Bariatric endoscopy: current state of the art, emerging technologies, and challenges

Abstract

Over the last few decades obesity has become a major health issue worldwide. Although dietary and lifestyle changes are the cornerstone of obesity management, it still poses a huge challenge for the majority of patients to permanently change their eating habits. Bariatric endoscopy represents an evolving filed of minimally invasive techniques and procedures for weight loss trying to respond to these challenges by developing new methods with the increasing role of endoscopists in the management of obesity. Areas covered: The aim of this article is to review the role and the advantages of bariatric endoscopy in the management of obesity by providing a comprehensive reference source and evaluating the currently available and emerging endoscopic devices and techniques for weight loss. Expert commentary: Endoscopic methods for weight loss represent a useful armamentarium in the management of obesity by providing improved effectiveness compared with medications, with a lower risk profile than traditional bariatric surgery. Although preliminary results of recently introduced methods are encouraging, many questions remain regarding the safety and efficacy of such interventions. Combining scientific background with advancements in technology is the key strategy for the further development of bariatric endoscopy.

Antibiotics to Prevent Relapse of Adjustable Gastric Balloon Hyperinflation: Feasible for Balloon Maintenance?

“…The Spatz adjustable balloon system was introduced in 2010. It is an endoscopically placed saline solution-filled silicone balloon that is approved for 12-month deployment; most other IGBs are only deployed for 6 months [9]. The Spatz balloon features a removable inflation tube that allows volume adjustment as required after insertion [9].…”

“…It is an endoscopically placed saline solution-filled silicone balloon that is approved for 12-month deployment; most other IGBs are only deployed for 6 months [9]. The Spatz balloon features a removable inflation tube that allows volume adjustment as required after insertion [9]. If the patient has food intolerance or pain, some liquid can be removed from the balloon while the balloon remains in the stomach.…”

“…If the patient has food intolerance or pain, some liquid can be removed from the balloon while the balloon remains in the stomach. On the other hand, fluid may be added if the appetite increases or the weight loss reaches a plateau [9].…”

“…The most common adverse events associated with IGBs are nausea, vomiting, and mild abdominal pain (up to 33% of the cases), which may require early removal [10]. Other possible complications include gastric ulcers, spontaneous deflation, rupture, colonization by fungus, balloon migration with intestinal obstruction, esophageal laceration/perforation, and gastric perforation [3, 9]. ­Recently, the Food and Drugs Administration issued a warning about the possibility of another complication with these balloons – hyperinflation of the balloon requiring its early removal [10].…”

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

“…Endoscopic bariatrics is still early in its development. There are ample opportunities to explore innovative techniques and devices in this space, including those that target gastric restriction, bypassing the duodenum, as well as duodenal resurfacing[162-165,169,170].…”