Clin Endosc.  2017 Jan;50(1):11-16. 10.5946/ce.2017.007.

Recent Trends in Endoscopic Bariatric Therapies

• Choi HS
• Chun HJ

• KMID: 2383484
• DOI: http://doi.org/10.5946/ce.2017.007

Abstract

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.

Keyword

Obesity; Endoscopy; Bariatrics; Gastroplasty

MeSH Terms

Bariatric Surgery
Bariatrics
Delivery of Health Care
Diabetes Mellitus
Electric Stimulation
Endoscopy
Gastric Emptying
Gastroplasty
Metabolic Diseases
Mortality
Obesity
Prevalence

Figure

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  Fig. 1. Therapeutic approach to obesity treatment. The effect of endoscopic bariatric treatment for weight loss is greater than that of drugs but lower than that of bariatric surgery, but endoscopic bariatric treatment features fewer complications than bariatric surgery. VBG, vertical band gastroplasty; RYGB, Rouxen-Y gastric bypass; DS, duodenal switch; BPD, biliopancreatic diversion.

Reference

1. ASGE Bariatric Endoscopy Task Force; ASGE Technology Committee, Abu Dayyeh BK, et al. Endoscopic bariatric therapies. Gastrointest Endosc. 2015; 81:1073–1086.

2. Espinet-Coll E, Nebreda-Durán J, Gómez-Valero JA, et al. Current endoscopic techniques in the treatment of obesity. Rev Esp Enferm Dig. 2012; 104:72–87.

3. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult bodymass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016; 387:1377–1396.

4. Lee CM, Colagiuri S, Ezzati M, Woodward M. The burden of cardiovascular disease associated with high body mass index in the Asia-Pacific region. Obes Rev. 2011; 12:e454–e459.

5. Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373:1083–1096.

6. Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes. 2010; 3:285–295.

7. Gotthardt JD, Bello NT. Can we win the war on obesity with pharmacotherapy? Expert Rev of Clin Pharmacol. 2016; 9:1289–1297.

8. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014; 370:2002–2013.

9. ASGE Technology Committee, Kethu SR, Banerjee S, et al. Endoluminal bariatric techniques. Gastrointest Endosc. 2012; 76:1–7.

10. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014; 149:275–287.

11. Stimac D, Majanović SK. Endoscopic approaches to obesity. Dig Dis. 2012; 30:187–195.

12. Alfredo G, Roberta M, Massimiliano C, Michele L, Nicola B, Adriano R. Long-term multiple intragastric balloon treatment-a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study. Surg Obes Relat Dis. 2014; 10:307–311.

13. Lopez-Nava G, Rubio MA, Prados S, et al. BioEnterics^® intragastric balloon (BIB^®). Single ambulatory center Spanish experience with 714 consecutive patients treated with one or two consecutive balloons. Obes Surg. 2011; 21:5–9.

14. Mion F, Ibrahim M, Marjoux S, et al. Swallowable Obalon^® gastric balloons as an aid for weight loss: a pilot feasibility study. Obes Surg. 2013; 23:730–733.

15. Machytka E, Klvana P, Kornbluth A, et al. Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management. Obes Surg. 2011; 21:1499–1507.

16. Trande P, Mussetto A, Mirante VG, et al. Efficacy, tolerance and safety of new intragastric air-filled balloon (Heliosphere BAG) for obesity: the experience of 17 cases. Obes Surg. 2010; 20:1227–1230.

17. Lopasso FP, Sakai P, Gazi BM, et al. A pilot study to evaluate the safety, tolerance, and efficacy of a novel stationary antral balloon (SAB) for obesity. J Clin Gastroenterol. 2008; 42:48–53.

18. Carvalho GL, Barros CB, Moraes CE, et al. The use of an improved intragastric balloon technique to reduce weight in pre-obese patients-preliminary results. Obes Surg. 2011; 21:924–927.

19. Gaggiotti G, Tack J, Garrido AB Jr, Palau M, Cappelluti G, Di Matteo F. Adjustable totally Implantable intragastric prosthesis (ATIIP) - Endogast for treatment of morbid obesity: one-year follow-up of a multicenter prospective clinical survey. Obes Surg. 2007; 17:949–956.

20. Gaur S, Levy S, Mathus-Vliegen L, Chuttani R. Balancing risk and reward: a critical review of the intragastric balloon for weight loss. Gastrointest Endosc. 2015; 81:1330–1336.

21. ASGE Bariatric Endoscopy Task Force; ASGE Technology Committee, Abu Dayyeh BK, et al. ASGE bariatric endoscopy task force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc. 2015; 82:425–438. e5.

22. Kim SH, Chun HJ, Choi HS, Kim ES, Keum B, Jeen YT. Current status of intragastric balloon for obesity treatment. World J Gastroenterol. 2016; 22:5495–5504.

23. ASGE Technology Committee, Banerjee S, Barth BA, et al. Endoscopic closure devices. Gastrointest Endosc. 2012; 76:244–251.

24. Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc. 2013; 78:530–535.

25. Song Y, Choi HS, Kim K, et al. A simple novel endoscopic successive suture device: a validation study for closure strength and reproducibility. Endoscopy. 2013; 45:655–660.

26. Mori H, Kobara H, Fujihara S, et al. Feasibility of pure EFTR using an innovative new endoscopic suturing device: the double-arm-bar suturing system (with video). Surg Endosc. 2014; 28:683–690.

27. Kim Y, Choi HS, Kim K, et al. A novel endoscopic surgical device for gastric volume reduction bariatric surgery. International Journal of Precision Engineering and Manufacturing. 2016; 17:467–472.

28. López-Nava G, Bautista-Castaño I, Jimenez A, de Grado T, Fernandez-Corbelle JP. The primary obesity surgery endolumenal (POSE) procedure: one-year patient weight loss and safety outcomes. Surg Obes Relat Dis. 2015; 11:861–865.

29. Lopez-Nava G, Galvão MP, Bautista-Castaño I, Jimenez-Baños A, Fernandez-Corbelle JP. Endoscopic sleeve gastroplasty: how I do it? Obes Surg. 2015; 25:1534–1538.

30. Sharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy. 2015; 47:164–166.

31. Rohde U, Hedbäck N, Gluud LL, Vilsbøll T, Knop FK. Effect of the EndoBarrier gastrointestinal liner on obesity and type 2 diabetes: protocol for systematic review and meta-analysis of clinical studies. BMJ Open. 2013; 3:e003417.

32. Rodriguez L, Rodriguez P, Gómez B, et al. Long-term results of electrical stimulation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease. Endoscopy. 2013; 45:595–604.

33. Rohde U, Hedbäck N, Gluud LL, Vilsbøll T, Knop FK. Effect of the EndoBarrier gastrointestinal liner on obesity and type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2016; 18:300–305.

34. Sandler BJ, Rumbaut R, Swain CP, et al. One-year human experience with a novel endoluminal, endoscopic gastric bypass sleeve for morbid obesity. Surg Endosc. 2015; 29:3298–3303.

35. Sauer N, Rösch T, Pezold J, et al. A new endoscopically implantable device (SatiSphere) for treatment of obesity--efficacy, safety, and metabolic effects on glucose, insulin, and GLP-1 levels. Obes Surg. 2013; 23:1727–1733.

36. Rajagopalan H, Cherrington AD, Thompson CC, et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes: 6-month interim analysis from the first-in-human proof-of-concept study. Diabetes Care. 2016; 39:2254–2261.

37. Sullivan S, Stein R, Jonnalagadda S, Mullady D, Edmundowicz S. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology. 2013; 145:1245–1252. e1-e5.

38. Forssell H, Norén E. A novel endoscopic weight loss therapy using gastric aspiration: results after 6 months. Endoscopy. 2015; 47:68–71.

39. Horbach T, Meyer G, Morales-Conde S, et al. Closed-loop gastric electrical stimulation versus laparoscopic adjustable gastric band for the treatment of obesity: a randomized 12-month multicenter study. Int J Obes (Lond). 2016; 40:1891–1898.

40. Verdam FJ, Schouten R, Greve JW, Koek GH, Bouvy ND. An update on less invasive and endoscopic techniques mimicking the effect of bariatric surgery. J Obes. 2012; 2012:597871.

41. Lebovitz HE, Ludvik B, Yaniv I, et al. Treatment of patients with obese type 2 diabetes with tantalus-DIAMOND^® gastric electrical stimulation: normal triglycerides predict durable effects for at least 3 Years. Horm Metab Res. 2015; 47:456–462.

42. Chiu JD, Soffer E. Gastric electrical stimulation for obesity. Curr Gastroenterol Rep. 2015; 17:424.

43. Abell TL, Johnson WD, Kedar A, et al. A double-masked, randomized, placebo-controlled trial of temporary endoscopic mucosal gastric electrical stimulation for gastroparesis. Gastrointest Endosc. 2011; 74:496–503. e3.

44. Ayinala S, Batista O, Goyal A, et al. Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc. 2005; 61:455–461.

45. Lonys L, Vanhoestenberghe A, Huberty V, et al. Design and implementation of a less invasive gastrostimulator. Eur J Transl Myol. 2016; 26:6019.