Small intestine‐targeted endoscopic bariatrics: Current status and future perspectives

Abstract

The global obesity epidemic shows no signs of slowing down. Endoscopic bariatric and metabolic therapies (EBMTs) are being increasingly adopted as treatment options for obesity and obesity‐related comorbidities, due to their minimally invasive nature and ease of delivery. According to the site of action along the gastrointestinal tract, EBMTs can be divided into two categories: gastric EBMTs, and small intestine‐targeted EBMTs. Unlike gastric EBMTs, which work through a volume‐restricting mechanism leading to early satiety and reduced caloric intake, small intestine‐targeted EBMTs can be metabolically beneficial through foregut and/or hindgut pathways independent of weight loss, and therefore have great potential for the treatment of obesity‐related metabolic comorbidities such as type 2 diabetes. Although none of the small intestine‐targeted EBMTs have been approved by the US Food and Drug Administration to date, their clinical efficacy and safety have been extensively explored in investigational trials. This review aims to summarize and provide a comprehensive understanding of small intestine‐targeted EBMTs in clinical and preclinical settings, and to further discuss their potential mechanisms of action.

Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control

“…Among the most commonly used EBMTs ( Table 1 ), 18 , 19 , 37 - 41 two directly target the small bowel as the DJBL and the duodenal mucosal resurfacing (DMR). While no EBMTs targeting the small bowel have been approved to date by the FDA for routine practice, 42 the initial data are promising.…”

“…36 Among the most commonly used EBMTs (Table 1), 18,19,3741 two directly target the small bowel as the DJBL and the duode nal mucosal resurfacing (DMR). While no EBMTs targeting the small bowel have been approved to date by the FDA for routine practice, 42 the initial data are promising. Reversible EBMT, endoscopic bariatric and metabolic therapy; TWL, total weight loss; EWL, excess weight loss; SAE, severe adverse event; DJBL, duodenaljejunal bypass liner; T2DM, type 2 diabetes mellitus; IGB, intragastric balloon; FDA, Food and Drug Administration; ESG, endoscopic sleeve gastroplasty; RCT, randomized controlled trial; POSE, primary obesity surgery endoluminal; DMR, duodenal mucosal resurfacing; NAFLD, nonalcoholic fatty liver dis ease.…”

Small intestine is a big player!

“…This is referred to as either restrictive or malabsorptive bariatric endoscopy procedures. In their recent article on small intestine‐targeted endoscopic bariatrics, Ren and Ji analyzed the current status and future perspectives in the endoscopic treatment of obesity and its related diseases 4 . Indeed, these minimally invasive treatments can achieve benefits comparable to bariatric surgery, but with fewer surgical risks 5 .…”