SUN-674 Metabolic Outcomes Combining Endoscopic Bariatric Procedures and GLP-1 Receptor Agonist Pharmacotherapy in Veterans with Obesity

Abstract Disclosure: J.F. Vasquez Mendez: None. D. Torres Pinzon: None. S. Meyer: None. G. Jordan: None. L. Kim: None. A. Cheloff: None. M. Santacatterina: None. J.O. Aleman Diaz: Novo Nordisk. V. Popov: None. Introduction: Endoscopic Bariatric Metabolic Therapies (EBMTs) combined with anti-obesity medications may improve weight loss and overall metabolic outcomes. This study aims to compare longitudinal outcomes of GLP1 Receptor Agonist (GLP1-RA) monotherapy versus combination of EBMTs and GLP1-RAs in veterans with obesity. Methods: We retrospectively identified patients between 2016-2024 with a BMI ≥30 kg/m² treated in our local weight management clinic (IRB 1671339). Patients were classified into semaglutide monotherapy, GLP1-RA (either Semaglutide, Dulaglutide or Liraglutide) combined with Endoscopic Sleeve Gastroplasty (ESG) or Intragastric Balloon (IGB) at a single urban Veterans hospital. Baseline and follow-up data were collected for 12 months. The primary endpoint was percent total weight loss (%TWL), while secondary endpoints included change in BMI and HbA1c. Results are presented as mean±SD, with significance tested by ANOVA or t-tests. Results: We included 29 patients with mean age 56.1±12.1 years, BMI 40.7±6.6 kg/m2, HbA1c 6.6±0.9% and 86% male sex. Of these, 20 were classified in the monotherapy group (90% with dysglycemia by HbA1c>5.7%), 5 patients in the combined GLP1-RA+ESG group (100% dysglycemia) and 4 patients in the GLP1-RA+IGB group (100% dysglycemia). Patients on EBMT (ESG+IGB) received 6 months of GLP1-RA post procedure, while patients on GLP1-RA received 12 months. At 12 months, both the monotherapy and combination therapy groups showed significant weight loss. No differences were observed between the groups in terms of %TWL, BMI change, or %BMI change. Monotherapy achieved %TWL of 5.6±6.1%, while the GLP1-RA+ESG group had %TWL of 4.7±4.2%, and the GLP1-RA+IGB group had a %TWL of 4.9±9.1%. Changes in BMI were similar between groups, with reductions of 2.1±2.5 kg/m² in monotherapy group, 1.7±1.7 kg/m² in the GLP1-RA+ESG group, and 2.2±4.2 kg/m² in the GLP1-RA+IGB group. Semaglutide monotherapy decreased HbA1c at 12 months by 0.33±0.96% compared to increased HbA1c by 0.49±0.63% in the GLP1-RA+EBMT group (p=0.012). Conclusions: In our local weight management clinic cohort of US veterans with obesity, we observe equivalent weight loss outcomes but reduction in HbA1c with semaglutide monotherapy compared to GLP1-RA+EBMT suggesting additional metabolic benefits. Limitations include small sample size and limited use of semaglutide in the combination groups. Further studies are required to confirm our findings. Presentation: Sunday, July 13, 2025