Endoscopic bariatric procedures

Obesity is a pandemy which affects 600 million adults worldwide. Surgery is the only therapy which has been shown effective on the long term. Transoral surgery (or endotherapy) is particularly attractive in this group of patients and has the potential for offering a less invasive alternative. If the only treatment currently available in routine is balloon implantation, which is effective at short term but unfortunately associated with weight regain after removal in the majority of the cases, other techniques currently under development or clinical investigations might fine their place in future treatment armamentarium. They include restrictive procedures, involving plicature formation or tissue apposition in order to reduce the volume of the stomach, decrease its compliance, and favor an early satiety. Other techniques focus on malabsorption, either by bypassing the contact of food with the jejunum (a feature which also improves type 2 diabetes) or by emptying the stomach after food intake. Several techniques also allow performing gastrojejunal anastomoses. These could be particularly useful in designing hybrid procedures combining laparoscopic and transoral approach resulting in less invasive surgical procedures. Even if, currently, none of these techniques can be recommended outside clinical protocols, it becomes more and more obvious that some of them will find their place in the near future.