Endoscopic Approaches to Obesity

Abstract

The prevalence of obesity is on the rise and is associated with significant morbidity, mortality, and health-related costs to both patients and society. Investigations for safe and effective treatments for obesity have significantly increased. Current treatments are generally divided into two categories: (1) conservative (e. g., diet, exercise, drugs) and (2) surgical management (e. g., gastric bypass). Longterm success via conservative means is low. While surgical gastric bypass leads to significantly greater and sustained weight loss in obese patients, it is often associated with serious adverse events and high costs. Many patients in need are also not suitable candidates for these more invasive procedures due to comorbidities. In an effort to capitalize on the efficacy of surgical weight loss treatments while reducing medical risks and costs, investigation into endoscopic and transoral approaches for the treatment of obesity has intensified. Endoscopic approaches primarily include restrictive (e. g., intragastric balloons, gastric stapling) or malabsorptive (e. g., duodenal-jejunal sleeve) devices and procedures. These less invasive approaches allow for outpatient or short-stay procedures and allow for treatment of individuals with comorbidities, older age, and super or mild obesity that are often excluded from surgical procedures. Efficacy observed with endoscopic methods typically lies between that observed for conservative and surgical approaches, with an improved safety profile over surgical procedures. Several of these endoscopic approaches are available worldwide but not in the USA, partly due to high regulatory hurdles for efficacy imposed by the Food and Drug Administration (FDA). Reimbursement coverage for these devices and procedures also remains a challenge.