Metabolic endoscopy: Today's science-tomorrow's treatment

United European Gastroenterol J. 2020 Jul;8(6):685-694. doi: 10.1177/2050640620926837.

Abstract

Obesity, type 2 diabetes mellitus (T2DM) and nonalcoholic steatohepatitis are increasing pandemic metabolic disorders. Lifestyle intervention (LSI) is the cornerstone treatment for these but is successful as standard care alone in only a few patients, given the modest weight loss at mid and long term. Conversely, bariatric surgery is the only proven effective treatment for these metabolic disorders, albeit offered only in a small percentage of cases because of its invasiveness and cost. The so-called endoscopic bariatric and metabolic therapies (EBMTs) include new, less-invasive technologies such as intragastric balloons, aspiration therapy, endoscopic sleeve gastroplasty, diversion devices, and duodenal mucosal resurfacing, currently at various stages of development. EBMTs, as an add-on to LSI, might represent an effective treatment filling the gap between medical and surgical management, taking into account, however, that obesity and its associated comorbidities constitute a chronic disease that needs lifelong therapy. In this review we describe the current scientific evidence surrounding EBMTs as well as future opportunities for such treatments in managing obesity and metabolic disorders.

Keywords: Obesity; endoscopic bariatric and metabolic therapy; metabolic disorders; nonalcoholic steatohepatitis; type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Bariatric Surgery / adverse effects
  • Bariatric Surgery / methods*
  • Bariatric Surgery / trends
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy
  • Comorbidity
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / surgery*
  • Endoscopy
  • Endoscopy, Digestive System / adverse effects
  • Endoscopy, Digestive System / methods*
  • Endoscopy, Digestive System / trends
  • Global Burden of Disease
  • Humans
  • Non-alcoholic Fatty Liver Disease / epidemiology
  • Non-alcoholic Fatty Liver Disease / metabolism
  • Non-alcoholic Fatty Liver Disease / surgery*
  • Obesity / epidemiology
  • Obesity / metabolism
  • Obesity / surgery*
  • Treatment Outcome
  • Weight Loss