Endoscopic Procedures for Weight Loss

Abstract

Purpose of Review To provide updated evidence on the endoscopic procedures for weight loss and to bring personal insights on the future of endobariatrics. Recent Findings Intragastric balloons promote significant improvement in histologic and radiologic aspects of non-alcoholic steatohepatitis; the endoscopic sleeve gastroplasty is effective up to 5 years and seems particularly beneficial to patients with BMI≤40kg/m 2 ; distal POSE is a promising technique but still lacks adequate clinical data; aspiration therapy triggers remarkable weight loss, but data on weight trends after removal of the device are still lacking; the satiety-inducing device, the sleeveballoon, the gastric mucosal devitalization, and the endoscopic magnetic partial jejunal diversion are promising procedures still under study and refinements. Summary Several therapeutic options are necessary during obesity’s natural history. Therefore, endobariatrics should act in harmony with lifestyle interventions, diet modification, psychological treatment, pharmacotherapy, and bariatric surgery seeking the best outcome in the long term.

Review about Psychological Barriers to Lifestyle Modification, Changes in Diet Habits, and Health-Related Quality of Life in Bariatric Endoscopy

“…Traditional treatments based on diet and nutritional advice have proven ineffective in the treatment of obesity [ 5 ]; however, bariatric endoscopic (BE) treatments have yielded improved results [ 6 , 7 , 8 , 9 ]. Consequently, BE is postulated to be a less invasive alternative to surgical interventions and useful for high-risk morbidly obesity [ 10 ].…”

“…Consequently, BE is postulated to be a less invasive alternative to surgical interventions and useful for high-risk morbidly obesity [ 10 ]. Scientific interest in these treatments has increased over recent years, with some studies employing these techniques demonstrating effective weight control up to 5 years later [ 6 ]. In relation with the rates of adverse events after BE techniques, serious side effects with the Orbera Intragastric Balloon were rare, with an incidence of migration and gastric perforation of 1.4% and 0.1%, respectively [ 11 ], and with Endoscopic Sleeve Gastroplasty and the POSE procedure [ 12 , 13 ], only a limited number of complications have been reported (postprocedure bleeding, perigastric collection with pleural effusion, perforation of the stomach, pneumothorax, and perihepatic or perisplenic abscess.…”

Endoscopic Bariatric and Metabolic Therapies for Liver Disease: Mechanisms, Benefits, and Associated Risks

“… 19 – 21 The major EBMTs currently available include intragastric balloons (IGBs), endoscopic sleeve gastroplasty (ESG), primary obesity surgery endoluminal (POSE), aspiration therapy, duodenal-jejunal bypass liner (DJBL), duodenal mucosal resurfacing (DMR), and incisionless magnetic anastomosis system. 22 Several observational studies suggest that EBMTs can improve liver steatosis, fibrosis, NAFLD activity score (NAS), and metabolic parameters in people with NAFLD/NASH. 23 – 25 Among obese LT candidates, EBMTs have been reported to induce significant short-term weight loss, thus reducing the incidence of obesity-related complications.…”