Endoscopic Management

Abstract

Endoscopic bariatric therapy consists of devices or procedures for primary weight loss or weight regain after Roux-en-Y gastric bypass that are placed or done endoscopically. In most cases, they result in less weight loss, but fewer complications than bariatric surgery; and more weight loss than lifestyle therapy or weight loss medications. These therapies are important advances to treat patients with obesity. This article focuses on therapies or devices with US Food and Drug Administration approval or those with current or planned US pivotal trials.

Experimental Gastric Non-Balloon Devices

“…The transpyloric shuttle (TPS; BAROnova, Goleta, CA, USA; Fig. 2 ) is delivered via an overtube and self-assembles in the stomach [ 4 , 6 , 7 ]. The shuttle features a large spherical silicon orb, a smaller cylindrical silicon bulb, and a flexible cord connecting the orb and the bulb [ 7 ].…”

“…The shuttle features a large spherical silicon orb, a smaller cylindrical silicon bulb, and a flexible cord connecting the orb and the bulb [ 7 ]. The smaller bulb is positioned on the duodenum, and the greater orb remains behind the pylorus, engaging in natural peristalsis with the smaller bulb [ 2 , 6 , 7 ]. The greater orb prevents migration from the stomach, whereas the smaller bulb passes through the duodenum, positioning the TPS across the pylorus.…”

“…The greater orb prevents migration from the stomach, whereas the smaller bulb passes through the duodenum, positioning the TPS across the pylorus. Such intermittent pyloric obstruction delays gastric emptying [ 2 , 6 , 7 ]. A preliminary study featured 20 patients with obesity randomized to TPS treatment for 3 or 6 months [ 2 , 6 ].…”

Advances in endoscopic balloon therapy for weight loss and its limitations

“…Once this is achieved, the catheter is used to inject gas (nitrogen-sulfur hexafluoride mixture) into the balloon. Each balloon has a volume of approximately 250 cc, totaling 750cc with 3 balloons[ 10 ].…”

Endoscopic Accessories Used for More Advanced Endoluminal Therapeutic Procedures

“…The DJBS implantation procedure is performed using an endoscope and fluoroscopy [43-48]. The efficacy and safety, investigated by several studies showed %EWL of 30%–47% at 52 weeks [49,50]. This device also appears to have efficacy in improving glycemic control, insulin resistance, and lipid profile [42].…”