Endoscopic management of obesity and metabolic diseases

• Published in: Trends in endocrinology and metabolism 2024-11
• Main Authors: Walradt, Trent, Jirapinyo, Pichamol
• Format: Article
• Language: English
• Subjects: diabetes; endoscopic bariatric and metabolic therapy; endoscopic gastric remodeling; endoscopic sleeve gastroplasty; intragastric balloon; metabolic diseases; metabolic dysfunction-associated steatotic liver disease; obesity; primary obesity surgery endoluminal
• ISSN: 1043-2760; 1879-3061; 1879-3061
• DOI: 10.1016/j.tem.2024.11.001

Endoscopic bariatric and metabolic therapies (EBMTs) are safe and effective treatments for obesity and its related metabolic comorbidities.EBMTs can be divided into gastric and small bowel interventions. Gastric EBMTs primarily induce weight loss, whereas improvement in metabolic conditions is a secondary effect. Small bowel interventions primarily affect metabolic conditions with or without associated weight loss.Understanding the mechanisms of action and metabolic implications of each EBMT may assist endoscopists in selecting the optimal treatment for individual patients. Obesity has become a global pandemic that is associated with a range of metabolic disorders. Traditional treatment options, such as lifestyle modification and anti-obesity medications, often exhibit limited efficacy and can lead to long-term weight gain, especially upon discontinuation of the medication. Although bariatric surgery is effective, its accessibility is constrained, and only a small percentage of eligible patients receive this intervention. Over the past two decades, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as minimally invasive and effective alternatives for managing obesity and its related comorbidities. This article reviews primary gastric and small bowel EBMTs, their mechanisms of action, key supporting literature, and the metabolic outcomes associated with each device and procedure. Obesity has become a global pandemic that is associated with a range of metabolic disorders. Traditional treatment options, such as lifestyle modification and anti-obesity medications, often exhibit limited efficacy and can lead to long-term weight gain, especially upon discontinuation of the medication. Although bariatric surgery is effective, its accessibility is constrained, and only a small percentage of eligible patients receive this intervention. Over the past two decades, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as minimally invasive and effective alternatives for managing obesity and its related comorbidities. This article reviews primary gastric and small bowel EBMTs, their mechanisms of action, key supporting literature, and the metabolic outcomes associated with each device and procedure.