Endobariatrics: well past infancy and maturing rapidly

Area of Science:

• Bariatric Endoscopy
• Metabolic Therapies
• Obesity Management

Background:

• Obesity prevalence increased during the COVID-19 pandemic, worsening outcomes.
• Intragastric balloons (IGBs) show short-term efficacy but lack long-term weight loss sustainability.
• Endoscopic bariatric metabolic therapies (EBMTs) are evolving rapidly.

Purpose of the Study:

• To review key developments in FDA-approved EBMTs over the past two years.
• To assess the comparative efficacy and durability of different EBMTs.
• To identify knowledge gaps in the field of endobariatrics.

Main Methods:

• Review of recent literature on FDA-approved EBMTs.
• Analysis of safety and efficacy data for intragastric balloons (IGBs) and endoscopic sleeve gastroplasty (ESG).
• Evaluation of aspiration therapy and emerging trends.

Main Results:

• IGBs offer short-term benefits for nonalcoholic fatty liver disease and quality of life but are not durable.
• Endoscopic sleeve gastroplasty (ESG) demonstrates greater efficacy and durability than IGBs, with fewer adverse events than surgery.
• Aspiration therapy is safe and effective but has lower acceptance.

Conclusions:

• Endobariatric field is maturing, with ESG potentially becoming a first-line therapy.
• Further research is needed on combining EBMTs with pharmacologic treatments for sustained weight loss.
• Emerging data on ESG may lead to revised clinical guidelines.