Multimodal Strategies for Obesity Management: Integration and Combination of GLP-1/GIP Therapies, Bariatric Endoscopy, and Metabolic Surgery: A Scoping Review

Background/Objectives: The development of GLP-1 receptor agonists (GLP-1RAs) and dual GLP-1/GIP receptor agonists has expanded the possibilities for multimodal obesity treatment. 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 May 16, 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: A total of 61 studies were included, of which 14 directly evaluated multimodal integration strategies involving pharmacotherapy, bariatric/metabolic endoscopy, and/or bariatric/metabolic surgery, encompassing approximately 6,401 participants. Retrospective cohort studies predominated (71.4%). Semaglutide and liraglutide were the most frequently investigated medications. The intragastric balloon was the most evaluated endoscopic intervention, followed by transoral outlet reduction (TORe), endoscopic sleeve gastroplasty (ESG), revisional ESG (R-ESG), and revisional procedures. Pharmacologic-endoscopic combinations were the most common strategy (42.9%), and most studies were conducted in the postoperative setting (71.4%). Overall, combined and sequential strategies achieved greater weight loss than isolated interventions, whereas revisional surgery demonstrated superior outcomes compared with pharmacotherapy in comparative studies. Conclusions: Evidence regarding multimodal strategies for obesity treatment remains limited and is predominantly observational. 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.