Advances and future directions in endoscopic bariatric therapies

Table 1 A summary of endoscopic bariatric therapies in obese patients

Methods	Advantages	Disadvantages	Limitations	Compared with surgery
IGB	The short-term effects are significant, typically lasting for about 6 months (TBWL: 10%-15%, EWL: 20%-30%)	This treatment carries a high risk of weight regain with limited weight loss efficacy. Common adverse effects include mild gastrointestinal discomfort, with potential risks of IGB migration and rupture	Long-term effects are uncertain; post-operative outcomes rely on patient cooperation (diet and behavior); they are not suitable for severely obese patients	This approach is minimally invasive and reversible, making it more suitable for patients with mild obesity. However, those with severe obesity and no contraindications are more suitable for traditional bariatric surgery. Additional advantages include shorter hospitalization, quicker recovery, and lower costs relative to surgical interventions
ESG	ESG demonstrates effective weight reduction with sustained efficacy for 24 months (TBWL: 15%-20%, EWL: 50%-60%), applicable to class I and class Ⅱ obesity, including patients with class III obesity who are unwilling or ineligible for conventional metabolic and bariatric surgery	The procedure is technically demanding with higher procedural costs. Common postoperative effects include gastrointestinal discomfort, with additional risks of suture-related complications
DJBS	DJBS provides effective weight loss, typically achieving 30%-40% EWL over 12 months without requiring permanent anatomical changes	As the common channel length shortens, so do diarrhea and severe vitamin A and vitamin D deficits, and there are risks such as sleeve migration
TOGA	TOGA delivers effective weight loss (30%-40% EWL), typically achieved within 12 months	Postoperative gastrointestinal discomfort may occur, with risks including gastric perforation. Some patients experience weight regain at 24-month follow-up
BTX-A	BTX-A demonstrates short-term efficacy and is indicated for patients with mild obesity	BTX-A demonstrates limited efficacy with ongoing debate in the medical community, showing only short-term effects (typically lasting 3-6 months). Potential complications include infection or toxicity
GES	GES demonstrates significant short-term efficacy, typically achieving 25%-35% EWL within 12 months	The technical requirements are high, and new systems need to be developed

IGB: Intragastric balloon; ESG: Endoscopic sleeve gastroplasty; DJBS: Duodenal-jejunal bypass sleeve; TOGA: Transoral gastroplasty; BTX-A: Botulinum toxin A; GES: Gastric electrical stimulation; TBWL: Total body weight loss; EWL: Excess weight loss.