Introduction

The management of obesity is often complicated by associated comorbidities such as type 2 diabetes, hypertension and hyperlipidaemia—all of which contribute to significant polypharmacy. High pill burden is linked to reduced adherence, increased healthcare costs, and lower quality of life. While Endoscopic Sleeve Gastroplasty (ESG) has been established as a minimally invasive intervention for weight loss, its impact on medication use remains underexplored. This study aims to evaluate changes in medication burden following ESG in a real-world cohort, with a focus on the potential for pharmacological de-escalation alongside weight loss.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. The primary outcome was change in medication burden, defined as the total number of prescribed medications at baseline, 6 months, and 12 months following ESG. Data on medication count were collected from electronic medical records, including all chronic medications prescribed for obesity-related comorbidities.

Results

At baseline, 17.8% of patients were on one or more oral anti-diabetic medications, 2.6% were on insulin, 30.9% were taking antihypertensives, and 22% were on lipid-lowering therapy. At 6 months post-ESG, the proportion of patients on anti-diabetic medications decreased to 15.2%, and insulin use dropped slightly to 2.1%. Anti-hypertensive use declined to 20.8%, and lipid-lowering therapy was reduced to 17.1%. By 12 months, further reductions were observed: 12.7% of patients remained on anti-diabetic medications, only 1.4% were on insulin, and use of anti-hypertensives and lipid-lowering agents fell to 20.8% and 18.8%, respectively.
The total number of medications per patient decreased significantly over time. At baseline, patients were on an average of 1.36 medications targeting diabetes, hypertension, and hyperlipidemia. This declined to 0.61 medications at 6 months and 0.59 at 12 months, corresponding to mean reductions of 0.75 (95% CI: 0.42–1.07, p < 0.001) and 0.77 (95% CI: 0.46–1.08, p < 0.001), respectively. These reductions were consistent across all major cardiometabolic drug classes.

Conclusion

In addition to driving meaningful weight loss, ESG contributes to a measurable reduction in medication burden for obesity-related comorbidities. These findings support the broader role of ESG in promoting pharmacologic de-escalation, potentially improving long-term adherence and quality of life in patients with obesity.

Disclosure

NIL

Introduction

In the southwest Netherlands, hospitals collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP consists of protocols addressing different stages in IBD treatment, such as initiation and switching of therapy, frequency and type of follow-up. This study assessed the adherence to the CP and identified barriers and facilitators to its implementation.

Aims & Methods

A mixed-methods study was conducted. Quantitative data was used to evaluate the adherence to different protocols of the CP and was collected retrospectively from electronic health records (EHRs) from December 2020 until March 2023. Surveys and semi-structured interviews were used to identify barriers and facilitators, using the Extended Normalisation Theory. Surveys were sent to all healthcare providers and interviews were conducted with gastroenterologists, IBD-nurses, healthcare assistants, and IT-personnel.

Results

A total of 299 patients were included. Adherence to the CP regarding the documentation of travel plans and vaccination status improved after implementing the CP (15% pre-implementation vs. 33% post-implementation), as well as written communication with general practitioners (31% vs. 83%) and body weight registration (12% vs. 50%). Among patients switching medication, 25% had a repeated screening for HIV, tuberculosis, and hepatitis B and C documented if prior tests were over a year old. Post-implementation, scheduling outpatient visits were more closely aligned with CP recommendations across CP protocols (57% vs. 100%), as did blood test ordering (10% vs. 44%). Disease activity scoring with validated questionnaires remained low (7% vs. 21%).  Adherence to registering medication adherence, current smoking status, and side effects during annual outpatient visits remained low (18% vs. 40%).
Of 85 surveys, 42 were completed, and 11 interviews were conducted. Facilitators were improving collaboration between healthcare providers and the potential to standardise care. Barriers included the complexity of the use in EHRs, difficulty for healthcare providers to change their current routine, and the heterogeneity of IBD.

Conclusion

A CP for the treatment of IBD with biologics and small molecules has been implemented to improve IBD care, however, adherence appears to be challenging, partially contributed to the difficulty healthcare providers experience in changing their behaviour. The gradual improvement indicates that increased familiarity with the CP may enhance adoption. Discrepancies between performed and documented tasks in EHRs may also contribute to lower adherence rates, which could be improved by audit and feedback sessions.

References

1. van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))

Disclosure

Drs. Visser received speaker fees from Lilly outside the submitted work. Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion outside the submitted work. Dr. van Noord reports personal fees from Janssen, Takeda, and Falk outside the submitted work. Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.

Introduction

Obesity is a global health challenge associated with significant morbidity, mortality, and economic burden. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a safe, incisionless, and minimally invasive alternative to bariatric surgery for patients with obesity who are either unwilling or unsuitable for surgical options. While ESG has demonstrated promising short-term results in terms of weight loss and metabolic improvement, there remains a paucity of data on long-term outcomes, particularly beyond one year. This study aims to evaluate the long-term efficacy of ESG in a large Asian cohort, focusing on total body weight loss (TBWL) as the primary outcome, with body mass index (BMI) change and absolute weight loss as secondary outcomes.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. The primary outcome was the percentage of total body weight loss (%TBWL) at 6, 12, and 24 months post-procedure.

Results

The cohort consisted predominantly of female patients (69%), with the majority being of Chinese ethnicity (42.8%). The mean age at baseline was 41.4 years (SD ± 10.6), and the mean baseline BMI was 35.0 kg/m² (SD ± 6.1). All ESG procedures were technically successful, with an average of five sutures placed per patient and a mean procedure time of 75 minutes (SD ± 17). No major complications were reported, and the average hospital stay was one day.
Follow-up data were available for 114 patients at 6 months, 86 at 12 months, and 41 at 24 months. The mean percentage total body weight loss was 15.9% (SD ± 10.5) at 6 months, 12.7% (SD ± 7.8) at 12 months, and 9.9% (SD ± 7.8) at 24 months, reflecting a sustained reduction in weight over time. As secondary outcomes, BMI decreased significantly from baseline by a mean of 6.0 kg/m² (SD ± 5.3) at 6 months, 4.2 kg/m² (SD ± 5.7) at 12 months, and 3.5 kg/m² (SD ± 5.7) at 24 months (all p < 0.001). These were accompanied by corresponding mean weight losses of 16.8 kg (SD ± 17.1), 12.1 kg (SD ± 8.6), and 9.6 kg (SD ± 9.0) at the respective timepoints, all statistically significant (p < 0.001).

Conclusion

ESG is a safe and effective endoscopic intervention for weight loss, with sustained and clinically meaningful reductions in total body weight, BMI, and absolute weight observed up to two years post-procedure. These real-world data from a large tertiary Asian centre support the long-term utility of ESG as a viable non-surgical option for obesity management.

Disclosure

​Nil