Bariatric endoscopy: from managing complications to primary metabolic procedures

Abstract

Obesity is a worldwide epidemic and is the second leading cause of preventable death. The approach to treating obesity involves a multidisciplinary approach including lifestyle interventions, pharmacological therapies, and bariatric surgery. Endoscopic interventions are emerging as important tools in the treatment of obesity with primary and revisional bariatric endoscopic therapies. These include intragastric balloons, aspiration therapy, suturing and plication, duodenal-jejunal bypass liners, endoscopic duodenal mucosal resurfacing, and incisionless magnetic anastomosis systems. Endoscopic interventions have also demonstrated efficacy in treating complications of bariatric surgery. Approaches include stenting, endoscopic internal drainage, and endoscopic vacuum-assisted closure. This review aimed to discuss the current endoscopic procedures used as primary and revisional bariatric therapy including those used for managing bariatric surgical complications.

Updates in metabolic bariatric endoscopy

“…EBMT has been traditionally categorized based on its therapeutic target, stomach or small bowel; however, extraluminal therapies are being developed to include metabolic organs such as the pancreas. 15 EBMT targeting the small intestine aims to alter the interaction between food and the proximal small intestine either by mimicking the limb exclusion and the rapid delivery of nutrients to the mid and distal jejunum that occurs after Roux-en-Y surgery and duodenal-jejunal bypass, or remodel the abnormal duodenal epithelium that has been shown to play a part in obesity, T2D, and NAFLD. Small bowel EBMT appears to improve the metabolic comorbidities of obesity, independent of weight loss, whereas gastric EBMT is focused more on weight loss and ultimately improves the metabolic sequelae.…”