Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments

Na, Hee Kyong

doi:10.5946/ce.2021.021

Cited by 10 publications

(9 citation statements)

References 37 publications

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“…Bariatric surgery is currently the most effective and durable treatment for obesity and its associated comorbidities. 3 - 5 However, <2% of eligible patients undergo bariatric surgery for a variety of reasons, including surgical risk, personal preference, fear, cost, and access. 6 Initial approaches to managing obesity and its related comorbidities involve lifestyle modifications encompassing diet and exercise.…”

Section: Introductionmentioning

confidence: 99%

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

Igi,

de Oliveira,

Matar

et al. 2024

Clin Endosc

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The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article comprehensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern exists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongoing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to support its routine use in clinical practice.

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Section: Introductionmentioning

confidence: 99%

“…Consequently, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as an alternative for patients with obesity, including those who are ineligible or reluctant to undergo bariatric and metabolic surgical intervention. 3 , 7 …”

Section: Introductionmentioning

confidence: 99%

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

Igi,

de Oliveira,

Matar

et al. 2024

Clin Endosc

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“…The reduction of gastric volume can be either achieved by placing space-occupying devices or by creating an endoscopic gastroplasty, plicating the stomach walls in order to decrease gastric lumen [ 14 ]. In recent years, new endoscopic devices and procedures that reduce the contact between food and the gastrointestinal wall have been developed, with the aim of mimicking surgical malabsorptive procedures [ 17 , 18 , 19 ]. One of the main goals of these novel endoscopic treatments is to combine the weight loss effect with an improvement of metabolic complications that are the most common cause of morbidity in obese patients.…”

Section: Introductionmentioning

confidence: 99%

A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going

et al. 2023

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Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice.

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Section: Introductionmentioning

confidence: 99%

“…EBMT reduces weight and ameliorates obesity-associated complications [ 12 , 13 ]. However, EBMTs can result in adverse events, including nausea, abdominal pain, and gastroesophageal reflux disease (GERD) [ 12 , 13 ]. GERD may diminish when EBMT is performed on obese patients because GERD may occur due to obesity, but GERD may also worsen due to the EBMT even though the patient has lost weight.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease

Kim

2021

Medicina

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Obesity is a chronic disease that is becoming increasingly more prevalent and is associated with many health problems, such as metabolic syndrome. The treatment options for obese patients include lifestyle modification, medications, endoscopic bariatric and metabolic therapies (EBMTs), and surgery. In particular, EBMTs have an excellent therapeutic effect and are less invasive than bariatric surgery. Although it is clear that EBMTs are relatively safe procedures, they can result in several adverse events. Among them, the relationship between EBMTs and gastroesophageal reflux disease (GERD) is unclear. Several studies have demonstrated that an intragastric balloon (IGB) may worsen GERD. There are a few studies on the effects of endoscopic sleeve gastroplasty (ESG) on GERD, but the linking evidence is insufficient. However, the conclusion is not simple. Because obesity is an important cause of GERD, and GERD naturally improves with weight loss after EBMTs, it is not easy to evaluate accurately the effect of EBMTs on GERD. This review aimed to discuss the effect of EBMTs on GERD and suggest future research directions.

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Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments

Cited by 10 publications

References 37 publications

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

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

A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going

The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease

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