Integration and Combination of GLP-1/GIP Therapies, Bariatric Endoscopy, and Metabolic Surgery in the Treatment of Obesity: A Scoping Review

Background: The development of glucagon-like peptide-1 receptor agonists (GLP-1 Ras or GLP-1) and dual glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide (GLP-1/GIP) receptor agonists has expanded the therapeutic options for multimodal obesity management. However, evidence regarding the integration, combination, or sequencing of these therapies with bariatric/metabolic endoscopy and bariatric/metabolic surgery has not been comprehensively synthesized. Methods: A scoping review was conducted following the methodological framework of Arksey and Levac, the recommendations of the Joanna Briggs Institute, and the PRISMA-ScR guidelines. A systematic search was performed in PubMed, Scopus, and Embase from database inception through 16 May 2026. Studies involving adults that evaluated GLP-1/GIP agonists in relation to endoscopic and/or surgical bariatric/metabolic procedures were included. Data extraction was independently performed by two reviewers, and the evidence was synthesized using descriptive and narrative analyses. Results: All 14 studies directly evaluated strategies involving the integration, combination, or sequencing of pharmacotherapy with bariatric/metabolic endoscopy and/or bariatric/metabolic surgery and therefore contributed to the primary synthesis. The reported sample sizes across the 14 included studies summed to approximately 6401 participants, with individual study sample sizes ranging from 40 to 4901 patients. Most were retrospective cohort studies (10/14; 71.4%), followed by randomized controlled trials or prospective studies (3/14; 21.4%) and comparative observational studies. GLP-1 were the most frequently evaluated pharmacological agents, particularly semaglutide (7/14; 50.0%) and liraglutide (6/14; 42.9%), whereas tirzepatide was investigated in two studies (2/14; 14.3%). Endoscopic interventions were evaluated in 11 of the 14 included studies (78.6%). The most frequently evaluated endoscopic intervention was the intragastric balloon (IGB) (4/14; 28.6%), followed by transoral outlet reduction (TORe) (1/14; 7.1%), endoscopic sleeve gastroplasty (ESG) (1/14; 7.1%), revisional ESG (R-ESG) (1/14; 7.1%), and other revisional endoscopic procedures. Conclusions: Evidence regarding integrated, combined, sequential, adjuvant, or comparative treatment strategies for obesity management remains limited and is predominantly derived from observational studies. The integration of pharmacotherapy with endoscopic and surgical interventions shows promising results; however, high-quality prospective studies and randomized clinical trials are needed to define the optimal treatment sequence and identify the patients most likely to benefit from these multimodal approaches.