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Endobariatrics: well past infancy and maturing rapidly.

Shreesh Shrestha1,2, Esha Shrestha3, Tilak Shah4

  • 1Division of Gastroenterology and Hepatology, Virginia Commonwealth University Health Center.

Current Opinion in Gastroenterology
|October 11, 2022
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Summary

Recent advancements in FDA-approved endoscopic bariatric metabolic therapies (EBMTs) show promise. Endoscopic sleeve gastroplasty (ESG) appears more effective and durable than intragastric balloons (IGBs) for sustained weight loss.

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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.