Role of the Gastroenterologist in Managing Obesity

John K DiBaise; Amy E Foxx-Orenstein


Expert Rev Gastroenterol Hepatol. 2013;7(5):439-451. 

In This Article

Bariatric Endotherapies

Despite the overall low rate of complications related to the most common bariatric operations performed, there continues to be considerable interest in the development of less invasive, safe and effective endoscopic alternatives to bariatric surgery. Endoscopic bariatric therapy (EBT) offers the potential for ambulatory procedures with improved access to use, a superior safety and cost profile compared to surgery and potential applicability to patients with lesser degrees of obesity. Endoscopic bariatric therapies may have a variety of roles in the treatment of the obesity including use as primary therapy to induce weight loss and improve obesity-related comorbidities, as a bridge to surgery in high-risk, severely obese individuals who may otherwise not be surgical candidates and as metabolic therapy where improvement in the metabolic disorders (i.e., type 2 diabetes, hyperlipidemia, hypertension) is of primary concern with only modest (e.g., 5% of total body weight) weight loss as a goal.[106] All EBTs should be expected to lead to modification of an individual's eating habits to promote weight loss that can be sustained. There should also be certain weight loss expectations associated with EBT when performed as primary or bridge therapy and based on available evidence, a minimum of 25% excess weight loss 12 months after the procedure has been recommended.[106] Excess weight loss is most commonly calculated as the difference between the individual's current weight and the weight of an individual with a BMI of 25 kg/m2. As the various EBTs will have varying degrees of efficacy and repeatability, they should ultimately be evaluated based upon their intended role and risk–benefit profile. Endoscopic bariatric therapies studied in humans to date have largely been limited to restrictive interventions including intragastric balloons, transoral stapled gastroplasty and endoluminal sutured vertical gastroplasty; however, an endoscopically placed duodenojejunal sleeve is currently being investigated and promotes weight loss through malabsorption as is a large-bore gastrostomy tube device through which aspiration of a portion of recently ingested meals can be accomplished by the obese individual.[107] While early, short-term results of these technologies are encouraging, long-term data regarding safety, efficacy and durability are lacking. A number of other devices that share some similarity to those described are also in development. There are currently no EBTs that are approved for use in the United States and, at present, the use of existing EBT cannot be recommended outside of a clinical trial. For a more complete discussion of these devices, the interested reader is directed to other recent reviews.[108,109]