Index Endoscopic Bariatric and Metabolic Therapies

The obesity epidemic is a significant global public health threat with over 650 million adults estimated to have obesity. Endoscopic bariatric and metabolic therapies (EBMTs) provide a cost-effective and safe option for patients who fail medical therapy. EBMTs are thought to lead to weight loss through similar molecular mechanisms as Bariatric surgery. EBMTs are divided into two groups, restrictive and malabsorptive or metabolic. Intragastric balloons were the first EBMTs to be introduced with randomized trials showing superior results compared to medical therapy. Endoscopic sleeve gastroplasty (ESG) and primary obesity surgery endoluminal (POSE) are incisionless endoscopic procedures used to reduce gastric volume with promising results and minimal adverse events. Malabsorptive therapies include endoluminal bypass liners, duodenal mucosal resurfacing, gastroduodenojejunal bypass sleeves, and endoscopic anastomosis devices. These therapies have shown significant reductions in Hgb A1C, fasting insulin and glucose, and %EWL. EBMTs show early promise as alternatives or adjuncts to surgery.