Development of an optimal pathway for endoscopic sleeve gastroplasty implementation in the NHS: a modified nominal group technique study

Currie, A, O'Neill, F, Hayee, B, Bansi, D, Parmar, C, McBride, E, Fernando, K, Grimes, L, Vijayaraman, A, Mahawar, K, Allan, C, Dhar, A, Clare, Ken, Pournaras, Dimitri J., Parretti, Helen and Kelly, J (2026) Development of an optimal pathway for endoscopic sleeve gastroplasty implementation in the NHS: a modified nominal group technique study. BMJ Open Gastroenterology, 13 (1).

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Abstract

Objective: The United Kingdom faces a significant obesity crisis and multiple management options are now available including pharmacotherapy, endoscopic and surgical interventions. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a NICE-approved, minimally invasive obesity care procedure which is a safe and effective option for selected patients. Despite its promise, NHS providers lack standardised guidance for implementation of this intervention. This initiative is aimed to create a comprehensive pathway for implementation of ESG within the NHS using a diverse stakeholder approach. Methods: A modified nominal group technique (NGT) was employed, bringing together a diverse group of healthcare professionals (HCPs) involved in obesity management from primary and secondary care, commissioner representatives, and patient groups in an iterative consensus-building process. The NGT methodology allowed for structured discussion, prioritisation of key elements, and sequential refinement of the pathway through multiple rounds of expert input and feedback. Results: The panel reached agreement on healthcare professional requirements, resource allocation, and identified key considerations for successful ESG implementation. Critical elements included primary care engagement, dietetic support, psychological assessment, and anaesthetic involvement alongside the procedural aspects of training and mentoring, patient selection and technical factors. Notably, no areas of significant disagreement were identified throughout the process, enabling the development of a comprehensive framework for ESG delivery. Conclusions: This framework provides practical proposals to facilitate ESG implementation across NHS centres, supporting multidisciplinary care delivery while acknowledging operational feasibility within existing NHS resource constraints.

Item Type:	Article
Additional Information:	Publisher Copyright: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
Uncontrolled Keywords:	endoscopic procedures,health service research,obesity,obesity surgery,gastroenterology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2715
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine
Related URLs:	https://www.scopus.com/pages/publication...
Depositing User:	LivePure Connector
Date Deposited:	20 Mar 2026 16:30
Last Modified:	26 Apr 2026 00:42
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102524
DOI:	10.1136/bmjgast-2025-002050

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