Antiobesity Medications and Endoscopic Bariatric Therapies: A Narrative Review

Abstract

The global obesity epidemic requires effective weight-loss solutions. Endoscopic bariatric therapies (EBTs), such as endoscopic sleeve gastroplasty, transoral outlet reduction, and intragastric balloons, provide minimally invasive alternatives to traditional surgery, demonstrating efficacy in weight loss and metabolic improvement. However, some patients experience suboptimal weight loss and recurrent weight gain. The addition of pharmacotherapy, particularly incretin analogs such as liraglutide, semaglutide, and tirzepatide, has been explored to improve EBT outcomes. Studies suggest that combining EBTs with pharmacotherapy, particularly following endoscopic sleeve gastroplasty, improves total body weight loss, while evidence for an additive benefit of intragastric balloons and antiobesity medications remains mixed. Although combination therapies with transoral outlet reduction for recurrent weight gain after Roux-en-Y gastric bypass show promise, the optimal timing and pharmacotherapeutic options need further clarification. Future studies should focus on refining patient selection, timing of medication initiation, and cost-effectiveness to maximize the benefits of combined treatments for managing obesity.