Current endoscopic techniques in the treatment of obesity

Abstract

Background: in recent years new endoscopic strategies and techniques for the treatment of obesity have emerged and developed. Aim of the study: in this article we will review and analyze the current state of the following techniques and the basic differential characteristics between each of them: balloons and prosthesis, injection of substances, systems of sutures, malabsorptives techniques and others currently in research. Methods: we will evaluate the endoscopic technique and their main indications, results, tolerances, complications and adverse effects observed, reporting our personal experience and in relation with an extensive literature review. Results: comparatively with the most widespread technique of the Bioenterics balloon, the Spatz balloon can provide greater weight loss but with worse tolerance and more complications and the Heliosphere Bag gets a similar weight loss but with greater technical difficulty. Other balloons and prosthesis (Ullorex, Semistationary, Silimed, Endogast) still require technical improvements and higher studies. The injection of botulinum toxin, although secure, seems to offer a smaller and more transient efficacy. Suture systems (TOGa, endoluminal vertical gastroplasty and POSE) appear to be effective but are technically more laborious. Malabsorptives procedures (Endobarrier, ValenTX) are somewhat laborious but effective, particularly indicated in obese patients with type 2 diabetes mellitus. Conclusions: the development of new endoscopic techniques and improvement in existing designs, suggest an increasingly important role of the endoscopist in the treatment of obesity. We consider it important to individually select and use the endoscopic technique, depending on the desirable outcomes (efficacy, tolerance, safety, adverse effects and risks) and the experience of each hospital. We believe that these techniques should be applied by specifically trained endoscopists in specialized hospitals.

Multicenter study on the safety of bariatric endoscopy

“…Other mild, atypical complications in our series that led to early device removal included isolated vomiting-hypokalemia, psychological/clinical intolerance without mucosal lesions upon endoscopy, and spontaneous balloon breakage without migration (both Orbera ® and Medsil ® ). In order to try and minimize these drawbacks, and to enhance efficacy and safety, new balloon concepts, designs and types are emerging of late (5)(6)(7)22). These include swallow balloons (Obalon ® , Therapeutics Inc., Carlsbad, CA, USA) (23), designed to save up one or two endoscopic procedures.…”

“…Initially, these techniques have seemingly shown fairly promising efficacy results (5)(6)(7)(8)(9)(10)(11)(12), with better outcomes when compared to diet alone (13). Furthermore, a priori they are more cost-effective and less invasive than surgery, hence a lower complication rate and higher safety should be expected.…”

The Newer Horizons in Bariatric Surgery

“…under GA. The liner is kept for duration of 12 months [8]. The future understanding of various mechanisms leading to obesity focuses on gut hormones and gut bacteria.…”

Bariatric Surgery: The Indications in Metabolic Disease

“…Biliopancreatic diversion (BPD) with or without duodenal switch is less commonly performed [8]. Minimally invasive techniques including the endoscopically placed synthetic duodenojejunal bypass liners, such as the EndoBarrier®, are also used as they improve glycemic control within the first year of use [9]. …”