Primary Endoscopic Bariatric and Metabolic Therapies and Mechanisms of Action

Obesity is a rising pandemic, and there has been an increase in the prevalence of obesity-related comorbidities including hypertension, hyperlipidemia, type 2 diabetes mellitus (T2DM), coronary artery disease, stroke, nonalcoholic fatty liver disease (NAFLD), gallbladder diseases, and certain types of cancer. In 2012, approximately 210 billion dollars were spent to treat obesity and its related comorbid conditions in the U.S., accounting for 21% of health care expenditures. Over the past two decades, endoscopic bariatric and metabolic therapies (EBMTs) have been developed to fill the treatment gap between medical and surgical therapy. Inspired by bariatric surgical interventions, EBMTs focus on altering the anatomy of the gastrointestinal (GI) tract, which likely leads to changes in GI motility, gut hormones, bile acid concentrations, and gut microbiota, which ultimately results in weight loss and improvement in metabolic outcomes. In this chapter, we review primary EBMTs, mechanisms of action, and their surgical correlates.