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Reviews
Mechanism of action and selection of endoscopic bariatric therapies for treatment of obesity
Wissam Ghusn, Gerardo Calderon, Barham K. Abu Dayyeh, Andres Acosta
Received December 31, 2023  Accepted February 3, 2024  Published online August 29, 2024  
DOI: https://doi.org/10.5946/ce.2024.005    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies (EBTs) are minimally invasive and safe procedures with favorable weight loss outcomes in obesity treatment. We aimed to present the weight loss mechanism of action of EBTs and an individualized selection method for patients with obesity. We searched PubMed, Medline, Scopus, Embase, and Google Scholar databases for studies on the topic from databases inception to July 1, 2023, written in English. We focused on EBTs potential mechanism of action to induce weight loss. We also present an expert opinion on a novel selection of EBTs based on their mechanism of action. EBTs can result in weight loss through variable mechanisms of action. They can induce earlier satiation, delay gastric emptying, restrict the accommodative response of the stomach, decrease caloric absorption, and alter the secretion of gastrointestinal hormones. Selecting EBTs may be guided through their mechanism of action by which patients with abnormal satiation may benefit more from tissue apposition devices and aspiration therapy while patients with fast gastric emptying may be better candidates for intragastric devices, endoscopic anastomosis devices, and duodenal mucosal resurfacing. Consequently, the selection of EBTs should be guided by the mechanism of action which is specific to each type of therapy.
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  • 86 Download
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The evolution and current state of bariatric endoscopy in Western countries
Maria Valeria Matteo, Vincenzo Bove, Valerio Pontecorvi, Loredana Gualtieri, Giorgio Carlino, Cristiano Spada, Ivo Boškoski
Received September 29, 2023  Accepted January 14, 2024  Published online May 24, 2024  
DOI: https://doi.org/10.5946/ce.2023.253    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.
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  • 255 Download
  • 1 Web of Science
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Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
Clin Endosc 2024;57(3):309-316.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.217
AbstractAbstract PDFPubReaderePub
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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  • Bacteroides and NAFLD: pathophysiology and therapy
    Jun Zhang, Jing Zhou, Zheyun He, Hongshan Li
    Frontiers in Microbiology.2024;[Epub]     CrossRef
  • 3,545 View
  • 136 Download
  • 1 Web of Science
  • 1 Crossref
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Original Articles
Defining the optimal technique for endoscopic ultrasound shear wave elastography: a combined benchtop and animal model study with comparison to transabdominal shear wave elastography
Thomas J. Wang, Marvin Ryou
Clin Endosc 2023;56(2):229-238.   Published online February 28, 2023
DOI: https://doi.org/10.5946/ce.2022.135
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Shear wave elastography (SWE) is used for liver fibrosis staging based on stiffness measurements. It can be performed using endoscopic ultrasound (EUS) or a transabdominal approach. Transabdominal accuracy can be limited in patients with obesity because of the thick abdomen. Theoretically, EUS-SWE overcomes this limitation by internally assessing the liver. We aimed to define the optimal technique for EUS-SWE for future research and clinical use and compare its accuracy with that of transabdominal SWE.
Methods
Benchtop study: A standardized phantom model was used. The compared variables included the region of interest (ROI) size, depth, and orientation and transducer pressure. Porcine study: Phantom models with varying stiffness values were surgically implanted between the hepatic lobes.
Results
For EUS-SWE, a larger ROI size of 1.5 cm and a smaller ROI depth of 1 cm demonstrated a significantly higher accuracy. For transabdominal SWE, the ROI size was nonadjustable, and the optimal ROI depth ranged from 2 to 4 cm. The transducer pressure and ROI orientation did not significantly affect the accuracy. There were no significant differences in the accuracy between transabdominal SWE and EUS-SWE in the animal model. The variability among the operators was more pronounced for the higher stiffness values. Small lesion measurements were accurate only when the ROI was entirely situated within the lesion.
Conclusions
We defined the optimal viewing windows for EUS-SWE and transabdominal SWE. The accuracy was comparable in the non-obese porcine model. EUS-SWE may have a higher utility for evaluating small lesions than transabdominal SWE.

Citations

Citations to this article as recorded by  
  • Endoscopic Ultrasound-based Shear Wave Elastography for Detection of Advanced Liver Disease
    Jad AbiMansour, Jerry Yung-Lun Chin, Jyotroop Kaur, Eric J. Vargas, Barham K. Abu Dayyeh, Ryan Law, Vishal Garimella, Michael J. Levy, Andrew C. Storm, Ross Dierkhising, Alina Allen, Sudhakar Venkatesh, Vinay Chandrasekhara
    Journal of Clinical Gastroenterology.2024;[Epub]     CrossRef
  • Response
    Divyanshoo R. Kohli, Mohammad Shadab Siddiqui
    Gastrointestinal Endoscopy.2024; 100(1): 161.     CrossRef
  • Advancements and challenges in gastrointestinal imaging
    Eun Jeong Gong, Chang Seok Bang
    World Journal of Clinical Cases.2024; 12(33): 6591.     CrossRef
  • Standardization of endoscopic ultrasound shear wave elastography
    Julio Iglesias-García, J. Enrique Domínguez-Muñoz
    Clinical Endoscopy.2023; 56(2): 185.     CrossRef
  • 2,680 View
  • 178 Download
  • 2 Web of Science
  • 4 Crossref
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Efficacy and safety of intragastric balloon for obesity in Korea
Kwang Gyun Lee, Seung-Joo Nam, Hyuk Soon Choi, Hang Lak Lee, Jai Hoon Yoon, Chan Hyuk Park, Kyoung Oh Kim, Do Hoon Kim, Jung-Wook Kim, Won Sohn, Sung Hoon Jung, Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity
Clin Endosc 2023;56(3):333-339.   Published online December 13, 2022
DOI: https://doi.org/10.5946/ce.2022.143
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Intragastric balloon (IGB) is the only available endoscopic bariatric and metabolic therapy in Korea. End-ball (Endalis) has the longest history of clinical use among the IGBs available in Korea. However, little clinical data on this system have been reported. In this study, we aimed to evaluate the efficacy and safety of End-ball in Korea.
Methods
We performed a retrospective cohort study of patients who underwent IGB insertion (End-ball) from 2013 to 2019. Demographic and anthropometric data were collected. The efficacy and safety of IGB treatment were analyzed.
Results
In total, 80 patients were included. Mean age was 33.7 years and 83.8% were female. Initial body mass index was 34.48±4.69 kg/m2. Body mass index reduction was 3.72±2.63 kg/m2 at the time of IGB removal. Percent of total body weight loss (%TBWL) was 10.76%±6.76%. Percentage excess body weight loss was 43.67%±27.59%. Most adverse events were minor, and 71.4% of participants showed nausea, vomiting, or abdominal pain.
Conclusions
IGB treatment showed good efficacy and safety profile in Korean patients with obesity. In terms of %TBWL and percentage excess body weight loss, the efficacy was similar to that in the Western population.

Citations

Citations to this article as recorded by  
  • Intragastric Balloons
    D.T.H. de Moura, Sergio A. Sánchez-Luna, Adriana Fernandes Silva, Alexandre Moraes Bestetti
    Gastrointestinal Endoscopy Clinics of North America.2024; 34(4): 687.     CrossRef
  • Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis
    Adriana Fernandes Silva, Alexandre Moraes Bestetti, Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Matheus de Oliveira Veras, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
    Obesity Surgery.2024; 34(10): 3735.     CrossRef
  • Endoscopic treatment of obesity: A protocol of updated systematic review with network meta-analysis of randomized controlled trials
    Eun Jeong Gong, Chang Seok Bang, Gwang Ho Baik, Dong Keon Yon
    PLOS ONE.2024; 19(9): e0308410.     CrossRef
  • How effective is intragastric balloon insertion as an obesity treatment in Korea?
    Youngdae Kim
    Clinical Endoscopy.2023; 56(3): 310.     CrossRef
  • Laparoscopy-assisted trans-hiatal endoscopic removal of an intragastric balloon after placement-related esophageal perforation
    Pablo Cortegoso Valdivia, Giorgio Dalmonte, Marina Valente, Lucia Ballabeni, Federica Gaiani, Gian Luigi de' Angelis, Federico Marchesi
    Endoscopy.2023; 55(S 01): E1137.     CrossRef
  • 3,252 View
  • 231 Download
  • 3 Web of Science
  • 5 Crossref
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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective
Yoona Chung, Dae Geun Park, Yong Jin Kim
Clin Endosc 2021;54(6):805-809.   Published online May 12, 2021
DOI: https://doi.org/10.5946/ce.2020.298
AbstractAbstract PDFPubReaderePub
Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

Citations

Citations to this article as recorded by  
  • Endoscopic therapies for bariatric surgery complications
    Abdelrahman Yakout, Enrique F. Elli, Vivek Kumbhari, Nader Bakheet
    Current Opinion in Gastroenterology.2024; 40(6): 449.     CrossRef
  • Endoscopic Management of Post-Sleeve Gastrectomy Complications
    Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
    Journal of Clinical Medicine.2024; 13(7): 2011.     CrossRef
  • Metabolic and Bariatric Surgeon Criteria—An International Experts’ Consensus
    Mohammad Kermansaravi, Sonja Chiappetta, Scott A. Shikora, Mario Musella, Lilian Kow, Edo Aarts, Syed Imran Abbas, Ahmad Aly, Ali Aminian, Luigi Angrisani, Syed Tanseer Asghar, Ahmad Bashir, Estuardo Behrens, Helmuth Billy, Camilo Boza, Wendy A. Brown, Da
    Obesity Surgery.2024; 34(9): 3216.     CrossRef
  • New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration
    Carlo Felix Maria Jung, Cecilia Binda, Luigi Tuccillo, Matteo Secco, Giulia Gibiino, Elisa Liverani, Chiara Petraroli, Chiara Coluccio, Carlo Fabbri
    Journal of Clinical Medicine.2024; 13(16): 4877.     CrossRef
  • Esophagojejunostomy or Fistulojejunostomy Are Safe Salvage Operations for Bariatric Surgery Leaks
    Steven G. Leeds, Kacie R. Kerlee, Lucas Fair, Daniel Tran, Daniel G. Davis, Gerald O. Ogola, Marc A. Ward
    Foregut: The Journal of the American Foregut Society.2023; 3(2): 157.     CrossRef
  • Comparison of long-term quality of life outcomes between endoscopic vacuum therapy and other treatments for upper gastrointestinal leaks
    Lucas Fair, Marc Ward, Meghana Vankina, Rashmeen Rana, Titus McGowan, Gerald Ogola, Bola Aladegbami, Steven Leeds
    Surgical Endoscopy.2023; 37(8): 6538.     CrossRef
  • Gastroesophageal Reflux Disease in Obesity: Bariatric Surgery as Both the Cause and the Cure in the Morbidly Obese Population
    Muaaz Masood, Donald Low, Shanley B. Deal, Richard A. Kozarek
    Journal of Clinical Medicine.2023; 12(17): 5543.     CrossRef
  • Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients
    Georgios-Ioannis Verras, Francesk Mulita, Charalampos Lampropoulos, Dimitrios Kehagias, Oliver Curwen, Andreas Antzoulas, Ioannis Panagiotopoulos, Vasileios Leivaditis, Ioannis Kehagias
    Journal of Personalized Medicine.2023; 13(9): 1422.     CrossRef
  • Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
    Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
    Obesity Surgery.2022; 32(2): 342.     CrossRef
  • Effectiveness and Safety of Laparoscopic Sleeve Gastrectomy for Weight Loss in Mild Obesity: Prospective Cohort Study with 3-Year Follow-up
    Ahmed Elnabil-Mortada, Haitham M. Elmaleh, Roger Ackroyd, Rabbah A. Khaled
    Obesity Surgery.2022; 32(6): 1918.     CrossRef
  • Endoscopic Self-Expanding Metallic Stent Placement in the Management of Post Laparoscopic Sleeve Gastrectomy Complications
    Hamidreza Goudarzi, Jacob R. Obney, Mahsa Hemmatizadeh, Taha Anbara
    Journal of Digestive Endoscopy.2022; 13(03): 136.     CrossRef
  • Primary Sleeve Gastrectomy and Leaks: The Impact of Fundus-Wall Thickness and Staple Heights on Leakage—An Observational Study of 500 Patients
    Clara Boeker, Barbara Schneider, Valentin Markov, Julian Mall, Christian Reetz, Ludwig Wilkens, Ibrahim Hakami, Christine Stroh, Hinrich Köhler
    Frontiers in Surgery.2021;[Epub]     CrossRef
  • Role of Rendezvous-Procedure in the Treatment of Complications after Laparoscopic Sleeve Gastrectomy
    Dörte Wichmann, Veit Scheble, Stefano Fusco, Ulrich Schweizer, Felix Hönes, Wilfried Klingert, Alfred Königsrainer, Rami Archid
    Journal of Clinical Medicine.2021; 10(23): 5670.     CrossRef
  • 4,307 View
  • 186 Download
  • 12 Web of Science
  • 13 Crossref
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FOCUSED REVIEW SERIES: Endoscopic Managements for Patients with Obesity and Its Related Comorbiditieses
Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments
Hee Kyong Na, Diogo Turiani Hourneaux De Moura, The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(1):25-31.   Published online January 29, 2021
DOI: https://doi.org/10.5946/ce.2021.021
AbstractAbstract PDFPubReaderePub
Obesity, along with its comorbidities, has become a significant public health concern worldwide. Bariatric surgery is considered the most effective treatment modality; however, only 2% of patients with obesity undergo bariatric surgery. Endoscopic bariatric and metabolic therapies (EBMTs) are emerging alternatives to traditional bariatric surgery for patients who are not eligible for or do not prefer surgical treatment. EBMTs are generally categorized as space-occupying, gastric restrictive, aspiration, and small bowel therapies. We aimed to review various non-balloon and non-gastroplasty devices with available clinical data and discuss the possible mechanisms of action, efficacy, and safety profile of these EMBTs.

Citations

Citations to this article as recorded by  
  • Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
    Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2024; 57(3): 309.     CrossRef
  • Intragastric Balloons
    D.T.H. de Moura, Sergio A. Sánchez-Luna, Adriana Fernandes Silva, Alexandre Moraes Bestetti
    Gastrointestinal Endoscopy Clinics of North America.2024;[Epub]     CrossRef
  • Current State of Endoscopic Bariatric Therapies
    Lee Ying, Samuel Butensky, Ysabel Ilang-Ying, Saber Ghiassi
    Surgical Clinics of North America.2024;[Epub]     CrossRef
  • Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis
    Adriana Fernandes Silva, Alexandre Moraes Bestetti, Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Matheus de Oliveira Veras, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
    Obesity Surgery.2024; 34(10): 3735.     CrossRef
  • Endoscopic treatment of obesity: A protocol of updated systematic review with network meta-analysis of randomized controlled trials
    Eun Jeong Gong, Chang Seok Bang, Gwang Ho Baik, Dong Keon Yon
    PLOS ONE.2024; 19(9): e0308410.     CrossRef
  • The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials
    Erika Yuki Yvamoto, Diogo Turiani Hourneaux de Moura, Igor Mendonça Proença, Epifanio Silvino do Monte Junior, Igor Braga Ribeiro, Pedro Henrique Boraschi Vieira Ribas, Matheus Cândido Hemerly, Victor Lira de Oliveira, Sergio A. Sánchez-Luna, Wanderley Ma
    Obesity Surgery.2023; 33(2): 585.     CrossRef
  • A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going
    Aurelio Mauro, Francesca Lusetti, Davide Scalvini, Marco Bardone, Federico De Grazia, Stefano Mazza, Lodovica Pozzi, Valentina Ravetta, Laura Rovedatti, Carmelo Sgarlata, Elena Strada, Francesca Torello Viera, Letizia Veronese, Daniel Enrique Olivo Romero
    Medicina.2023; 59(3): 636.     CrossRef
  • Endoscopic Bariatric Therapy for Obesity and Metabolic Syndrome
    Sang Pyo Lee
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(4): 247.     CrossRef
  • The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease
    Su-Young Kim
    Medicina.2021; 57(8): 737.     CrossRef
  • 5,029 View
  • 172 Download
  • 5 Web of Science
  • 9 Crossref
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The Clinical and Metabolic Effects of Intragastric Balloon on Morbid Obesity and Its Related Comorbidities
Joon Hyun Cho, Mohammad Bilal, Min Cheol Kim, Jonah Cohen, The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(1):9-16.   Published online January 29, 2021
DOI: https://doi.org/10.5946/ce.2020.302
AbstractAbstract PDFPubReaderePub
Obesity is becoming increasingly prevalent worldwide, and its metabolic sequelae lead to a significant burden on healthcare resources. Options for the management of obesity include lifestyle modification, pharmacological treatment, surgery, and endoscopic bariatric therapies (EBTs). Among these, EBTs are more effective than diet and lifestyle modification and are less invasive than bariatric surgery. In recent years, there have been significant advances in technologies pertaining to EBTs. Of all the available EBTs, there is a significant amount of clinical experience and published data regarding intragastric balloons (IGBs) because of their comparatively long development period. Currently, the United States Food and Drug Administration (FDA) has approved three IGBs, including Orbera (Apollo Endosurgery, Austin, TX, USA), ReShape Duo (ReShape Medical, San Clemente, CA, USA), and Obalon (Obalon Therapeutics, Carlsbad, CA, USA). The aim of this review is to summarize the available literature on the efficacy of IGBs in weight loss and their impact on obesity-related metabolic diseases.

Citations

Citations to this article as recorded by  
  • Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
    Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2024; 57(3): 309.     CrossRef
  • Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion’s Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker
    Danut Dejeu, Paula Dejeu, Paula Bradea, Anita Muresan, Viorel Dejeu
    Clinics and Practice.2024; 14(3): 765.     CrossRef
  • Efficacy and safety of intragastric balloon for obesity in Korea
    Kwang Gyun Lee, Seung-Joo Nam, Hyuk Soon Choi, Hang Lak Lee, Jai Hoon Yoon, Chan Hyuk Park, Kyoung Oh Kim, Do Hoon Kim, Jung-Wook Kim, Won Sohn, Sung Hoon Jung
    Clinical Endoscopy.2023; 56(3): 333.     CrossRef
  • How effective is intragastric balloon insertion as an obesity treatment in Korea?
    Youngdae Kim
    Clinical Endoscopy.2023; 56(3): 310.     CrossRef
  • Overview on the endoscopic treatment for obesity: A review
    Maheeba Abdulla, Nafeesa Mohammed, Jehad AlQamish
    World Journal of Gastroenterology.2023; 29(40): 5526.     CrossRef
  • Endoscopic Bariatric Therapy for Obesity and Metabolic Syndrome
    Sang Pyo Lee
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(4): 247.     CrossRef
  • Status of bariatric endoscopy–what does the surgeon need to know? A review
    Diogo Turiani Hourneaux de Moura, Anna Carolina Batista Dantas, Igor Braga Ribeiro, Thomas R McCarty, Flávio Roberto Takeda, Marco Aurelio Santo, Sergio Carlos Nahas, Eduardo Guimarães Hourneaux de Moura
    World Journal of Gastrointestinal Surgery.2022; 14(2): 185.     CrossRef
  • Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments
    Hee Kyong Na, Diogo Turiani Hourneaux De Moura
    Clinical Endoscopy.2021; 54(1): 25.     CrossRef
  • 4,983 View
  • 217 Download
  • 8 Web of Science
  • 8 Crossref
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The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy
Jin Young Yoon, Román Turró Arau, The study group for endoscopic bariatric and metabolic therapies in the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(1):17-24.   Published online January 22, 2021
DOI: https://doi.org/10.5946/ce.2021.019
AbstractAbstract PDFPubReaderePub
Endoscopic sleeve gastroplasty (ESG) is a therapeutic endoscopic technique for reducing the size of the gastric reservoir in obese patients, using a full-thickness endoscopic suturing device. The effectiveness of ESG in weight loss is significantly greater than that of high-intensity diet and lifestyle therapy and lower than that of laparoscopic sleeve gastrectomy (LSG). The efficacy at 12 months after ESG in terms of percentage of total body weight loss and excess body weight loss was approximately 16% and 60%, respectively. The well-known predictive factors for increased weight loss by ESG are good compliance with regular monitoring and post-procedure care involving a multidisciplinary team approach. Although the underlying mechanism of weight loss induced by ESG is debatable, delayed gastric emptying and early satiation are some of the proposed mechanisms. The pooled rate of adverse events after ESG reported in several meta-analysis studies ranged from 1.5% to 2.3% and the incidence of new-onset gastroesophageal reflux disease after ESG was negligible, indicating that ESG has a superior safety profile to LSG. Moreover, ESG reduced the risk of obesity-related metabolic comorbidities, evidenced by the reduction in HbA1c level, systolic blood pressure, triglyceride level, and risk of hepatic steatosis and fibrosis; it even improved the quality of life. ESG could be considered safe and qualify as an alternative treatment to LSG.

Citations

Citations to this article as recorded by  
  • Performance of Endoscopic Sleeve Gastroplasty by Obesity Class in the United States Clinical Setting
    Khushboo Gala, Vitor Brunaldi, Christopher McGowan, Reem Z. Sharaiha, Daniel Maselli, Brandon Vanderwel, Prashant Kedia, Michael Ujiki, Eric Wilson, Eric J. Vargas, Andrew C. Storm, Barham K. Abu Dayyeh
    Clinical and Translational Gastroenterology.2024; 15(1): e00647.     CrossRef
  • Recent advances in therapeutic interventions of polycystic ovarian syndrome
    Sakshi Upendra Lad, Ganesh Sunil Vyas, Sharfuddin Mohd, Vijay Mishra, Sheetu Wadhwa, Saurabh Singh, Vancha Harish
    Obesity Medicine.2024; 48: 100543.     CrossRef
  • Fundus-to-Antrum Ratio Measured with Fluoroscopy within One Week after Endoscopic Sleeve Gastroplasty Predicts Total Body Weight Loss over Time
    Kaveh Hajifathalian, Kamal Amer, Dema Shamoon, Donevan Westerveld, Louis Aronne, Amit Mehta, Angela Wong, Grace Lo, Sarah Oh, Andrea Siobhan Kierans, Kamal M. Hassan, Ali Lahooti, Reem Z. Sharaiha
    Journal of Clinical Medicine.2024; 13(13): 3933.     CrossRef
  • Endoscopic treatment of obesity: A protocol of updated systematic review with network meta-analysis of randomized controlled trials
    Eun Jeong Gong, Chang Seok Bang, Gwang Ho Baik, Dong Keon Yon
    PLOS ONE.2024; 19(9): e0308410.     CrossRef
  • The Efficacy Comparison of Endoscopic Bariatric Therapies: 6-Month Versus 12-Month Intragastric Balloon Versus Endoscopic Sleeve Gastroplasty
    K. Kozłowska-Petriczko, K. M. Pawlak, K. Wojciechowska, A. Reiter, Ł. Błaszczyk, J. Szełemej, J. Petriczko, A. Wiechowska-Kozłowska
    Obesity Surgery.2023; 33(2): 498.     CrossRef
  • Endobariatrics: a Still Underutilized Weight Loss Tool
    Niel Dave, Enad Dawod, Okeefe L. Simmons
    Current Treatment Options in Gastroenterology.2023; 21(2): 172.     CrossRef
  • Safety and efficacy of endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy in obese type 2 diabetes patients
    Vimal Thomas, Tarun Kumar Suvvari, Anu Varghese, Nikhat Kousar Ahmed, Yasmine Tarek Elsherif, Aasim Akthar Ahmed
    Surgery Open Digestive Advance.2023; 11: 100098.     CrossRef
  • Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey
    James D. Haddad, Jaime P. Almandoz, Victoria Gomez, Allison R. Schulman, Jay D. Horton, Jeffrey Schellinger, Sarah E. Messiah, M. Sunil Mathew, Elisa Morales Marroquin, Anna Tavakkoli
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  • Endoscopic Sleeve Gastroplasty (ESG) Versus Laparoscopic Sleeve Gastroplasty (LSG): A Comparative Review
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Original Article
Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis
Pichamol Jirapinyo, Diogo T. H. de Moura, Laura C. Horton, Christopher C. Thompson
Clin Endosc 2020;53(6):686-697.   Published online February 28, 2020
DOI: https://doi.org/10.5946/ce.2019.181
AbstractAbstract PDFPubReaderePub
Background
/Aims: Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
Methods
A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Results
Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 – -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 – 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 – -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7–6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 – -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 – -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 – -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5–16.7) %TWL and 25.6 (16.0–35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8–1.8) % and 9.0 (3.9–14.0) U/L. The pooled SAE rate was 4.1%.
Conclusions
Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.

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Focused Review Series: Updates on endoscopic bariatric and metabolic therapieses
Small Bowel Endoscopic Bariatric Therapies
Eun Jeong Gong, Do Hoon Kim
Clin Endosc 2018;51(5):425-429.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.153
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies that emulate some of the principles of bariatric surgery have been developed as a less invasive option for the treatment of obesity and related comorbidities. Small bowel endoscopic bariatric therapies include bypass sleeves, incisionless anastomosis systems, and duodenal mucosal resurfacing. Clinical experience with small bowel devices suggests that endoscopic bariatric procedures can be safely implemented and that these devices are effective for both weight loss and metabolic improvement. Although the mechanisms behind these effects should be further elucidated, endoscopic bariatric therapies may be more effective and safer adjunctive interventions than lifestyle modifications and pharmacological regimens for patients with obesity or obesity-related comorbidities.

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Experimental Gastric Non-Balloon Devices
Youn I Choi, Kyoung Oh Kim
Clin Endosc 2018;51(5):420-424.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.150
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies (EBTs) are promising alternatives to the conventional surgeries used to treat obesity and related metabolic conditions, targeting gastrointestinal anatomical and physiological processes. Many EBTs are at various stages of development and are aimed at promoting an early sense of satiety via anatomical and physiological mechanisms. In the present study, we focused on relevant clinical issues and future perspectives with regard to gastric non-balloon methods treating obesity.

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Currently Available Non-Balloon Devices
Hang Lak Lee
Clin Endosc 2018;51(5):416-419.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.143
AbstractAbstract PDFPubReaderePub
Obesity and metabolic syndrome are known to have an impact on the economy. Obesity and metabolic syndrome affect about 40% population in the America alone, and with about 400 million obese adults in the world, obesity is a global concern. Moreover, the prevalence of overweight children is increasing. Bariatric surgery remains the gold standard for the treatment of obesity; however, endoscopic approaches may have a significant role in the management of metabolic syndrome and obesity. Until recently, many endoscopic methods have been introduced; however, few methods are used in practice, whereas others are under experimental research. Endoscopists have an important role in the treatment of obesity because endoscopic therapies have demonstrated their safety and efficacy over the past few years. Endoscopic bariatric therapies can be categorized as follows: space occupying, malabsorption, and gastric volume reduction. In this review, we summarize the currently available non-balloon type endoscopic procedure.

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Various Intragastric Balloons Under Clinical Investigation
Seong Ji Choi, Hyuk Soon Choi
Clin Endosc 2018;51(5):407-415.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.140
AbstractAbstract PDFPubReaderePub
Obesity is a chronic disease with an exponentially increasing incidence rate, and its negative effects are well documented in numerous studies. As a result, the importance of bariatric therapy cannot be overemphasized, and many bariatric treatment methods with varying mechanisms have been developed. Of the available treatment methods, intragastric balloons, introduced in the 1980s, have been shown to be a safe and effective treatment modality; various intragastric balloon products have been developed and are currently being widely used in clinical settings. However, the disadvantages of intragastric balloons, such as unclear long-term weight loss benefits and complications experienced during insertion and removal, preclude their wider use. In this review, we discuss different intragastric balloon products, focusing on those under clinical investigation, and suggest future research directions.

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Case Report
Gastric Ulceration and Bleeding with Hemodynamic Instability Caused by an Intragastric Balloon for Weight Loss
Larrite Reed, Hawa Edriss, Kenneth Nugent
Clin Endosc 2018;51(6):584-586.   Published online June 1, 2018
DOI: https://doi.org/10.5946/ce.2018.038
AbstractAbstract PDFPubReaderePub
Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015–2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.

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Review
Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity
Deepanshu Jain, Bharat Singh Bhandari, Ankit Arora, Shashideep Singhal
Clin Endosc 2017;50(6):552-561.   Published online June 13, 2017
DOI: https://doi.org/10.5946/ce.2017.032
AbstractAbstract PDFPubReaderePub
Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant (p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.

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Focused Review Series: Endoscopic Accessories Used for ESD
Endoscopic Accessories Used for More Advanced Endoluminal Therapeutic Procedures
Hyunsoo Chung
Clin Endosc 2017;50(3):234-241.   Published online May 31, 2017
DOI: https://doi.org/10.5946/ce.2017.079
AbstractAbstract PDFPubReaderePub
Endoscopic accessories describe an extensive variety of auxiliary instruments used for diagnostic and therapeutic endoscopy. Various endoscopic accessories have been developed over the previous few decades and are mostly used for treating neoplastic lesions, such as early gastrointestinal (GI) carcinomas and premalignant lesions. Because of extensive research on natural orifice endoluminal surgery (NOTES) in the early 2000s and recent technological developments, new devices have been developed for various advanced endoluminal therapeutic procedures. In particular, a remarkable development of endoscopic management was achieved in the field of gastroesophageal reflux disease (GERD) and obesity. In both conditions, there is treatment gap between medical and surgical therapy. A large proportion of the patients who do not respond to medical treatment and lifestyle modification, still hesitate to directly undergo surgical treatment. To bridge this gap, endoscopic management has been receiving increasing attention. In this article, I review endoscopic and/or endoluminal devices used for the treatment of GERD and obesity with proposed mechanisms of their function.
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Case Report
Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings
In Kyung Yoo, Hoon Jai Chun, Yoon Tae Jeen
Clin Endosc 2017;50(6):602-604.   Published online May 18, 2017
DOI: https://doi.org/10.5946/ce.2017.015
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

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Focused Review Series: Roleses of Bariatric Endoscopy in Obesity Treatment
Role of Restrictive Endoscopic Procedures in Obesity Treatment
Hang Lak Lee
Clin Endosc 2017;50(1):17-20.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2017.022
AbstractAbstract PDFPubReaderePub
It is well recognized that obesity is a big problem and it can induce large economic burden. Obesity affects about 40% people in the America alone and obesity also is the worldwide problem, with about 400 million obese adults. Moreover, another problem of obesity is the increasing prevalence of overweight children. Though bariatric surgery remains the gold treatment modality in the obesity treatment, endoluminal approaches may have the meaningful role for weight control. Endoscopists should have a role in the management of obesity because endoluminal therapies demonstrate their safety and efficacy over the coming years. Endoluminal therapies can be summarized by above methods: space occupying, malabsorption method, and reduction of gastric volume. In this review, we will introduce various restrictive endoscopic procedures in obesity treatment.

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Recent Clinical Results of Endoscopic Bariatric Therapies as an Obesity Intervention
Fateh Bazerbachi, Eric J. Vargas Valls, Barham K. Abu Dayyeh
Clin Endosc 2017;50(1):42-50.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2017.013
AbstractAbstract PDFPubReaderePub
Despite advances in lifestyle interventions, anti-obesity medications, and metabolic surgery, the issue of health burden due to obesity continues to evolve. Interest in endoscopic bariatric techniques has increased over the years, as they have been shown to be efficacious, reversible, relatively safe, and cost effective. Further, these techniques offer a therapeutic window for some patients who may otherwise be unable to undergo bariatric surgery. This article aims to review the literature on the safety and efficacy of currently offered endoscopic bariatric techniques, as well as those that are in the pipeline of end-development and regulatory approval.

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Recent Trends in Endoscopic Bariatric Therapies
Hyuk Soon Choi, Hoon Jai Chun
Clin Endosc 2017;50(1):11-16.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2017.007
AbstractAbstract PDFPubReaderePub
Obesity and its associated metabolic diseases including diabetes mellitus are severe medical problems that are increasing in prevalence worldwide and result in significant healthcare expenses. While behavioral and pharmacological treatment approaches are partly effective in the short term, their effects are not long-lasting. Although previous studies have described bariatric surgery as the most effective treatment for obesity, it is associated with morbidity, mortality, and economic burden. Endoluminal interventions performed entirely using gastrointestinal flexible endoscopy offer alternative approaches to the treatment of obesity that are safer and more cost-effective than current surgical approaches. The use of endoluminal techniques in the field of metabolic obesity disease has diverse promising applications including endoscopic gastroplasty, intragastric balloon, endoluminal malabsorptive bariatric procedures, and gastric electrical stimulation (GES) for the modulation of gastric emptying. This review discusses recent trends and roles in endoscopic bariatric therapies using the currently available endoluminal and transgastric technologies.

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Role of Malabsorptive Endoscopic Procedures in Obesity Treatment
Jae Myung Park
Clin Endosc 2017;50(1):26-30.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2017.004
AbstractAbstract PDFPubReaderePub
The incidence of obesity is increasing, and more definitive treatment modalities are needed. Endoluminal procedures, including restrictive endoscopic procedures, endoscopic gastroplasty, and malabsorptive endoscopic procedures, can reduce weight in obese patients and control obesity-related comorbidities. Malabsorptive endoscopic interventions also offer the potential for an ambulatory procedure that may be safer and more cost-effective compared with laparoscopic surgery. Malabsorptive endoscopic intervention can induce weight reduction and improve obesity-related metabolic parameters, despite complications such as device migration, obstruction, and abdominal pain. Improvement in technique will follow the development of new devices.

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Role of Endoscopic Gastroplasty Techniques in the Management of Obesity
Yunho Jung
Clin Endosc 2017;50(1):21-25.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2016.147
AbstractAbstract PDFPubReaderePub
Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up.

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    Malkhaz Mizandari, Pedram Keshavarz, Tamta Azrumelashvili, Fereshteh Yazdanpanah, Elnaz Lorzadeh, Hamidreza Hosseinpour, Amir Bazyar, Seyed Faraz Nejati, Faranak Ebrahimian Sadabad
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Original Article
Obesity and Cecal Intubation Time
Deepanshu Jain, Abhinav Goyal, Jorge Uribe
Clin Endosc 2016;49(2):187-190.   Published online February 12, 2016
DOI: https://doi.org/10.5946/ce.2015.079
AbstractAbstract PDFPubReaderePub
Background
/Aims: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors.
Methods
A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2 ]: I, <24.9; II, 25 to 29.9; III, ≥30). CI time was used as a marker for a difficult colonoscopy. Mean CI times (MCT) were compared for statistical significance using analysis of variance tests.
Results
A total of 926 subjects were included. Overall MCT was 15.7±7.9 minutes, and it was 15.9±7.9 and 15.5±7.9 minutes for men and women, respectively. MCT among women for BMI category I, II, and III was 14.4±6.5, 15.5±8.3, and 16.2±8.1 minutes (p=0.55), whereas for men, it was 16.3±8.9, 15.9±8.0, and 15.6±7.2 minutes (p=0.95), respectively.
Conclusions
BMI had a positive association with CI time for women, but had a negative association with CI for men.

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Case Report
Asymptomatic Gastric Band Erosion Detected during Routine Gastroduodenoscopy
Gee Young Yun, Woo Sub Kim, Hye Jin Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2016;49(3):294-297.   Published online February 11, 2016
DOI: https://doi.org/10.5946/ce.2016.001
AbstractAbstract PDFPubReaderePub
The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up, thus eliminating the possibility of serious complications.

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    GV Ramiro
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Review
Novel Endoscopic Management of Obesity
Jerome Dargent
Clin Endosc 2016;49(1):30-36.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.30
AbstractAbstract PDFPubReaderePub
Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory.

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Obesity and Endoscopic Treatment
Sung Soo Kim, M.D.
Korean J Gastrointest Endosc 2011;42(5):275-282.   Published online May 28, 2011
AbstractAbstract PDF
Obese patients have been increasing with the development of a social economy. Obesity is a disease with high mortality rates due to associated cardiovascular disease and diabetes. Diet or exercise therapy, medications, bariatric surgery are used for treating obesity. However, although bariatric surgery is safe and effective, it is expensive, and reoperation is a burden if patients fail to lose weight. Operative complications are also a problem. The recent development of endoluminal techniques may permit obesity treatment and many endoscopic procedures have been attempted. The role of endoscopy for treating obesity is treating the postoperative complications of bariatric surgery, for example, a stricture or widening of the anastomosis, fistula, or leaks. Second, endoscopic applications could be used for weight reduction to temporarily bridge surgery for high-risk patients with obesity, and for reducing weight in patients unable to undergo surgery. This article provides a brief overview of bariatric surgery and its complications and introduces several endoscopic applications to treat obesity. (Korean J Gastrointest Endosc 2011;42:275-282)
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