[Endoscopic bariatric therapy in obesity and metabolic disorders: applications and research advances]

Obesity and its related metabolic diseases have become a global public health challenge. Traditional weight loss methods have limited efficacy in patients with moderate to severe obesity, while bariatric surgery, although effective, carries a relatively high risk. Endoscopic weight loss techniques, due to their minimally invasive nature, safety, and reversibility, have gradually become an important supplement to obesity treatment. This article systematically reviews the research progress of gastric and small intestine-related endoscopic bariatric procedures, including intragastric balloon therapy, endoscopic sleeve gastroplasty, gastric bypass stents, and duodenal mucosal resurfacing.The authors believe that gastric-related procedures are suitable for patients whose primary goal is weight loss. Among these, the adjustable intragastric balloon offers the highest flexibility, being non-invasive and reversible with good short-term weight loss effects, making it suitable for bridging to bariatric surgery in patients with severe obesity. Endoscopic sleeve gastroplasty achieves weight loss effects closest to those of bariatric surgery, with favorable long-term weight loss outcomes, and is suitable for weight loss treatment in patients with contraindications to bariatric surgery. Gastric drainage procedures result in poor patient experience due to issues related to fistula tubes; moreover, the small sample size of studies on gastric-related endoscopic procedures means they are not considered representative. In contrast, small intestine-related procedures are more suitable for patients focusing on the improvement of metabolic diseases. Overall, endoscopic techniques exhibit significant short-term efficacy, but their long-term efficacy and standardization still require further research. In the future, it will be necessary to integrate artificial intelligence-assisted operations and individualized treatment strategies to optimize efficacy and expand clinical application.