New Era: Endoscopic treatment options in obesity-a paradigm shift

Jason Glass, Ahson Chaudhry, Muhammad S Zeeshan, Zeeshan Ramzan, Jason Glass, Ahson Chaudhry, Muhammad S Zeeshan, Zeeshan Ramzan

Abstract

The prevalence of obesity continues to rise, and along with it comes a multitude of health-related consequences. The healthcare community has consistently struggled with providing treatment options to obese patients, in part due to the reluctance of patients in pursuing the more effective (yet invasive) surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric bypass. On the other hand, the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy (Orlistat, Phenteramine, Phentermine/Topiramate, Locaserin, Naltrexon/Buproprion, and Liraglutide) have very limited efficacy, especially in the morbidly obese patients. Despite our best efforts, the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and society. Bariatric endoscopy is an evolving field generated to combat this epidemic through minimally invasive techniques. These procedures can be performed in an ambulatory setting, are potentially reversible, repeatable, and pose less complications than their invasive surgical counterparts. These modalities are designed to alter gut metabolism by means of space occupation, malabsorption, or restriction. In this review we will discuss different bariatric endoscopic options (such as intragastric balloons, endoscopic sleeve gastroplasty, endoscopic aspiration therapies and gastrointestinal bypass sleeves), their advantages and disadvantages, and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.

Keywords: AspireAssist; Bariatric endoscopy; Bariatric medicine; Bariatrics; Endoscopic sleeve gastroplasty; Intragastric balloon; Obesity.

Conflict of interest statement

Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest.

Figures

Figure 1
Figure 1
Common bariatric surgical procedures. A: Rou-en-Y gastric bypass; B: Adjustable gastric band; C: Sleeve gastrectomy; D: Biliopancreatic diversion with duodenal switch. Reprinted from “Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: State of the art. Nat Rev Gastroenterol Hepatol 2017; 14: 160-169”. With permission from RightsLink.
Figure 2
Figure 2
A step wise approach to obesity management. A shift in the paradigm of current trends of obesity. The authors of this manuscript suggest that bariatric endoscopy should be incorporated in the armamentarium of obesity treatment, with the potential of using each modality in combination (when clinically feasible).
Figure 3
Figure 3
A summary of bariatric endoscopic techniques. EBTs: Endoscopic bariatric treatments; GI: Gastrointestinal; ESG: Endoscopic sleeve gastroplasty; IGB: Intragastric balloon. Reprinted from “ASGE Bariatric Endoscopy Task Force; ASGE Technology Committee, Abu Dayyeh BK, Edmundowicz SA, Jonnalagadda S, Kumar N, Larsen M, Sullivan S, Thompson CC, Banerjee S. Endoscopic bariatric therapies. Gastrointest Endosc 2015; 81: 1073-1086”. With permission from Elsevier.

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Source: PubMed

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