Endoscopic bariatric therapies for obesity: a review

Staudenmann, Dominic A; Sui, Zhixian; Saxena, Payal; Kaffes, Arthur J; Marinos, George; Kumbhari, Vivek; Aepli, Patrick; Sartoretto, Adrian

doi:10.5694/mja2.51179

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Surgical procedures, operative

Nutritional and metabolic diseases

Summary

▪ Obesity is reaching pandemic proportions globally, with overweight or obesity affecting at least two‐thirds of Australian adults.
▪ Bariatric surgery is an effective weight loss strategy but is constrained by high resource requirements and low patient acceptance.
▪ Multiple endoscopic bariatric therapies have matured, with well established and favourable safety and efficacy profiles in multiple randomised controlled trials (RCTs), and are best used within a multidisciplinary setting as an adjuvant to lifestyle intervention.
▪ Three types of intragastric balloon are currently in use in Australia offering average total weight loss ranging from 10% to 18%, with others available internationally.
▪ Endoscopic sleeve gastroplasty produces average total weight loss of 15–20% with low rates of severe complications, with RCT data anticipated in December 2021.
▪ Bariatric and metabolic endoscopy is rapidly evolving, with many novel, promising therapies currently under investigation.

1 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
2 Praxis Balsiger Seibold und Partner, Bern, Switzerland
3 Université de Fribourg, Fribourg, Switzerland
4 University of New South Wales, Sydney, NSW
5 Royal Prince Alfred Hospital, Sydney, NSW
6 The BMI Clinic, Sydney, NSW
7 Mayo Clinic, Jacksonville, FL, United States
8 Luzerner Kantonsspital (LUKS), Lucerne, Switzerland

Correspondence: dominic.staudenmann@magendarmsuisse.ch

Competing interests:

No relevant disclosures.

1. World Health Organization. Obesity: overweight and obesity fact sheet 2020: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (viewed Nov 2020).
2. Bentham J, Di Cesare M, Bilano V, et al. Worldwide trends in body mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population‐based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017; 390: 2627–2642.
3. Hayes AJ, Lung TWC, Bauman A, et al. Modelling obesity trends in Australia: unravelling the past and predicting the future. Int J Obes (Lond) 2017; 41: 178–185.
4. Hartmann‐Boyce J, Johns DJ, Jebb SA, et al. Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review, meta‐analysis and meta‐regression. Obes Rev 2014; 15: 598–609.
5. Hassan Y, Head V, Jacob D, et al. Lifestyle interventions for weight loss in adults with severe obesity: a systematic review. Clin Obes 2016; 6: 395–403.
6. Look AHEAD Research Group; Pi‐Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 Diabetes. Diabetes Care 2007; 30: 1374–1383.
7. Curioni CC, Lourenço PM. Long‐term weight loss after diet and exercise: a systematic review. Int J Obes (Lond) 2005; 29: 1168–1174.
8. Patel D. Pharmacotherapy for the management of obesity. Metabolism 2015; 64: 1376–1385.
9. Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 2017; 377: 1143–1155.
10. Ryan DH. Guidelines for obesity management. Endocrinol Metab Clin North Am 2016; 45: 501–510.
11. Durrer Schutz D, Busetto L, Dicker D, et al. European practical and patient‐centred guidelines for adult obesity management in primary care. Obes Facts 2019; 12: 40–66.
12. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741–752.
13. Chang SH, Stoll CRT, Song J, et al. The effectiveness and risks of bariatric surgery an updated systematic review and meta‐analysis, 2003–2012. JAMA Surg 2014; 149: 275–287.
14. Wharton S, Serodio KJ, Kuk JL, et al. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity. Clin Obes 2016; 6: 154–160.
15. Ponce J, DeMaria EJ, Nguyen NT, et al. American society for metabolic and bariatric surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis 2016; 12: 1637–1639.
16. Abu Dayyeh BK, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology 2017; 152: 716–729.
17. Abu Dayyeh BK, Kumar N, Edmundowicz SA, 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.
18. ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy; Ginsberg GG, Chand B, Cote GA, et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc 2011; 74: 943–953.
19. Sullivan S, Kumar N, Edmundowicz SA, et al. ASGE position statement on endoscopic bariatric therapies in clinical practice. Gastrointest Endosc 2015; 82: 767–772.
20. Usuy E, Brooks J. Response rates with the Spatz3 adjustable balloon. Obes Surg 2018; 28: 1271–1276.
21. Kim SH, Chun HJ, Choi HS, et al. Current status of intragastric balloon for obesity treatment. World J Gastroenterol 2016; 22: 5495–5504.
22. Brooks J, Srivastava ED, Mathus‐Vliegen EMH. One‐year adjustable intragastric balloons: results in 73 consecutive patients in the UK. Obes Surg 2014; 24: 813–819.
23. Sartoretto A, Sui Z, Hill C, et al. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg 2018; 28: 1812–1821.
24. Da Silva JR, Proença L, Rodrigues A, et al. Intragastric balloon for obesity treatment: safety, tolerance, and efficacy. GE Port J Gastroenterol 2018; 25: 236–242.
25. Imaz I, Martínez‐Cervell C, García‐Álvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta‐analysis. Obes Surg 2008; 18: 841–846.
26. Mitura K, Garnysz K. Tolerance of intragastric balloon and patient’s satisfaction in obesity treatment. Wideochir Inne Tech Maloinwazyjne 2015; 10: 445–449.
27. Ienca R, Al Jarallah M, Caballero A, et al. The procedureless Elipse gastric balloon program: multicenter experience in 1770 consecutive patients. Obes Surg 2020; 30: 3354–3362.
28. Jamal MH, Almutairi R, Elabd R, et al. The safety and efficacy of procedureless gastric balloon: a study examining the effect of elipse intragastric balloon safety, short and medium term effects on weight loss with 1‐year follow‐up post‐removal. Obes Surg 2019; 29: 1236–1241.
29. Neto MG, Silva LB, Grecco E, et al. Brazilian intragastric balloon consensus statement (BIBC): practical guidelines based on experience of over 40 000 cases. Surg Obes Relat Dis 2018; 14: 151–159.
30. Gaur S, Levy S, Mathus‐Vliegen L, et al. Balancing risk and reward: a critical review of the intragastric balloon for weight loss. Gastrointestinal Endosc 2015; 81: 1330–1336.
31. Popov VB, Ou A, Schulman AR, et al. The Impact of intragastric balloons on obesity‐related co‐morbidities: a systematic review and meta‐analysis. Am J Gastroenterol 2017; 112: 429–439.
32. Schulman AR, Popov V, Thompson CC. Randomized sham‐controlled trials in endoscopy: a systematic review and meta‐analysis of adverse events. Gastrointestinal Endosc 2017; 86: 972–985.
33. Stavrou G, Tsaousi G, Kotzampassi K. Life‐threatening visceral complications after intragastric balloon insertion: is the device, the patient or the doctor to blame? Endosc Int Open 2019; 07: E122–E129.
34. Rahman AA, Loi K. Gastric perforation as a complication of intragastric balloon. Surg Obes Relat Dis 2018; 14: 719–722.
35. Yoo IK, Chun HJ, Jeen YT. Gastric perforation caused by an intragastric balloon: endoscopic findings. Clin Endosc 2017; 50: 602–604.
36. Kumar N. Endoscopic therapy for weight loss: gastroplasty, duodenal sleeves, intragastric balloons, and aspiration. World J Gastroenterol 2015; 7: 847.
37. Kumar N, Abu Dayyeh BK, Lopez‐Nava Breviere G, et al. Endoscopic sutured gastroplasty: procedure evolution from first‐in-man cases through current technique. Surg Endosc 2018; 32: 2159–2164.
38. Graus Morales J, Crespo Pérez L, Marques A, et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc 2018; 32: 3936–3942.
39. Hill C, El Zein M, Agnihotri A, et al. Endoscopic sleeve gastroplasty: the learning curve. Endosc Int Open 2017; 05: E900–E904.
40. Lopez‐Nava G, Galvão MP, Bautista‐Castaño I, et al. Endoscopic sleeve gastroplasty: how I do it? Obes Surg 2015; 25: 1534–1538.
41. 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.
42. Sharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy 2014; 2012: 164–166.
43. Novikov AA, Afaneh C, Saumoy M, et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare? J Gastrointest Surg 2018; 22: 267–273.
44. Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol 2017; 15: 504–510.
45. Neto MG, Silva LB, de Quadros LG, et al. Brazilian consensus on endoscopic sleeve gastroplasty. Obes Surg 2021; 31: 70–78.
46. Espinós JC, Turró R, Moragas G, et al. Gastrointestinal physiological changes and their relationship to weight loss following the POSE procedure. Obes Surg 2016; 26: 1081–1089.
47. Bazerbachi F, Vargas Valls EJ, Abu Dayyeh BK. Recent clinical results of endoscopic bariatric therapies as an obesity intervention. Clin Endosc 2017; 50: 42–50.
48. Horgan S, Jacobsen G, Weiss GD, et al. Incisionless revision of post‐Roux-en‐Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis 2010; 6: 290–295.
49. Vargas EJ, Bazerbachi F, Rizk M, et al. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta‐analysis. Surg Endosc 2018; 32: 252–259.
50. Thompson CC, Abu Dayyeh BK, Kushner R, et al. Percutaneous gastrostomy device for the treatment of class II and Class III obesity: results of a randomized controlled trial. Am J Gastroenterol 2017; 112: 447–457.
51. Sullivan S, Stein R, Jonnalagadda S, et al. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology 2013; 145: 1245–1252.
52. Rohde U, Hedbäck N, Gluud LL, et al. 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.
53. Jirapinyo P, Haas AV, Thompson CC. Effect of the duodenal‐jejunal bypass liner on glycemic control in patients with type 2 diabetes with obesity: a meta‐analysis with secondary analysis on weight loss and hormonal changes. Diabetes Care 2018; 41: 1106–1115.
54. Patel N, Mohanaruban A, Ashrafian H, et al. EndoBarrier: a safe and effective novel treatment for obesity and type 2 diabetes? Obes Surg 2018; 28: 1980–1989.
55. Younus H, Chakravartty S, Sarma DR, et al. EndoBarrier as a pre bariatric surgical intervention in high‐risk patients: a feasibility study. Obes Surg 2018; 28: 3020–3027.
56. US Food and Drug Administration. TransPyloric Shuttle/TransPyloric Shuttle delivery device — P180024. https://www.fda.gov/medical-devices/recently-approved-devices/transpyloric-shuttletranspyloric-shuttle-delivery-device-p180024 (viewed Nov 2020).
57. Marinos G, Eliades C, Muthusamy VR, et al. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3‐ and 6‐month study. Surg Obes Relat Dis 2014; 10: 929–934.
58. Kumbhari V, Lehmann S, Schlichting N, et al. Gastric mucosal devitalization is safe and effective in reducing body weight and visceral adiposity in a porcine model. Gastrointest Endosc 2018; 88: 175–184.
59. Neto MG, Silva LB, Grecco E, et al. Brazilian intragastric balloon consensus statement (BIBC): practical guidelines based on experience of over 40 000 cases. Surg Obes Relat Dis 2018; 14: 151–159.
60. Sartoretto A, Sui Z, Hill C, et al. Endoscopic sleeve gastroplasty (ESG) is a reproducible and effective endoscopic bariatric therapy suitable for widespread clinical adoption: a large, international multicenter study. Obes Surg 2018; 28: 1812–1821.
61. Hajifathalian K, Ang B, Dawod QM, et al. 175 Long‐term follow up and outcomes after endoscopic sleeve gastroplasty for treatment of obesity (5 year data) [abstract]. Gastrointest Endosc 2019; 89 (Suppl): AB58.
62. Lopez‐Nava G, Sharaiha RZ, Vargas EJ, et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow‐up. Obes Surg 2017; 27: 2649–2655.
63. Nyström M, Machytka E, Norén E, et al. Aspiration therapy as a tool to treat obesity: 1 to 4 year results in a 201‐patient multi‐center post‐market European registry study. Obes Surg 2018; 28: 1860–1868.
64. Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis 2014; 10: 952–972.
65. Hu Z, Sun J, Li R, et al. A comprehensive comparison of LRYGB and LSG in obese patients including the effects on QoL, comorbidities, eight loss, and complications: a systematic review and meta‐analysis. Obes Surg 2020; 30: 819–827.

Online responses are no longer available. Please refer to our instructions for authors page for more information.

Endoscopic bariatric therapies for obesity: a review

Topics

Summary

Author

Comment

Do you have any competing interests to declare? *