TOPLINE:

Gastric sleeve endoscopy together with lifestyle modification (diet and exercise) was associated with greater continued weight loss than lifestyle modification alone in patients who had stopped taking a GLP-1 receptor agonist (RA). At 12 months, the combination was associated with 17% total weight loss compared to 0.1% with lifestyle modification alone.

METHODOLOGY:

• Discontinuation of GLP-1 RAs is common and is associated with weight regain; therefore, researchers conducted a multicenter cohort study looking at the efficacy of gastric sleeve endoscopy together with lifestyle modification compared to lifestyle modification alone in promoting continued weight loss.
• The study included 59 patients; 35 underwent gastric sleeve endoscopy in addition to lifestyle modifications (mean age, 46 years), and 24 underwent lifestyle modification alone (mean age, 59 years) between August 2021 and September 2024.
• Approximately 90% of study participants had been previously taking semaglutide, while about 10% had been taking tirzepatide; reasons for discontinuation included intolerance or less than 5% total weight loss.
• The primary endpoint was percentage total weight loss at 12 months. Secondary endpoints included the proportion achieving 5% or more and 10% or more of total weight loss, changes in BMI and excess weight loss, and any serious adverse events.

TAKEAWAY:

• Participants who underwent gastric sleeve endoscopy along with lifestyle modifications had greater weight loss — 97% had 5% total weight loss or more, and 77% had 10% total weight loss or more — compared to 29% and 13%, respectively, in the lifestyle modifications-only group.
• Mean BMI after gastric sleeve endoscopy decreased from 38 to 32, whereas it remained largely unchanged in the lifestyle modifications-only participants.
• Mean excess weight loss was 40% in the combination group compared with -0.1% for the lifestyle modifications-only group.
• No serious adverse events were reported in either group.

IN PRACTICE:

“In patients discontinuing GLP-1RAs, [gastric sleeve endoscopy] plus [lifestyle modification] is a safe and effective minimally invasive intervention that results in clinically significant weight loss compared to [lifestyle modification] alone,” the study authors concluded. 

Everything is done through the mouth while the patient is asleep, the study author told Medscape Medical News. The procedure takes approximately 1 hour and the average cost is about $12,000 across the country, although insurance coverage is increasing, she added.

"This study showed that [gastric sleeve endoscopy] is a tool that can be used as a safe and minimally invasive option to help patients with continued weight loss after discontinuing GLP-1 medications," said Supriya Rao, MD, medical director of the obesity medicine program at Lowell General Hospital-Tufts Medicine, Lowell, Massachusetts, who was not involved in the study.

SOURCE:

The study was presented as a poster presentation (Poster Su1816) at Digestive Disease Week (DDW) 2026 in Chicago by Pichamol Jirapinyo, MD, MPH, associate director of bariatric endoscopy at Brigham and Women’s Hospital in Boston.

LIMITATIONS:

The study size was modest with 59 total participants. 

DISCLOSURES:

The study was funded by Boston Scientific. Jirapinyo disclosed she is a consultant for Boston Scientific. Rao had no disclosures.