• What Endoscopic Techniques are Available for Weight Loss?

What Endoscopic Techniques are Available for Weight Loss?

Endoscopic techniques have been approved by the FDA for management of obesity, with many new devices and technologies in development. The pros and cons of these approaches, and the questions to be answered, are covered in a review article by Andrew C. Storm et al in the November issue of Clinical Gastroenterology and Hepatology.

Endobariatric techniques fill a zone between pharmacologic agents and invasive surgery.

Endobariatrics is a new field of gastroenterology aimed at addressing the obesity epidemic. Endobariatric procedures approved by the FDA include several intragastric balloons (IGBs), gastric aspiration therapy, and endoscopic sleeve gastroplasty (ESG). They are less invasive than weight-loss (bariatic) surgery.

These are urgently needed because large percentages of many populations are either overweight or obese, causing public health crises. Patients are best treated by a combination of approaches to address the nutritional, educational, psychological, and motivational aspects of weight management. However, obesity therapies, including lifestyle and diet modification, accountability, exercise, counseling, medications, and surgery, vary in their invasiveness and efficacy (see figure).

Endoscopic therapies are in the middle of the range, offering efficacy with a risk profile similar to other therapeutic endoscopic procedures. Endoscopic approaches are less invasive and have less risk than surgery, and are more effective than medical therapy, so they might be used in a large group of patients.

Storm et al explain which patients should be considered for endobariatric procedures, and summarize the amount of body weight loss expected from the different endobariatric techniques. In the short- to mid-term, these procedures reduce body weight and obesity-related comorbidities, such as diabetes and hypertension.

Endobariatric procedures are all transoral therapies that do not require skin incisions, with the exception (for aspiration therapy) of a small abdominal incision for placement of a gastric aspiration tube. Storm et al review post-endobariatic procedures. Nausea is common and patients are placed on a modified diet. Patients receiving an IGB can have dyspepsia and/or reflux symptoms for 1 to 2 weeks after balloon placement—these symptoms generally respond to additional gastric acid antisecretory therapy.

Technologies in development include IGBs that do not require endoscopy for placement or removal, duodenojejunal bypass liners or sleeves, and duodenal resurfacing.

The authors explain that the reversibility, repeatability, and cost effectiveness of endobariatric procedures make them attractive options for filling the gap in obesity therapy between medications and bariatric surgery.

Storm et al emphasize, however, that endoscopic bariatric procedures are only part of a comprehensive multidisciplinary obesity care system. Patients undergoing endobariatric procedures must be followed to insure that they maintain a healthy lifestyle and long-term weight loss.