Endoscopic Treatment Of Obesity Research Articles

Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus.

Obesity is a chronic and multifactorial condition characterized by abnormal weight gain due to excessive adipose tissue accumulation that represents a growing worldwide challenge for public health. In addition, obese patients have an increased risk of hiatal hernia, esophageal, and gastric dysfunction, as well as gastroesophageal reflux disease, which has a prevalence over 40% in those seeking endoscopic or surgical intervention. Surgery has been demonstrated to be the most effective treatment for severe obesity in terms of long-term weight loss, comorbidities, and quality of life improvements and overall mortality decrease. The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and reproducible approaches to the treatment of obesity. With the endorsement of the International Society for Diseases of the Esophagus, we started a Delphi process to develop consensus statements on the most appropriate diagnostic workup to preoperatively assess gastroesophageal function before bariatric surgical or endoscopic interventions. The Consensus Working Group comprised 11 international experts from five countries. The group consisted of gastroenterologists and surgeons with a large expertise with regard to gastroesophageal reflux disease, bariatric surgery and endoscopy, and physiology. Ten statements were selected, on the basis of the agreement level and clinical relevance, which represent an evidence and experience-based consensus of the International Society for Diseases of the Esophagus.

A New and Effective Technique in the Endoscopic Treatment of Obesity and Regulation of Diabetes: The Pyloric Revision.

This study aimed to investigate the role of the functional structure of the pylorus in obesity and diabetes and to determine the efficacy of a new method, pyloric revision (PR), in the treatment. The pyloric structures of the patients who applied for endoscopic obesity treatment were examined, and the patients were classified as normotonic (NP), hypotonic (HP), and atonic (AP) according to their pyloric structures. PR was applied to those with pyloric structural disorders. Patients with NP were also given the preferred endoscopic treatment (balloon, botulinum toxin, Kanlioz technique). In addition, the pre-procedure fasting blood glucose (FBG) and glycated hemoglobin levels (HbA1c) of the patients were compared with the sixth-month post-procedure status. In order to compare the pyloric structure and other parameters in normal weights with the obese group, a second group of 100 normal-weight (BMI<25) individuals was formed and compared with the study group. In patients with HP (93 patients) and AP (61 patients), a statistically significant decrease was found between HbA1c and FBG levels before treatment and six months after treatment (p˂0.02, p<0.001, respectively). There was a statistically significant difference in favor of the endoscopic obesity treatment group (EOTG) in terms of pyloric disorder, HbA1c, and FPG levels between the EOTG and the normal weight group (NWG) (p<0.0001). We recommend using PR as an easy-to-perform, effective, minimally invasive, reproducible, and cost-effective technique that does not require hospitalization.

Comparison of botulinum toxin applications in the treatment of obesity

Obesity is a global health problem, however, there is no consensus on the treatment for patients with a BMI between 30 and 35. Intragastric botulinum toxin injection (IGBT) has been proposed as a new endoscopic treatment for obesity, with the potential to delay gastric emptying and increase satiety by temporarily paralyzing the injected area. A retrospective study was conducted on 157 patients who received antral or fundus dominant IGBT and were followed up for 6 months with a diet program from January 2020 to December 2022. The patients were divided into three groups: Group 1 consisted of patients who received more injections in the fundus during IGBT, group 2 consisted of patients who received more injections in the antrum during IGBT, and group 3 consisted of patients who were only followed up with a diet program. Group 1 patients received 10 fundus and 10 antrum injections, while group 2 patients received 18 antrum and 2 fundus injections. Group 3 patients were only followed up with a diet program. Both antral and fundus dominant IGBT were effective in reducing body weight, and there was a significant difference between the two groups in terms of weight loss. Both groups 1 and 2 had significantly greater weight loss than group 3 (p&lt;0.001). Antral and fundus dominant IGBT can be considered as a potential treatment option for obese patients with a BMI between 30 and 35 who do not meet the criteria for bariatric surgery.

Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner.

The duodenal-jejunal bypass liner (Endobarrier) is an endoscopic treatment for obesity and type 2 diabetes mellitus (T2DM). It creates exclusion of the proximal small intestine similar to that after Roux-en-Y Gastric Bypass (RYGB) surgery. The objective of this study was to employ a reductionist approach to determine whether bypass of the proximal intestine is the component conferring the effects of RYGB on food intake and sweet taste preference using the Endobarrier as a research tool. A nested mechanistic study within a large randomised controlled trial compared the impact of lifestyle modification with vs. without Endobarrier insertion in patients with obesity and T2DM. Forty-seven participants were randomised and assessed at several timepoints using direct and indirect assessments of food intake, food preference and taste function. Patients within the Endobarrier group lost numerically more weight compared to the control group. Using food diaries, our results demonstrated similar reductions of food intake in both groups. There were no significant differences in food preference and sensory, appetitive reward, or consummatory reward domain of sweet taste function between groups or changes within groups. In conclusion, the superior weight loss seen in patients with obesity and T2DM who underwent the Endobarrier insertion was not due to a reduction in energy intake or change in food preferences.

Endoscopic Treatment of Obesity Using an Adjustable Intragastric Balloon

Endoscopic Treatment of Obesity Using an Adjustable Intragastric Balloon

Endoscopic Treatment of Obesity and Nutritional Aspects of Bariatric Endoscopy.

Obesity is a significant problem worldwide. Several serious diseases that decrease patient quality of life and increase mortality (high blood pressure, dyslipidaemia, type 2 diabetes etc.) are associated with obesity. Obesity treatment is a multidisciplinary and complex process that requires maximum patient compliance. Change of lifestyle is fundamental in the treatment of obesity. While pharmacotherapeutic options are available, their efficacy is limited. Surgical treatment though highly effective, carries the risk of complications and is thus indicated mostly in advanced stages of obesity. Endoscopic treatments of obesity are less invasive than surgical options, and are associated with fewer complications and nutritional deficits. Currently, there is a large spectrum of endoscopic methods based on the principles of gastric volume reduction, size restriction and gastric or small bowel bypass being explored with only few available in routine practice. The aim of this publication is to present an up-to-date summary of available endoscopic methods for the treatment of obesity focusing on their efficacy, safety and nutritional aspects.

Tu1914 – Body Composition As Follow Up of the Endoscopic Treatment of Obesity with Intragastric Balloons

Tu1914 – Body Composition As Follow Up of the Endoscopic Treatment of Obesity with Intragastric Balloons

Systematization of Nutritional Care In Endoscopic Treatment for Obesity.

Propose the systematization of nutritional care in the endoscopic treatment of obesity. This is a bibliographical review, since the initial proposal was a systematic review. This method became unfeasible due to the inexistence of studies that address this theme. Thus, a bibliographic survey was carried out, considering the endoscopic treatment as a restrictive treatment, as well as the information referring to case reports and multicentric studies. Nutrition participation involves nutritional assessment and diagnosis, dietary planning pertinent to the adequate evolution of food consistency, as well as the use of food supplements compatible with the Gastric Sleeve due to food restriction. The Bariatric Plate Model (BPM) can be useful in the nutritional education of the patient after gastric endosuture, associated with water consumption and the performance of scheduled physical exercise, as well as periodic monitoring with the multiprofessional team. Specialized nutritional care is necessary, through a protocol of nutritional assistance defined after gastric endosuture, in order to achieve long-term weight loss and maintenance goals. The BPM can be an excellent form of nutritional education, observing protein intake as a macronutrient base.

Nutritional deficiencies and bone metabolism after endobarrier in obese type 2 patients with diabetes.

Endobarrier® is a minimally invasive, reversible endoscopic treatment for obesity. It provokes malabsorption along 60 cm of the small intestine, which can contribute to the development of vitamin deficiencies and to changes in bone mineral density (BMD). To determine the prevalence of nutrient deficiencies, changes in body composition and BMD during the first year after Endobarrier® placement. Twenty-one patients with type 2 diabetes met inclusion criteria. Levels of vitamins, micro and macronutrients were assessed prior and at 1, 3 and 12 months post-operatively. DEXA was performed before and 12 months after implant. Nineteen patients completed the 12 months follow-up. Vitamin D deficiency was the most prevalent finding before Endobarrier® implant. The percentage of patients with severe deficiency decreased from 19 to 5% at 12 months after supplementation. Microcytic anaemia was initially present in 9.5% of patients and increased to 26.3% at 12 months. Low ferritin and vitamin B12 levels were observed in 14.2 and 4.8% of patients before the implant and worsened to 42 and 10.5%. Low concentrations of magnesium and phosphorus were also common but improved along the study. A significant but not clinically relevant decrease in BMD of 4.14 ± 4.0% at the femoral neck was observed at 12 months without changes in osteocalcin levels. Vitamin deficiencies are common after Endobarrier® implant. It is therefore important to screen patients prior to and at regular intervals after the implant, and to encourage adherence to diet counselling and supplementation.

Endoscopic treatment of obesity and complications after bariatric surgery.

Prevalence and incidence of obesity in the population has been increasing for decades. Due to associated comorbidities, treatment of obesity has become a global health topic and should be addressed with multimodal strategies. As conservative treatment has high rates of failure, bariatric surgery is often performed, especially in cases of severe obesity. However, interventional endoscopic options are gaining importance as less invasive approach. Intragastric balloons and duodenojejunal bypass liners are the most frequent applied endoscopic therapies. Besides primary bariatric intervention, endoscopy may also help bridging towards surgery. Management of postsurgical adverse events (e.g. leakage, stenosis) can be handled endoscopically as well. This article summarizes current knowledge and available endoscopic treatment options for obesity.

Role of the gastroenterologist in the management of the obese patient

Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.

Efficacy of Intragastric Balloon Treatment for Adolescent Obesity.

Several studies conducted in adults suggest that intragastric balloon (IGB) is an effective and safe method for weight loss. Although the prevalence of obesity in adolescents has increased in recent years, the outcomes of IGB treatment in this age group are not known. The aim of this study was to evaluate the safety and efficacy of IGB treatment for weight loss in adolescents followed up for 6months. This is a retrospective longitudinal study including 27 adolescents (14-19years; 23 female). All participants were referred to IGB treatment by their attending physician, presented body mass index (BMI)≥29kg/m2 (>p97 BMI/age index) and failed to lose weight in clinical treatments. A liquid-filled nonadjustable IGB with a volume of 600 to 700ml was used for 6months. All patients were included in a multidisciplinary program, and adherence to this program was evaluated as the number of attended appointments. There were no serious complications or deaths. The BMI decreased from 37.04 to 31.18kg/m2 (p<0.0001), body weight decreased from 102.21 to 86.23kg (p<0.0001), and excess weight diminished from 35.18 to 19.12kg (p<0.0001). The % excess weight loss (%EWL) was 56.19 and % total weight loss (%TWL) 16.35. Adherence to the multidisciplinary program correlated directly with %EWL (r=0.55; p=0.0033) and %TWL (r=0.53; p=0.0052). Endoscopic treatment of obesity with an IGB is safe, effective, and may be an emerging therapeutic option for adolescents.

Endoscopic treatment of obesity.

Obesity and its comorbid illnesses affect millions worldwide and are one of the major causes of preventable death in the world. Bariatric surgery is currently offered to individuals with a BMI greater than 40 kg/m or greater than 35 kg/m with obesity-related comorbidities such as hypertension or diabetes. Endoscopic bariatric therapies, with their reduced invasiveness and potential reversibility, may complement surgical approaches for achieving weight loss. At the time of this writing, two endoscopically placed intragastric balloons and an endoscopically placed aspiration tube have been approved by the Food and Drug Administration for weight loss purposes. Some devices employ a suturing platform to create plications or to appose two surfaces. Other endoscopic strategies under investigation to treat obesity-related comorbidities such as diabetes include duodenal mucosal resurfacing and creation of a partial jejunoileal diversion using self-assembling magnets. Current endoscopic methods for the treatment of obesity utilize various mechanisms, including occupying gastric volume, reducing gastric capacity, altering caloric absorption, or aspirating gastric contents. The long-term outcomes and cost-effectiveness of these strategies remain to be fully elucidated. The landscape of endoscopic bariatric therapies continues to evolve.

Papel del digestólogo en el manejo del paciente obeso

Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.

Su1976 Endoscopic Treatment of Obesity With a Duodenal-Jejunal Bypass Sleeve: Does Impairment of Fat Absorption Explain Weight Loss?

Su1976 Endoscopic Treatment of Obesity With a Duodenal-Jejunal Bypass Sleeve: Does Impairment of Fat Absorption Explain Weight Loss?

Trans-oral Endoscopic Restrictive Implant System: endoscopic treatment of obesity?

BackgroundEndoscopic treatment of obesity might be an alternative to surgical treatment or, preoperatively, serve as an auxiliary therapy to surgery in patients at increased surgical risk. ObjectiveTo evaluate 6-month safety and efficacy of the Trans-Oral Endoscopic Restrictive Implant System (TERIS) as weight-loss device. SettingUniversity hospital. MethodsPatients 18–50 years with a body mass index (BMI) of 40–50 kg/m2 or 35–40 kg/m2 with obesity-related co-morbidities were eligible. Included patients underwent an endoscopic creation of a gastric pouch through attachment of a silicone restrictive implant to 5 cardia plications. Main outcome measurements were safety, expressed as serious adverse events and adverse events, and efficacy, expressed as percentage of excess weight loss (EWL), weight loss (WL), and excess BMI loss (EBMIL). ResultsEighteen patients (3 males) with BMI of 42.1 kg/m2 (interquartile range 40.3–46.9) were included. Three serious adverse events occurred (2 pneumoperitoneum, 1 perforation). Adverse events subsided spontaneously or with medication. In 62.5% of patients, the anchors remained intact for 6 months. Presented as mean (±standard deviation), excess weight loss after 6 months was 30.1% (±9.8), weight loss was 15.1% (±5.3), and excess BMI loss was 37.7% (±12.4). In those who continued the study beyond the first 6 months, weight losses could only partially be maintained due to the detachment of anchors and the unimpeded passage of food. ConclusionsThree serious adverse events occurred in the first 7 patients. TERIS tolerability results improved after major changes in the system and the operating procedure. TERIS proved to be an effective 6-month treatment of obesity. As yet, because of the poor durability of the system, it cannot be recommended as a standalone endoscopic bariatric therapy. Therefore, the company decided to discontinue the TERIS system and to further develop the successful parts of it, such as the articulating circular endoscopic stapler.

Tu1468 A Pre-Clinical Animal Study Evaluating the Feasibility and Efficacy of a Combined Intragastric Balloon and Duodenal-Jejunal Bypass Sleeve for the Endoscopic Treatment of Obesity

Tu1468 A Pre-Clinical Animal Study Evaluating the Feasibility and Efficacy of a Combined Intragastric Balloon and Duodenal-Jejunal Bypass Sleeve for the Endoscopic Treatment of Obesity

Endoscopic treatment of obesity

Obesity is a worldwide epidemic, complex metabolic disease associated with a variety of severe comorbidities. Bariatric surgery provides the patients with the benefits of sustained weight loss and improves obesity-related comorbidities, but can result in potentially life-threatening complications. Gastrointestinal endoscopy has recently been proposed as a scarless and noninvasive approach to obesity. Most of the current endoluminal devices and techniques are comparable to restrictive surgery. A variety of medical devices and procedures have been evaluated in recent years; however, with the exception of the intragastric balloon, evaluation of all the other endoluminal procedures is limited by the numbers of patients treated, the short follow-up and especially by the study design. Today, only a few devices have been evaluated in randomized controlled trials. The preliminary results of the first studies are extremely promising, but definitive statements cannot be drawn yet.

Endoscopic Treatment of Obesity

The increasing incidence of obesity and overweight among children and adolescents will be reflected by the imminent increase in the number of obese patients who require more definitive methods of treatment. There is great interest in new, safe, simple, nonsurgical procedures for weight loss. To provide an overview of new endoscopic methods for the treatment of obesity. An English-language literature search on endoscopic interventions, endoscopically placed devices and patient safety was performed in the MEDLINE and Cochrane Library databases. The literature search yielded the following weight loss methods: space-occupying devices (widely used), gastric capacity reduction, modifying gastric motor function and malabsorptive procedures. A commercially available intragastric balloon was the most commonly used device for weight loss. In specific subgroups of patients, it improved quality of life, decreased comorbidities and served as a bridge to surgery. More evidence regarding the potential benefits and safety of other commercially available intragastric balloons is needed to clarify whether they are superior to the most commonly used one. Moreover, early experiences with transoral gastroplasty, the duodenal-jejunal bypass sleeve and an adjustable, totally implantable intragastric prosthesis, indicate that they may be viable options for obesity treatment. Other agents, such as botulinum toxin and a device known as the 'butterfly', are currently at the experimental stage. New endoscopic methods for weight loss may be valuable in the treatment of obesity; however, more clinical experience and technical improvements are necessary before implementing their widespread use.

Endoscopic Treatment of obesity with an Intragastric balloon

Endoscopic Treatment of obesity with an Intragastric balloon