Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

Abstract

The steady increase in bariatric surgery has led to room for innovation. Endoscopy has become an important tool for evaluation, diagnosis, management of complications, and even for primary bariatric interventions. Leaks are the most feared complication and new endoscopic therapies have been developed such as septotomy, doublepigtail stents, and endoscopic vacuum therapy. Additionally, primary bariatric endoscopic procedures are gaining popularity and the new procedures include intragastric balloons, stoma reduction, aspiration therapy, among others. The altered anatomy and reoperation increase the risk of complications after bariatric surgery, especially when managing conditions like achalasia, gastroparesis, and cholelithiasis. Per-oral endoscopic myotomy, per-oral pyloromyotomy, and endoscopic ultrasound-guided transgastric endoscopic retrograde cholangiopancreatography provide a less invasive approach to address these conditions. This narrative review article intends to expose current endoscopic therapies for the management of primary bariatric procedures, complications and related conditions.

Weight Loss Effect of GLP-1 RAs With Endoscopic Bariatric Therapy and Bariatric Surgeries

“…Although EBT can provide greater weight loss effects than obesity pharmacotherapies, it remains less effective than BS [ 10 , 20 ], even if the rate of complications associated with EBS is far lower than with BS [ 46 , 47 ]. Some EBTs, including IGB-based treatments, can also be used as a bridge therapy for weight loss before BS [ 48 ]. Despite the initial weight loss effect of EBT, it is linked with nonsustained weight loss and a high rate of failure [ 48 ].…”

“…Some EBTs, including IGB-based treatments, can also be used as a bridge therapy for weight loss before BS [ 48 ]. Despite the initial weight loss effect of EBT, it is linked with nonsustained weight loss and a high rate of failure [ 48 ].…”

Overview on the endoscopic treatment for obesity: A review

“…Currently, a wide range of endoscopic procedures, based on the principles of stomach volume reduction, small bowel or gastric bypass, and size restriction, are being investigated, with a few being used in daily practice[ 30 ]. Innovative endoscopic therapies, such as double-pigtail stents, septostomy, and endoscopic vacuum therapy, have been developed[ 31 ]. Newer endoscopic approaches, such as intragastric balloons (IGBs), aspiration therapy (AT), small bowel devices, and endoscopic plication and suturing techniques, have been developed[ 32 ] and show significant effects.…”