pain and nausea are the most common adverse events in the days following it. For most patients, it doesn’t even require a hospital stay.

However, it’s not as effective as a gastric sleeve or bypass. Where those procedures might help a person lose 20 to 30 percent of their weight, ESG typically produces a loss of 15 to 20 percent.

An RCT of Adding Semaglutide

This is where the new study at DDW suggests interesting possibilities. Researchers from the U.S. and Brazil conducted a randomized controlled study of endoscopy with or without semaglutide. Of course, one group received a placebo injection, but the other received up to 1.5 mg weekly of semaglutide. This dose is lower than the 2.4 mg dose FDA is reviewing for stand-alone therapy of obesity. However it’s higher than the 1.0 mg maximum dose approved for treating diabetes.

The researchers found that average weight loss for patients who received only ESG was 19.6% – a fairly typical result for ESG. For the combination of ESG and semaglutide, weight loss was significantly higher – 26.7%. Lead author Anna Carolina Hoff commented:

“ESG has been available to patients for years, but it has not always been as successful as surgical options in helping patients lose weight. We now have a minimally invasive procedure that can be just as successful when combined with semaglutide and can be made available to even more people looking to lose a significant amount of weight.”

Yes, But…

Without a doubt, these are interesting results. Pairing endoscopy with semaglutide might offer the possibility of outcomes that match more invasive surgical procedures.

But we’ll wait for a full peer-reviewed publication of these results before celebrating. Even so, the picture will not be complete until longer-term data comes forth, because obesity care is not a sprint. It’s a marathon. This is a chronic condition and the long-term outcomes are what really matters.

Click here and here for reports on this study, here for the study abstract. For more perspective on ESG, this paper is worthwhile.

A Pair of Shoes, painting by Vincent van Gogh / WikiArt

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May 20, 2021