DOWNERS GROVE, Ill – September 23, 2019 –
On Monday, the Association for Bariatric Endoscopy (ABE), a Division of the American Society for Gastrointestinal Endoscopy (ASGE), released two documents to provide recommendations
and guidance on the training and
privileging of physicians who provide endoscopic procedures for weight
loss. These documents are intended to ensure the highest quality of care
for patients with obesity now that non-surgical procedures are becoming
as an option for treating many of these patients.
bariatric therapies (EBT) include various types of balloons that can be
placed into the stomach to reduce a patient’s stomach capacity;
procedures to reshape the stomach; or those
that enable food that’s been eaten to “bypass” the stomach. Many of
these procedures are temporary and are reversed once a patient’s weight-loss goal has been met.
options, unlike traditional bariatric surgery, are performed using a
small, flexible lighted scope inserted through the patient’s mouth.
In 2015, as EBT options began to grow and develop markedly, ABE was formed to provide a deep focus on these procedures within the gastrointestinal endoscopy community.
“These procedures represent an attractive and
effective option for patients who are within a certain percentage of
excess body weight, or for those who may not be good candidates for
They also work well as a bridge for patients who are not succeeding
with lifestyle changes or medication, but who may not feel ready for a
more invasive surgical treatment,” said Christopher Thompson, MD,
immediate past chair of ABE. “It’s important that we
share these best practices for training physicians to ensure the highest quality for these procedures.”
The ABE/ASGE Position Statement on Training and Privileges for Primary
Endoscopic Bariatric Therapies outlines the fundamental
principles for effective training to provide comprehensive care, for
acquisition of the required endoscopic skills, and for assuring that quality care is provided as endoscopic bariatric procedures
continue to be integrated into practice.
to Nitin Kumar, MD, who co-authored the position statement with Dr.
Thompson, “Obesity is a multiorgan system chronic disease for which
gastrointestinal endoscopy is playing an increasing
therapeutic role. Treatment of these patients requires a comprehensive
approach, with mastery of technical skill as well as an understanding of
The document covers three essential principles for providing quality EBT:
of patients with obesity, including program requirements for the
integration of EBT into existing practice. These include current
knowledge and understanding of lifestyle interventions
(such as diet and exercise), behavior modification, pharmacotherapy, and bariatric surgery, in addition to current knowledge regarding EBT.
- Endoscopic skills, including residency or fellowship training in gastrointestinal endoscopy, with documentation of skills and competence.
- EBT procedure- and device-specific knowledge, including indications, contraindications, risks, benefits and outcomes for these procedures.
The document refers to existing standards of practice as well as definitions of endoscopic competence, and it outlines both major and minor skills.
addition to these principles, the position statement addresses
physician certification. It also makes recommendations to aid
institutions in defining criteria for awarding privileges for
an individual to perform EBT.
The Obesity Core Curriculum document contains recommendations for training of physicians. It is intended for use by gastroenterology program directors and faculty, including those involved
in teaching endoscopy, as well as for trainees in gastroenterology.
a small proportion of gastroenterologists currently treat obesity;
however, given the burden of disease, there is an urgent need for
greater involvement of physicians from multiple specialties,
including gastroenterology, to be actively involved in the care of
patients with obesity,” noted lead author Rahul Pannala, MB, BS, MPH.
The curriculum was developed to provide an overview of the cognitive and technical content areas that all gastroenterology (GI) fellows should learn pertaining to the evaluation and management
of patients with obesity and to serve as a guide to published references, videos, and other available resources.
According to Jonathan Cohen, MD, FASGE, immediate past chair of ASGE’s Training Committee and co-author of the curriculum document, “By providing this framework to trainers and trainees, ABE
hope to facilitate the incorporation of this important material into
training programs to ensure that physicians are well prepared for future
professional responsibilities in this area.”
The focus of bariatric endoscopists’ work involves carrying out endoscopic weight-loss procedures and
providing follow-up care to those patients. However, in addition,
often are called upon to manage adverse events from bariatric surgery;
provide treatment to address weight regain after bariatric surgery; or
otherwise follow up with surgical patients. The societies note that
treating both types of patients requires certain
this document addresses the core concepts that all general
gastroenterology fellows should acquire about lifestyle intervention;
pharmacologic, endoscopic, and surgical treatments
for obesity; evaluation and
management of gastrointestinal conditions that accompany obesity;
challenges associated with sedation in patients with obesity; endoscopic
evaluation of patients’ anatomy following bariatric surgery; and the management of selected
adverse events in patients who have had bariatric surgery.
ABE Chair Shelby Sullivan, MD said, “ASGE and ABE
are committed to helping patients with obesity. The weight loss that’s
possible through these procedures has helped patients to reverse
become fit for organ transplants, and
achieve many other life-changing health improvements. We have seen this
for ourselves. Our societies are proud that our member endoscopists can
play an expert role in guiding the treatment of these patients.”
Both documents were published online on Monday, September 23 at
They will appear in the November print issue of
GIE: Gastrointestinal Endoscopy.
For more information, visit the ABE website at
About the Association for Bariatric Endoscopy
The Association for Bariataric Endoscopy (ABE), a Division of the American Society for
Gastrointestinal Endoscopy (ASGE), promotes the safe and effective integration
of endoscopic bariatric therapies into practice by providing state-of-the-art
information, education and practice support. ABE members are an active community of gastrointestinal endoscopists,
surgeons, and clinicians, with a special interest in this rapidly
developing and growing endoscopic field, who are currently offering —
or preparing to offer– the latest bariatric endoscopic procedures to
improve the health and wellness of patients with obesity.