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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 25, 2015; 7(9): 847-859
Published online Jul 25, 2015. doi: 10.4253/wjge.v7.i9.847
Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration
Nitin Kumar
Nitin Kumar, Developmental Endoscopy Lab, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Kumar N solely contributed to this manuscript.
Conflict-of-interest statement: Nitin Kumar has not received any fees for serving as a speaker, for consultancy or advisory boards, or related research funding. Nitin Kumar does not own any stock and/or shares in companies discussed in this article. Nitin Kumar was a site co-investigator for the USGI ESSENTIAL trial, site co-investigator for the Apollo PROMISE trial, and site co-investigator Aspire PATHWAY trial.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nitin Kumar, MD, Developmental Endoscopy Lab, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Thorn 1404, Boston, MA 02115, United States. nitinkumar.101@gmail.com
Telephone: +1-314-3324224 Fax: +1-617-2646342
Received: September 8, 2014
Peer-review started: September 10, 2014
First decision: December 17, 2014
Revised: May 23, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: July 25, 2015
Abstract

A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.

Keywords: Weight loss, OverStitch, Aspire, Transoral outlet reduction, Gastric balloon, Orbera, EndoBarrier, Apollo, Primary Obesity Surgery Endolumenal, Gastric bypass, Duodenal sleeve, Intragastric

Core tip: A broad array of endoscopic procedures and devices will be approved to treat obesity and its metabolic comorbidities in the coming years. A robust body of safety, efficacy, and cost effectiveness data will continue to develop. Endoscopists should have familiarity with target population, benefits, contraindications, and adverse events for each device or procedure. Furthermore, the use of these devices and procedures in the context of a diet and lifestyle management program will be important to ensure success.