From Surgery to Endoscopy: Comprehensive Review of Bariatric Approaches in Pediatric and Adolescent Patients

Background and Objectives: Pediatric and adolescent obesity is a growing global health concern that is often associated with cardiometabolic comorbidities. Lifestyle interventions represent first-line therapy; however, many adolescents with moderate-to-severe obesity fail to achieve clinically meaningful weight loss. The objective of this review is to provide a comprehensive overview of surgical and endoscopic interventions for adolescent obesity. Materials and Methods: A structured search of PubMed, Scopus, Web of Science and the Cochrane Library was conducted. Studies reporting outcomes of bariatric surgery (sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB)) and endoscopic interventions (endoscopic sleeve gastroplasty (ESG) and intragastric balloons (IGBs)) in patients ≤ 21 years were included. Data on weight loss, BMI reduction, metabolic outcomes, adverse events and follow-up were extracted and summarized. Results: Bariatric surgery remains the most effective intervention, with SG and RYGB achieving substantial and durable weight loss and high rates of comorbidity remission. ESG is an emerging intervention with preliminary short-term efficacy and safety data, though evidence is limited to small pediatric cohorts. IGBs provide reversible, non-surgical weight reduction with consistent short-term efficacy, but long-term durability is variable and largely dependent on adherence to behavioral programs. Across all interventions, psychosocial support, family involvement and multidisciplinary care significantly influence the outcomes. Conclusions: Procedural interventions play a pivotal role in adolescents with moderate-to-severe obesity. IGBs could represent a minimally invasive, reversible option, particularly as bridging or adjunctive therapy. Prospective, long-term studies are needed to optimize patient selection, evaluate developmental safety and determine sustainable outcomes.