At the BSG Live ‘26 meeting recently, Dr Rehan Haidry presented the British Society of Gastroenterology’s first ever national guideline on Bariatric & Metabolic Endoscopy — a landmark piece of work he chaired on behalf of the BSG Guideline Development Group, commissioned by the BSG Clinical Services Committee.
Why this guideline matters
More than 1 billion people worldwide are living with obesity. In the UK almost 3 in 10 adults are affected, projected to rise to around 4 in 10 by 2050. While GLP-1 medications have transformed obesity care, weight is often regained after stopping treatment – and fewer than 1% of eligible patients ever receive bariatric surgery.
Endoscopic bariatric and metabolic procedures sit in the gap between medication and surgery. These minimally invasive, incisionless options can produce meaningful, durable weight loss and metabolic improvement. Until now, there has been no UK-specific guidance on how and when to use them most effectively.
What the guideline recommends…
Developed with a multidisciplinary panel – involving gastroenterology, endoscopy, bariatric surgery, obesity medicine, dietetics and a patient representative – and built on a full systematic review and GRADE-assessed evidence, the guideline sets out recommendations across governance and patient selection. Some key elements for patients include:
- Endoscopic procedures should be delivered within multidisciplinary bariatric services, with informed shared decision-making and patients selected on health impairment rather than BMI alone
- Endoscopic gastroplasty (such as ESG) supported as a weight-loss option alongside lifestyle management, with the strongest and most durable evidence of the procedures reviewed
- Revisional gastroplasty and transoral outlet reduction (TORe) — for patients who are regaining weight after previous bariatric surgery
- Intragastric balloons — supported for short-term weight loss
- Duodenal-jejunal bypass liner and duodenal mucosal ablation — currently recommended within research settings only, pending further evidence
Cleveland Clinic London: the knowledge and expertise
Dr Haidry’s team at Cleveland Clinic London is the only centre in the UK currently able to offer patients the full spectrum of procedures covered by this new national guideline — from endoscopic sleeve gastroplasty and TORe through to intragastric balloons and duodenal-jejunal bypass liner supported by a sull spectrum multidisciplinary (MDT) service.
Considering your metabolic health?
If you’d like to understand which of these options might suit your circumstances best, Dr Haidry can talk you through the evidence.
Read more about ESG, TORe and bypass liner device Reset.