Endoscopic Therapeutics for the Management of Obesity

Obesity is a chronic, multifactorial disease associated with significant comorbidities and rising global prevalence. Lifestyle interventions alone often fail to achieve sufficient or durable weight loss, while pharmacologic and surgical therapies face limitations in cost, access, or patient acceptance.

To review the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity, highlighting efficacy, safety, and clinical applications.

A narrative review of current EBMTs, including intragastric balloons (IGBs), endoscopic sleeve gastroplasty (ESG), duodenal mucosal resurfacing (DMR), and duodenal-jejunal bypass liners, with emphasis on FDA-approved and investigational devices.

IGBs achieve 7-14% total body weight loss but are temporary and limited by tolerability. ESG provides 15-25% weight loss as a durable, minimally invasive alternative to surgery, with some metabolic benefits. DMR improves glycemic control in type 2 diabetes with modest weight loss effects. Duodenal-jejunal bypass liners demonstrate weight loss and HbA1c reduction but remain investigational due to device migration and safety concerns.

EBMTs bridge the treatment gap between lifestyle, pharmacologic, and surgical options. They offer safe, minimally invasive, and effective strategies for weight loss and metabolic improvement, expanding access to obesity care.