Endoluminal Bariatric Interventions : Where do we stand ? Where are we going ?

Background : Obesity is an epidemic leading to high morbidity, mortality, and therefore health-related costs. Thus, there is a huge need for development of safe and effective treatments. Even though success rates of conservative methods are highly limited, the surgi- cal approaches lead to major complications in as many as 25% of the patients. In this study, we aimed to review the currently avail- able, less-invasive, endoscopic bariatric techniques which provides an option to reduce the risks of the patients and the medical costs. Methods : A systematic literature review through Pubmed and Medline was performed to find the studies on this topic, and all controlled clinical trials, case reports, and case series were re- viewed. Results : Endoluminal bariatric interventions include restrictive, malabsorptive approaches, and other techniques including trans- pyloric shuttle, botulinum toxin, gastric pacing and vagal nerve stimulation. Restrictive procedures act by limiting the gastric vol- ume and leading to early satiety, while malabsorptive procedures create a malabsorption state. Transpyloric shuttle is a device de- creasing the rate of gastric emptying. Botox injection causes a delay in gastric emptying, and vagal nerve stimulation modulates eating behavior. Conclusion : Endoluminal bariatric techniques can become the primary choice of therapy in the near future for bariatric care. (Acta gastroenterol. belg., 2015, 78, 415-423).