Endoscopic treatments of obesity: a comprehensive review

Background: Obesity remains a significant problem in the United States. Bariatric surgery is the most effective treatment for obesity, but it is cost-prohibitive on both a national and individual scale. Access is also limited, and less than 1% of the eligible population receives bariatric surgery. Endoscopic therapies for obesity have emerged as an alternative to bariatric surgery, 2 of which have recently been approved by the U.S. Food and Drug Administration (FDA). This study provides a comprehensive overview of the endoscopic treatments of obesity and summarizes their outcomes.

Objectives: To provide clinicians with a comprehensive overview of the endoscopic treatments of obesity.

Setting: University Hospital, United States.

Methods: Multiple searches of PubMed were conducted using various keywords and MeSH terms. Backwards citation searching and hand-searching were also conducted to ensure completeness.

Results: The current endoscopic treatments of obesity can be divided into 6 main categories: 1) space-occupying devices, 2) restrictive procedures, 3) bypass liners, 4) electrical stimulation, 5) aspiration therapy, and 6) other therapies. Intragastric balloons, a space-occupying device, are the best-studied of all the treatments. They show 30%-50% excess weight loss after device removal but lack significant long-term follow-up.

Conclusions: With the recent Food and Drug Administration approval of intragastric balloons, this treatment is likely to rise in popularity. Short-term outcomes appear promising but long-term results are unclear.