Novel Nonsurgical Endoscopic Approaches for the Treatment of Obesity

Abstract

Globally, obesity is a leading cause of preventable death and is associated with >60 comorbid medical conditions, including 10 types of cancer that are strongly associated with body mass index. There are a number of traditional obesity treatments-for example, lifestyle management (eg, decreased caloric intake and increased expenditure), pharmacotherapy, and bariatric surgery. Recently, endoscopic approaches have emerged as a viable alternative for weight loss. Endoscopically placed intragastric balloons were introduced in the early 1980s for the treatment of medically complicated obesity but, unfortunately, had high rates of complications, such as premature deflation leading to obstruction. Despite these shortcomings, these devices have experienced a renewal, with a second generation of improved devices being approved for clinical use in 2015. In addition to the intragastric balloons, there are a number of other endoscopic approaches to weight loss that are either Food and Drug Administration approved or undergoing evaluation (aspiration therapy, duodenal jejunal bypass sleeve). The current review examines the literature available and discusses the practical clinical considerations involved.

Assessment of the Metabolic Response After Echo-endoscopic Gastric Bypass An experimental animal study

“…One potential solution is the use of flexible endoscopy alone or in conjunction with other techniques (i.e. endoscopic ultrasonography) as the main frame for the introduction of new ultra-minimally invasive methods in the clinical setting [4][5][6].…”

Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity

“…Other serious adverse events that have been reported with IGBs include hyperinflation, acute pancreatitis, esophageal mucosal injury during placement or removal, fungal colonization of the balloon, and aspiration pneumonitis …”

“…18 Other serious adverse events that have been reported with IGBs include hyperinflation, acute pancreatitis, esophageal mucosal injury during placement or removal, fungal colonization of the balloon, and aspiration pneumonitis. 4,13,16,19,20 Two additional designs of IGBs are currently being studied and have not yet been approved by the FDA. The Spatz Adjustable Balloon (Spatz, New York) was designed to overcome the side effects of other IGB designs, including early intolerance ultimately requiring device removal and plateau in weight loss at 6 months.…”

Challenging obesity, diabetes, and addiction: the potential of lorcaserin extended release

“… 14 , 15 Therapies such as bariatric surgery are an option for those with BMI >35 kg/m 2 with medical comorbidities or those with BMI >40 kg/m 2 , with the two most common procedures being the Roux-en-Y gastric bypass and the sleeve gastrectomy. 13 The US Food and Drug Administration (FDA) has also recently approved a number of endoscopically placed devices such as the intra-gastric balloons and aspiration devices. 13 However, many find endoscopic approaches and bariatric surgery too invasive of an option and opt for other approaches.…”

“… 13 The US Food and Drug Administration (FDA) has also recently approved a number of endoscopically placed devices such as the intra-gastric balloons and aspiration devices. 13 However, many find endoscopic approaches and bariatric surgery too invasive of an option and opt for other approaches.…”