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Released on Sep 23, 2019

ASGE and ABE Release Guidance on Curriculum, Training and Privileges for Physicians Providing Endoscopic Procedures for Weight Loss


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 more common as an option for treating many of these patients.

Endoscopic 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.

EBT 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 surgery. 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.

According 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 pathophysiology.” 

The document covers three essential principles for providing quality EBT:

Management 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.

In 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.

“Only 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 and ASGE 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, bariatric endoscopists 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 competencies.

Specifically, 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 diabetes, 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 giejournal.org

They will appear in the November print issue of GIE: Gastrointestinal Endoscopy.

For more information, visit the ABE website at www.bariendo.org

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.