Endoscopic Management of Clinically Severe Obesity: Primary and Secondary Therapeutic Procedures

In the treatment of epidemic obesity and metabolic disorders, conservative approaches often fail to achieve the treatment goal in patients with very high BMI. To date, bariatric surgery accomplishes the most sustainable results in patients with morbid obesity. This leads to a treatment gap for lower and middle classes of obesity defined by BMI. Primary endoscopic procedures, which are less invasive than surgery, may be able to sufficiently fill this gap. Furthermore, secondary endoscopic procedures have developed into an essential addition regarding complication management of bariatric surgeries. The purpose of this review was to point out the latest developments in the field of bariatric endoscopy, including both primary and secondary procedures.

Innovative devices and their possible applications will be discussed. These include various endoscopic suturing techniques as well as newly developed implants for the upper gastrointestinal tract to counteract the obesity epidemic. The growing understanding of the pathophysiology of obesity and the role of the gastrointestinal tract allows for the development of more effective endoscopic procedures regarding obesity treatment.