Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices

Abstract

Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.

Endogenous glucagon‐like peptide (GLP)‐1 as alternative for GLP‐1 receptor agonists: Could this work and how?

“…51 For gastric banding, the effect on body weight might be assumed to depend on the gastric restriction but appears to involve additional mechanisms. 52 Vertical sleeve gastrectomy (SG) and gastric bypass (Roux-en-Y gastric bypass, RYGB) have additional metabolic effects, and have been shown to improve T2D within days after surgery, even before significant weight loss occurs. 53 While the mechanisms may be multifactorial, an increase in GLP-1 levels and bile acids (at least in rodents) may be involved.…”

“…The effectiveness of bariatric surgery has triggered many attempts to identify the mechanisms involved 51 . For gastric banding, the effect on body weight might be assumed to depend on the gastric restriction but appears to involve additional mechanisms 52 . Vertical sleeve gastrectomy (SG) and gastric bypass (Roux‐en‐Y gastric bypass, RYGB) have additional metabolic effects, and have been shown to improve T2D within days after surgery, even before significant weight loss occurs 53 .…”

Roles of Gastric Emptying and Gastrointestinal Transit Following Ileal Interposition in Alleviating Diabetes in Goto-Kakizaki Rats

“…On the other side, studies in adjusted gastric banding (AGB) reported that AGB has no influence or even delays gastric emptying ( 11 , 12 ). Some GI devices were also reported to decrease GI emptying although the bariatric effects are good ( 13 ).…”