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program, it is important to ensure that nurses or assistants (endoscopy technicians) undergo a robust
training session on the use of bariatric endoscopy devices. We suggest developing a pre, intra and post
procedural checklist to ensure the procedures go smoothly for beginning bariatric endoscopists. When the
first case is being performed, it is essential to disclose this fully to the patient. In regard to preparation for
the first in-human ESG for the endoscopist, it is advisable for the endoscopist to have no other cases for
that day. The schedule should be fully blocked for this case. The endoscopist should have no other clinical
responsibilities such as being on-call or covering the inpatient procedures. This way the endoscopist is
completely focused on this procedure alone. Discussion should be done in advance with the endoscopy
team as well as anesthesia, and expectations clearly laid out that given that this will be the first procedure
of the endoscopist, it could take more time. The bariatric surgery team should be available for back-up in
case of any complication. Proctoring from expert clinicians is highly recommended for the first several
ESG cases and beyond those given a lengthy learning curve, ongoing industry presence during ESG cases is
essential. These efforts ensure that the procedure will be carried as safely as possible.

CONCLUSION
As bariatric endoscopy gains market traction, more formal training will become widely available. However,
in the interim as new programs continue to develop, it is important to have a multidisciplinary approach
in treating obesity. All stakeholders involved should be on board prior to starting a bariatric endoscopy
program. The bariatric endoscopist should be adequately trained in not only performing basic bariatric
endoscopic procedures but should be adept in managing post bariatric surgery complications.

DECLARATIONS
Authors’ contributions
Conceived, drafted, edited and revised the mansucript: Mlabasati J, Bilal M, Cohen J

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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