Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4567-4579
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4567
New Era: Endoscopic treatment options in obesity–a paradigm shift
Jason Glass, Ahson Chaudhry, Muhammad S Zeeshan, Zeeshan Ramzan
Jason Glass, Zeeshan Ramzan, Department of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Ahson Chaudhry, Muhammad S Zeeshan, Zeeshan Ramzan, Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, TX 75216, United States
Ahson Chaudhry, School of Medicine, Temple University Hospital, Philadelphia, PA 19140, United States
Author contributions: Glass J was responsible for review of the literature, manuscript writing, and figure/table generation; Chaudhry A and Zeeshan MS were responsible for collecting reference articles, manuscript writing and figure/table generation; Ramzan Z provided expertise in the field of gastrointestinal endoscopy, manuscript writing and editing, and designing the aims of the manuscript.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest.
Open-Access: This article is an open-access article which was selected byan 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zeeshan Ramzan, MD, FACP, FACG, FASGE, Assistant Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center, VA North Texas Health Care System, 4500 South Lancaster Road, Dallas, TX 75216, United States. zeeshanramzan@hotmail.com
Telephone: +1-214-8571603 Fax: +1-214-4624842
Received: March 29, 2019
Peer-review started: March 29, 2019
First decision: June 10, 2019
Revised: July 30, 2019
Accepted: August 7, 2019
Article in press: August 7, 2019
Published online: August 28, 2019

The prevalence of obesity continues to rise, and along with it comes a multitude of health-related consequences. The healthcare community has consistently struggled with providing treatment options to obese patients, in part due to the reluctance of patients in pursuing the more effective (yet invasive) surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric bypass. On the other hand, the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy (Orlistat, Phenteramine, Phentermine/Topiramate, Locaserin, Naltrexon/Buproprion, and Liraglutide) have very limited efficacy, especially in the morbidly obese patients. Despite our best efforts, the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and society. Bariatric endoscopy is an evolving field generated to combat this epidemic through minimally invasive techniques. These procedures can be performed in an ambulatory setting, are potentially reversible, repeatable, and pose less complications than their invasive surgical counterparts. These modalities are designed to alter gut metabolism by means of space occupation, malabsorption, or restriction. In this review we will discuss different bariatric endoscopic options (such as intragastric balloons, endoscopic sleeve gastroplasty, endoscopic aspiration therapies and gastrointestinal bypass sleeves), their advantages and disadvantages, and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.

Keywords: Bariatric endoscopy, Bariatrics, Obesity, Intragastric balloon, Bariatric medicine, AspireAssist, Endoscopic sleeve gastroplasty

Core tip: The prevalence of obesity has risen to an alarming level. The associated morbidity and mortality of this epidemic affects the community and health related economics directly. Current options include lifestyle modifications, pharmacotherapy, and surgery; the latter being the most effective, however most invasive and prone to complications. Bariatric endoscopy, with methods including intragastric balloons, sleeve gastroplasty, and aspiration techniques, provides an effective and less invasive option for weight loss in obese patients.