Endobariatrics and Metabolic Endoscopy: Can We Solve the Obesity Epidemic with Our Scope?
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ENDOSCOPY AND SURGERY (S KOMANDURI, SECTION EDITOR)
Endobariatrics and Metabolic Endoscopy: Can We Solve the Obesity Epidemic with Our Scope? Jad Farha 1 & Shahem Abbarh 1 & Zadid Haq 1 & Mohamad I. Itani 1 & Andreas Oberbach 2 & Vivek Kumbhari 1 & Dilhana Badurdeen 1 Accepted: 16 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Obesity is a chronic relapsing disease that results in cardiovascular disease, diabetes mellitus, and nonalcoholic fatty liver disease. Currently, surgery represents the most effective treatment. However, the advent of minimally invasive endoscopic bariatric therapy (EBT) has shifted the treatment paradigm to less invasive, cost-effective procedures with minimal complications and recovery time that are preferred by patients. In this review, we will describe current and future EBTs, focusing on outcomes and safety. Recent Findings The endoscope has provided an incisionless portal into the gastrointestinal tract for placement of spaceoccupying devices and intraluminal procedures. EBTs are no longer solely manipulating anatomic alterations; instead, they aim to improve metabolic parameters such as glycated hemoglobin, low-density lipoprotein, cholesterol, and hepatic indices by targeting the mucosal layer of the gastrointestinal tract. Summary The endoscope has succeeded in facilitating clinically meaningful weight loss and improvement of metabolic parameters. Future, solutions to the obesity epidemic will likely entail genetic testing, evaluation of the microbiome, and delivery of personalized therapy, utilizing combination endoscopic modalities that change the anatomy and physiology of individual patients, with new targets such as the abnormal metabolic signal. Keywords Obesity . Bariatric . Endoscopy . Metabolic diseases This article is part of the Topical Collection on Endoscopy and Surgery
Introduction
* Dilhana Badurdeen [email protected]
Treatment of obesity with the gastric bypass was first described by Edward Mason in 1966 [1] with subsequent modification by Alden [2] and the addition of a Roux-en-Y configuration by Griffen [3] in 1977. Yet half a decade later, the obesity epidemic has reached critical capacity. To date, bariatric surgery is still the most effective modality for long-term weight loss but adoption is poor due to perceived complications, cost, and fear of undergoing surgery [4]. Despite the preference for non-surgical management options, patients are often unappeased with the minimal weight loss outcomes of diet, lifestyle, and pharmacotherapy. Thus, a new era has emerged with the development of novel devices and techniques to achieve clinically meaningful weight loss and metabolic improvement without the need for surgical intervention. Endoscopic bariatric therapy (EBT) therapy includes devices or instruments that require flexible endoscopy to target the anatomy or physiology of the stomach or small intestine in an attempt to manipulate the complex coaction of metabolic, neuro-hormonal, behavioral, and mi
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