Obesity remains a tremendous public health, clinical, and scientific challenge globally. Conventional approaches in the management of obesity offer limited potential for sustained weight loss. Bariatric surgery, although it represents the most effective weight loss treatment, has its own risks and is associated with substantial costs and limited patient applicability. Endoscopic weight loss procedures are considered as the major breakthrough in the management of obesity. Endoluminal interventions performed entirely through the gastrointestinal tract have evolved as a result of an attempt to replicate some of the anatomical features and the physiological effects of the traditional weight loss surgery while being reversible, less invasive, and more cost-effective. Restrictive procedures act to decrease gastric volume by space-occupying devices and/or by suturing or stapling techniques that alter gastric anatomy, whereas malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. Other procedures act by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve blocking) or by gastric aspiration. It is important to underline that the majority of endoscopic weight loss procedures are still being evaluated and are not yet available routinely. Even though some of the techniques and devices that have recently emerged have demonstrated promising short-term results, evidence on their safety and long-term efficacy from well-designed and well-conducted research should be given before they can become an inherent part of everyday clinical practice. Given the rapid development of endoscopic weight loss procedures, this review considers the current state and recent trends in endoscopic management of obesity.

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IntroductionBeside psychological distress of breast cancer diagnosis and patophysiological characteristics of breast cancer it is also known that different treatments could have influence on mental well-being. The aim of this study was to investigate treatment of depression, anxiety and breast cancer in Slovenian female patients.ResultsIn the study were included 314 female patients with breast cancer treated at the Institute of Oncology Ljubljana between September 2004 and July 2005. Only 18 patients were not surgically treated. Majority (80%) of all patients were treated also with chemotherapy. In combination with chemotherapy 43% of all patients received also radiotherapy and 50% received also hormonal therapy. Altogether 72 (22,9%) patients expressed clinically important serious anxiety (Hospital Anxiety and Depression (HAD) score of 11 or more on anxiety subscale), 39 (12,4%) clinically significant serious depression (HAD score of 11 or more on depression subscale) and 51 (16,2%) clinically significant depression and anxiety combined (HAD score of 11 or more on both subscales). Among patients with clinically significant serious anxiety 19 (26,4%) patients were psychiatrically treated before inclusion into study. Among patients with clinically significant serious depression 13 (33,3%) patients were psychiatrically treated before inclusion into study and among patients with clinically significant serious anxiety and depression 24 (47,0%) patients were psychiatrically treated before inclusion into study.ConclusionsLess then half of patients with breast cancer with comorbid clinically significant expressed serious anxiety and/or depression has been psychiatrically treated before the inclusion in the study.

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