S769 Trends in GLP-1 Receptor Agonist Therapy Post-Endoscopic Sleeve Gastroplasty

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are now popular anti-obesity pharmacotherapy and can be used as an adjunct to endobariatric procedures such as endoscopic sleeve gastroplasty (ESG). We examined trends in initiation, percent total body weight loss (%TBWL), and barriers to continuation of therapy among patients who initiated GLP-1 RA post-ESG. Methods: A single-center retrospective study examined patients who underwent ESG at an academic tertiary care center between June 2021 and September 2023. Inclusion criteria included patients who underwent ESG alone, or ESG followed by GLP-1 RA therapy at any time post-ESG. Demographic data, GLP-1 RA use, and %TBWL (i.e., weight loss divided by pre-ESG weight) at 1, 3, 6, 12, and 24 months post-ESG were assessed. Average %TBWL and percentage difference in body mass index (BMI) between pre-ESG and time of GLP-1 RA initiation, and reasons for discontinuing therapy, were assessed. Exclusion criteria included the use of additional non-GLP-1 RA anti-obesity pharmacotherapy, or the use of any anti-obesity pharmacotherapy prior to ESG. Results: Fifty-four patients underwent ESG alone, while 15 were started on a GLP-1 RA post-ESG. Demographic data were similar between the 2 groups. GLP-1 RA included semaglutide and tirzepatide. Semaglutide was most popularly prescribed (80%). The time between ESG and GLP-1 RA initiation varied widely, with a median time of 12 months post-ESG (mean 16 ± 12). Average BMI at GLP-1 RA initiation was 33.4. At time of GLP-1 RA initiation, average %TBWL compared to pre-ESG weight was 7.8%, and average percentage difference in BMI compared to pre-ESG was 6.0%. Notably, there was no difference in %TBWL at any time point post-ESG between the 2 groups. Among those treated with GLP-1 RA, 3 patients discontinued therapy: 1 due to intolerable nausea and vomiting; 1 patient discontinued semaglutide due to insurance problems and switched to tirzepatide; and 1 patient discontinued semaglutide and switched to tirzepatide for an unknown reason. Conclusion: Our results show that while timing of GLP-1 RA initiation post-ESG varies widely, one motivation behind initiation is plateau of weight loss. We did not find a significant difference in %TBWL between patients who received ESG alone vs concomitant GLP-1 RA therapy; perhaps this is related to the fact that ESG and GLP-1RA concomitantly delay gastric emptying. Further studies are warranted to explore this relationship and the effect of GLP-1 RA therapy post-ESG on long term weight outcomes.