Background:
Obesity is a
chronic disease that impairs quality of life and leads to several comorbidities. When
conservative therapies fail, bariatric surgical options such as
Roux-en-Y gastric bypass (RYGB) and sleeve
gastrectomy (SG) are the most effective
therapies to induce persistent
weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic
therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic
gastroplasty, have been shown to be effective in inducing
weight loss compared to
diet modifications alone. Endoscopic
gastroplasty is usually superior to IGBs in maintaining
weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing
weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of
body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (
hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric
therapies: Weight regain may occur in up to one third of patients after
bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of
argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of
stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric
therapies focusing on their efficacy and safety and their potential application in clinical practice.