Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2016; 22(31): 7069-7079
Published online Aug 21, 2016. doi: 10.3748/wjg.v22.i31.7069
Weight loss endoscopy: Development, applications, and current status
Nitin Kumar
Nitin Kumar, Bariatric Endoscopy Institute, Addison, IL 60101, United States
Author contributions: Kumar N solely contributed to this manuscript.
Conflict-of-interest statement: Kumar N has not received any fees for serving as a speaker, for consultancy or advisory boards, or related research funding; Kumar N does not own any stock and/or shares in companies discussed in this article; Kumar N was a site co-investigator for the USGI ESSENTIAL trial, site co-investigator for the Apollo PROMISE trial, and site co-investigator Aspire PATHWAY trial.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nitin Kumar, MD, Director, Bariatric Endoscopy Institute, 1450 W Lake Street, Ste 101, Addison, IL 60101, United States.
Telephone: +1-630-3879362 Fax: +1-877-5490515
Received: April 4, 2016
Peer-review started: April 4, 2016
First decision: May 12, 2016
Revised: June 10, 2016
Accepted: June 28, 2016
Article in press: June 28, 2016
Published online: August 21, 2016

Obesity and its comorbidities - including diabetes and obstructive sleep apnea - have taken a large and increasing toll on the United States and the rest of the world. The availability of commercial, clinical, and operative therapies for weight management have not been effective at a societal level. Endoscopic bariatric therapy is gaining acceptance as more effective than diet and lifestyle measures, and less invasive than bariatric surgery. Various endoscopic therapies are analogues of the restrictive or bypass components of bariatric surgery, utilizing gastric remodeling or intestinal anastomosis to achieve proven weight loss and metabolic benefits. Others, such as aspiration therapy, employ novel mechanisms of action. Intragastric balloons have recently been approved by the United States Food and Drug Administration, and a number of other technologies have completed large multicenter trials (such as AspireAssist aspiration therapy and Primary Obesity Surgery Endolumenal). Endoscopic sleeve gastroplasty and transoral outlet reduction for endoscopic revision of gastric bypass have proven safe and effective in a number of studies. As devices are approved for use, data will continue to accumulate for safety, effectiveness, and cost effectiveness. Bariatric endoscopists should be prepared to appropriately target and apply various endoscopic bariatric therapies in the context of a comprehensive long-term weight management program.

Keywords: Weight loss, Intragastric balloon, Gastric balloon, Orbera, Reshape dual balloon, Endoscopic sleeve, Endoscopic sleeve gastroplasty, Primary obesity surgery endolumenal, Gastric bypass, Gastric bypass revision, Obesity

Core tip: Endoscopic bariatric therapies (EBT) are entering clinical practice. The bariatric endoscopist must be able to provide comprehensive care to patients who are overweight, have obesity, or have weight-related comorbidities. In addition to performing EBT, the endoscopist should be capable of determining appropriateness for EBT, understanding alternatives, ruling out organic causes for weight gain, and recognizing eating disorders. Patients should concurrently be enrolled in a long-term weight management program in order to maintain the benefits of EBT.