Weight Loss Effect of GLP-1 RAs With Endoscopic Bariatric Therapy and Bariatric Surgeries

Abstract

Background Different treatment modalities are available for obesity management, including lifestyle changes, pharmacotherapy, endoscopic interventions, and surgeries. Limited evidence is currently available on the weight loss effect of combining glucagon-like peptide 1 receptor agonists (GLP-1 RAs) with endoscopic bariatric therapy (EBT) and bariatric surgeries (BS). Objectives In this systematic review we compared the weight loss effect and metabolic changes of combining GLP-1 RAs with EBT and BS. Methods Literature searches were performed in the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, Embase, PubMed, Google Scholar, and PRISMA databases. Only randomized control trials and retrospective studies were included. Results A total of eleven studies were included. Nine studies compared BS with and without liraglutide and two compared EBT with and without liraglutide. Adding liraglutide to EBT or BS provided significant weight loss when compared with EBT or BS alone. When changes in weight were compared across the studies, EBT with liraglutide showed a weight loss effect comparable to the net weight loss (i.e., nadir weight loss after BS– regained weight) achieved following BS alone. Conclusion This review showcases a promising approach for managing obesity that combines GLP-1 RAs with EBT. This approach is expected to achieve shorter hospital stays, fewer side effects, and longer-term weight loss benefits than BS alone. However, additional prospective studies with higher-quality, more consistent outcome measures for weight loss and metabolic changes are needed to further evaluate the approach.

Semaglutide for weight loss: unanswered questions

“…However, three retrospective real-world studies support the effectiveness and good safety profile of semaglutide for the treatment of weight recurrence after bariatric surgery, as evidenced by a mean 6-month body weight reduction of 9.8–10.3% ( 44 – 46 ). Ongoing prospective studies, such as the BARI-STEP trial, aim to determine the role of semaglutide in individuals who have experienced insufficient weight loss or excessive weight regain following bariatric surgery ( 47 , 48 ). Another potential, albeit untested yet, therapeutic application of semaglutide is that of neoadjuvant pharmacotherapy prior to bariatric surgery.…”

“…Prospective studies are warranted to determine whether semaglutide use in the preoperative setting could improve patient outcomes and reduce complications of bariatric operations, especially in individuals with very high BMI exceeding 50 kg/m 2 . Finally, future research efforts should also be directed towards the combination of semaglutide with, rapidly evolving, endoscopic bariatric therapies, such as intragastric balloons or endoscopic sleeve gastrectomy ( 48 ).…”