New Era: Endoscopic treatment options in obesity–a paradigm shift

Table 1 A summary of currently available non-lifestyle modalities in bariatric medicine

Treatment options	Indication	Duration	Efficacy	Advantages	Disadvantages
Pharmacological methods	BMI of ≥ 27 kg/m2 with one obesity related complication or patients with a BMI of ≥ 30 kg/m2	Varies depending on the agent	2%-10% weight loss depending on the agent[33]	Mild to moderately effective	Adverse side effect profile dependent on the medication
				Non-invasive
				Reusable	No evidence for long term effectiveness
Intragastric Balloons	BMI between 30 and 40 kg/m2	6 mo	%TBWL 7%-15%	Reversible	High rates of nausea and vomiting
			%EWL 30%-47%	Repeatable
			At 6 mo duration[34]	Can be used in combination of other modalities	Some reports of gastric perforation in rare cases
Aspiration therapy	BMI of 35-55 kg/m2	Long term duration	%TBWL 14%-18%	Effective	Must see doctors at scheduled intervals
			%EWL 37-54%	Minimal side effects
			From 6-24 mo[35]	Long duration of use	Abdominal pain, peristomal complications
Endoscopic Gastroplasty	BMI between 30 and 40 kg/m2	Long term follow-up studies in progress	%TBWL 12%-19%	Adaptive new technology with a lot of promise	Requires expertise and technical skills
			At 6-24 mo duration[35]	Minimally invasive	Perigastric fluid collections, extragastric bleeding
Lap Band	BMI of 35 kg/m2 with obesity related complications or BMI of 40 kg/m2	Reversible	Mean percentage weight loss at 5 yr was 15.9 ± 12.4%[35]	Sustained weight loss at 5 yr	Need for explant up to 12% Vomiting, nausea, dysphagia, GERD
				Improvements in hgb a1c, cholesterol
Sleeve gastrectomy	BMI of 35 kg/m2 with obesity related complications or BMI of 40 kg/m2	Permanent, but can be bridged to RYGB	49%EWL at 5 yr[36]	Long term sustained weight loss	Significant adverse events
				Cardiometabolic risk factor modifying; hyperlipidemia, diabetes	Overall morbidity rate of 19% at 5 yr
RYGB	BMI of 35 kg/m2 with obesity related complications or BMI of 40 kg/m2	Permanent	57%EWL at 5 yr[36]	Long term sustained weight loss	Significant adverse events related to surgery
				Cardiometabolic risk factor modifying; hyperlipidemia, diabetes	Overall morbidity rate of 26% at 5 yr

%EWL: Percentage excess weight loss; %TBWL: Percentage total body weight loss; BMI: Body mass index; GERD: Gastroesophageal reflux disease; RYGB: Roux-en-Y gastric bypass.