Skip to main content
SpringerLink
Log in

Endoscopic Approaches to Obesity

  • Chapter
  • First Online:
Integrative Weight Management

Part of the book series: Nutrition and Health ((NH))

  • 2242 Accesses

Abstract

The prevalence of obesity is on the rise and is associated with significant morbidity, mortality, and health-related costs to both patients and society. Investigations for safe and effective treatments for obesity have significantly increased. Current treatments are generally divided into two categories: (1) conservative (e.g., diet, exercise, drugs) and (2) surgical management (e.g., gastric bypass). Long-term success via conservative means is low. While surgical gastric bypass leads to significantly greater and sustained weight loss in obese patients, it is often associated with serious adverse events and high costs. Many patients in need are also not suitable candidates for these more invasive procedures due to comorbidities.

In an effort to capitalize on the efficacy of surgical weight loss treatments while reducing medical risks and costs, investigation into endoscopic and transoral approaches for the treatment of obesity has intensified. Endoscopic approaches primarily include restrictive (e.g., intragastric balloons, gastric stapling) or malabsorptive (e.g., duodenal-jejunal sleeve) devices and procedures. These less invasive approaches allow for outpatient or short-stay procedures and allow for treatment of individuals with comorbidities, older age, and super or mild obesity that are often excluded from surgical procedures. Efficacy observed with endoscopic methods typically lies between that observed for conservative and surgical approaches, with an improved safety profile over surgical procedures. Several of these endoscopic approaches are available worldwide but not in the USA, partly due to high regulatory hurdles for efficacy imposed by the Food and Drug Administration (FDA). Reimbursement coverage for these devices and procedures also remains a challenge.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BMI:

Body mass index

CCK:

Cholecystokinin

CDC:

Centers for Disease Control and Prevention

CDRH:

Centers for Devices and Radiological Health

EVG:

Endoluminal vertical gastroplasty

EWL:

Excess weight loss

FDA:

US Food and Drug Administration

GERD:

Gastroesophageal reflux disease

GES:

Gastric electrical stimulation

GI:

Gastrointestinal

HbA1c:

Hemoglobin A1c

HDL:

High-density lipoprotein

IGB:

Intragastric balloon

LDL:

Low-density lipoprotein

LGBP:

Laparoscopic gastric bypass

T2DM:

Type 2 diabetes mellitus

WHO:

World Health Organization

References

  1. WHO. WHO factsheet: obesity and overweight. N°311. Geneva: WHO; 2012

    Google Scholar 

  2. The NS, Suchindran C, North KE, et al. Association of adolescent obesity with risk of severe obesity in adulthood. JAMA. 2010;304(18):2042–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Pietzsch J, Zanchi MG, Linehan JH. Medical device innovators and the 510(k) regulatory pathway: implications of a survey-based assessment of industry experience. J Med Device. 2012;6:021015.

    Article  Google Scholar 

  4. Centers for Disease Control and Prevention. Overweight and obesity facts. http://www.cdc.gov/obesity/index.html. Accessed 16 Nov 2012.

  5. Hausken T, Berstad A. Wide gastric antrum in patients with nonulcer dyspepsia. Effect of cisapride. Scand J Gastroenterol. 1992;27:427–32.

    Article  CAS  PubMed  Google Scholar 

  6. Jones KL, Doran SM, Hveem K, et al. Relation between postprandial satiation and antral area in normal subjects. Am J Clin Nutr. 1997;66:127–32.

    CAS  PubMed  Google Scholar 

  7. Wang FB, Powley TL. Topographic inventories of vagal afferents in gastrointestinal muscle. J Comp Neurol. 2000; 421:302–24.

    Article  CAS  PubMed  Google Scholar 

  8. Ritter RC. Gastrointestinal mechanisms for satiation for food. Physiol Behav. 2004;81:249–73.

    Article  CAS  PubMed  Google Scholar 

  9. Leek BF. Abdominal visceral receptors. Handbook of sensory physiology, vol 111. In: Neil E, editors. Part 1: Enteroreceptors. Berlin: Springer-Verlag; 1971. p. 116–160.

    Google Scholar 

  10. Gibbs J, Young RC, Smith GP. Cholecystokinin decreases food intake in rats. J Comp Physiol Psychol. 1973; 84:488–95.

    Article  CAS  PubMed  Google Scholar 

  11. Moran TH, Ameglio PJ, Peyton HJ, et al. Blockade of type A, but not type B, CCK receptors postpones satiety in rhesus monkeys. Am J Physiol Regul Integr Comp Physiol. 1994;265:R620–4.

    Google Scholar 

  12. Schwartz GJ, McHugh PR, Moran TH. Pharmacological dissociation of responses to CCK and gastric loads in rat mechanosensitive vagal afferents. Am J Physiol Regul Integr Comp Physiol. 1994;267:R303–8.

    CAS  Google Scholar 

  13. Inui A, Asakawa A, Bowers CY, et al. Ghrelin, appetite, and gastric motility: the emerging role of the stomach as an endocrine organ. FASEB J. 2004;18(3):439–56.

    Article  CAS  PubMed  Google Scholar 

  14. Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30.

    Article  PubMed  Google Scholar 

  15. Benjamin SB, Maher KA, Calteau EL, et al. Double-blind controlled trial of the Garren-Edwards balloon as an adjuvant treatment for exogenous obesity. Gastroenterology. 1988;95:581–8.

    CAS  PubMed  Google Scholar 

  16. Mathus-Vliegen EM, Tytgat CN. Intragastric balloon for morbid obesity: result, patient’s tolerance and balloon life span. Br J Surg. 1990;77:76–9.

    Article  CAS  PubMed  Google Scholar 

  17. Roman S, Napoleon B, Mion F, et al. Intragastric balloon for “non-morbid” obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg. 2004;14(4):539–44.

    Article  PubMed  Google Scholar 

  18. Busetto L, Segato G, De Luca M, et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg. 2004;14(5):671–6.

    Article  PubMed  Google Scholar 

  19. Machytka E, Klvana P, Kornbluth A, et al. Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management. Obes Surg. 2011;21(10):1499–507.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Saruc M, Boler M, Karaarslan M, et al. Intragastric balloon treatment of obesity must be combined with bariatric surgery: a pilot study in Turkey. Turk J Gastroenterol. 2010;21(4):333–7.

    PubMed  Google Scholar 

  21. Mathus-Vliegan EM, Tygat GN. Intragastric balloon for treatment-resistant obesity: safety. Tolerance and efficacy of 1 year balloon treatment followed by a 1-year balloon free follow-up. Gastrointest Endosc. 2005;61:19–26.

    Article  Google Scholar 

  22. Verdam FJ, Schouten R, Greve JW, et al. An update on less invasive and endoscopic techniques mimicking the effect of bariatric surgery. J Obes. 2012. Epub 2012 Aug 21.

    Google Scholar 

  23. ASGE Technology Committee, Kethu SR, Banerjee S, Barth BA, et al. Endoluminal bariatric techniques. Gastrointest Endosc. 2012;76(1):1–7. Epub 2012 May 12.

    Article  Google Scholar 

  24. Noria SF, Mikami DJ. Transoral surgery for morbid obesity. World J Gastrointest Endosc. 2011;3(11):201–8.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kohn GP, Galanko JA, Overby DW, et al. Recent trends in bariatric surgery case volume in the United States. Surgery. 2009;146(2):375–80.

    Article  PubMed  Google Scholar 

  26. Mathus-Vliegen EM. Intragastric balloon treatment for obesity: what does it really offer? Dig Dis. 2008; 26(1):40–4.

    Article  PubMed  Google Scholar 

  27. Imaz I, Martinez-Cervell C, Garcia-Alvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18(7):841–6.

    Article  PubMed  Google Scholar 

  28. Martinez-Brocca MA, Belda O, Parejo J, et al. Intragastric balloon-induced satiety is not mediated by modification in fasting or postprandial plasma ghrelin levels in morbid obesity. Obes Surg. 2007;17(5):649–57.

    Article  PubMed  Google Scholar 

  29. Ricci G, Bersani G, Rossi A, et al. Bariatric therapy with IGB improves liver dysfunction and insulin resistance in obese patients. Obes Surg. 2008;18:1438–42.

    Article  PubMed  Google Scholar 

  30. Crea N, Pata G, Della Casa D, et al. Improvement of metabolic syndrome following intragastric balloon: 1 year follow-up analysis. Obes Surg. 2009;19:1084–8.

    Article  PubMed  Google Scholar 

  31. Herve JC, Wahlen CH, Schaeken A, et al. What becomes of patients one year after the intragastric balloon has been removed? Obes Surg. 2005;15(6):864–70.

    Article  CAS  PubMed  Google Scholar 

  32. Dastis NS, François E, Deviere J, et al. Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years. Endoscopy. 2009;41(7):575–80. Epub 2009 Jul 8.

    Article  PubMed  Google Scholar 

  33. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.

    Article  PubMed  Google Scholar 

  34. Qadeer MA. Advances in endoscopy; current developments in diagnostic and therapeutic endoscopy. Gastroenterol Hepatol. 2011;7(7):484–6.

    Google Scholar 

  35. Frutos MD, Morales MD, Lujan J, et al. Intragastric balloon reduces liver volume in super obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17:150–4.

    Article  PubMed  Google Scholar 

  36. Zerrweck C, Maunoury V, Caiazzo R, et al. Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in super-super obese patients. Obes Surg. 2012;22(5): 777–82.

    Article  PubMed  Google Scholar 

  37. Melissas J, Mouzas J, Filis D, Daskalakis M, et al. The intragastric balloon—soothing the path to bariatric surgery. Obes Surg. 2006;16:897–902.

    Article  PubMed  Google Scholar 

  38. Lecumberri E, Krekshi W, Matía P, et al. Effectiveness and safety of air-filled balloon Heliosphere BAG® in 82 consecutive obese patients. Obes Surg. 2011;21(10):1508–12.

    Article  PubMed  Google Scholar 

  39. Genco A, Bruni T, Doldi SB, et al. BioEnterics intragastric balloon: the Italian experience with 2,515 patients. Obes Surg. 2005;15(8):1161–4.

    Article  CAS  PubMed  Google Scholar 

  40. Dumonceau JM. Evidence-based review of the bioenterics intragastric balloon for weight loss. Obes Surg. 2008; 18(12):1611–7. Epub 2008 Jun 21.

    Article  PubMed  Google Scholar 

  41. Mathus-Vliegen EM. Obesity: intragastric balloons; a bubble to combat the obesity bubble? Nat Rev Gastroenterol Hepatol. 2010;7(1):7–8.

    Article  PubMed  Google Scholar 

  42. Genco A, Balducci S, Bacci V, et al. Intragastric balloon or diet alone? A retrospective evaluation. Obes Surg. 2008;18(8):989–92.

    Article  PubMed  Google Scholar 

  43. Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI ≥ 50). Obes Surg. 2005;15:612–7.

    Article  PubMed  Google Scholar 

  44. Mion F, Gincul R, Roman S, et al. Tolerance and efficacy of an air-filled balloon in in-morbidly obese patients. Results of a prospective, multicenter study. Obes Surg. 2007;17:764–9.

    Article  PubMed  Google Scholar 

  45. Forestieri P, De Palma GD, Formato A, et al. Heliosphere Bag in the treatment of severe obesity: preliminary experience. Obes Surg. 2006;16(5):635–7.

    Article  CAS  PubMed  Google Scholar 

  46. De Castro ML, Morales MJ, Del Campo V, et al. Efficacy, safety and tolerance of two types of intragastric balloons placed in obese subjects. A double-blind comparative study. Obes Surg. 2007;20:1642–6.

    Article  Google Scholar 

  47. Lopasso FP, Sakai P, et al. A pilot study to evaluate the safety, tolerance, and efficacy of a novel stationary antral balloon (SAB) for obesity. J Clin Gastroenterol. 2008;42(1):48–53.

    Article  PubMed  Google Scholar 

  48. Ponce J, Quebbemann BB, Patterson EJ. A prospective, randomized, multicenter study to evaluate the safety and efficacy of the intragastric dual-balloon in obesity. Surg Obes Relat Dis. 2013;9:290–5. Epub 2012 Jul 31.

    Google Scholar 

  49. Mahmood Z, McMahon BP, Arfin Q, Byrne PJ, Reynolds JV, Murphy EM, Weir DG. Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up. Gut. 2003;52:34–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis. 2010;6(3):282–8. Epub 2010 Feb 20.

    Article  PubMed  Google Scholar 

  51. Fogel R, De Fogel J, Bonilla Y, et al. Clinical experience of transoral suturing for an endoluminal vertical gastroplasty: 1-year follow-up in 64 patients. Gastrointest Endosc. 2008;68:51–8.

    Article  PubMed  Google Scholar 

  52. Brethauer SA, Chand B, Schauer PR, et al. Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients. Surg Obes Relat Dis. 2010;6:689–94.

    Article  PubMed  Google Scholar 

  53. Brethauer SA, Chand B, Schauer PR, et al. Transoral gastric volume reduction as intervention for weight management: 12-month follow-up of TRIM trial. Surg Obes Relat Dis. 2012;8(3):296–303. Epub 2011 Nov 9.

    Article  PubMed  Google Scholar 

  54. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic roux-en-y gastric bypass on type II diabetes. Ann Surg. 2003;238:467–85.

    PubMed Central  PubMed  Google Scholar 

  55. Deviere J, Ojeda Valdes G, Cuevas-Herrara L, et al. Safety, feasibility and weight loss after transoral gastroplasty: first human multicenter trial. Surg Endosc. 2008;22:589–98.

    Article  CAS  PubMed  Google Scholar 

  56. Moreno C, Closset J, Dugardeyn S, et al. Transoral gastroplasty is safe, feasible and induces weight loss in morbidly obese patients: results of the second human pilot study. Endoscopy. 2008;40:406–13.

    Article  CAS  PubMed  Google Scholar 

  57. Familiari P, Costamagna G, Bléro D, et al. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome. Gastrointest Endosc. 2011;74(6):1248–58.

    Article  PubMed  Google Scholar 

  58. Gleeson J. Burgos v. Satiety, Inc. Document 23; 2010 Justia.com, US Law. http://law.justia.com/cases/federal/district-courts/new-york/nyedce/1:2010cv02680/305598/23. Accessed 16 Nov 2012.

  59. Nanni G, Familiari P, Mor A, et al. Effectiveness of the Transoral Endoscopic Vertical Gastroplasty (TOGa®): a good balance between weight loss and complications, if compared with gastric bypass and biliopancreatic diversion. Obes Surg. 2012;12:1897–902. Epub 2012 Sep 23.

    Google Scholar 

  60. Pollack A. Hoping to avoid the knife. The New York Times. 2011. http://www.nytimes.com/2011/03/17/health/research/17devices.html?pagewanted=all&_r=0. Accessed 16 Nov 2012.

  61. de Jong K, Mathus-Vliegen EM, Veldhuyzen EAML, et al. Short-term safety and efficacy of the trans-oral endoscopic restrictive implant system for the treatment of obesity. Gastrointest Endosc. 2010;72(3):497–504.

    Article  PubMed  Google Scholar 

  62. Biertho L, Hould FS, Lebel S, et al. Transoral endoscopic restrictive implant system: a new endoscopic technique for the treatment of obesity. Surg Obes Relat Dis. 2010;6(2):203–5.

    Article  PubMed  Google Scholar 

  63. Manouchehri N, Birch DW, Menzes C, et al. Natural orifice surgery: endoluminal pouch reduction following failed vertical banded gastroplasty. Obes Surg. 2011;21(11):1787–91.

    Article  PubMed  Google Scholar 

  64. Brengman SG, Denk PM, Swanstrom LL. Durability of endoscopically placed sutures utilized for bariatric and non-bariatric applications. IFSO World Congress 2010 Sep 3–7, Los Angeles, CA.

    Google Scholar 

  65. Korner J, Bessler M, Cirilo LJ, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005;90:359–65.

    Article  CAS  PubMed  Google Scholar 

  66. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  67. Rodriguez-Grunert L, Neto MPG, Alamo M, et al. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve. Surg Obes Relat Dis. 2008;4:55–9.

    Article  PubMed  Google Scholar 

  68. Gersin KS, Rothstein RL, Rosenthal RJ, et al. Open-label sham-controlled trial of an endoscopic duodenal-jejunal bypass liner for preoperative weight loss in bariatric surgery patients. Gastrointest Endosc. 2010;71:876–93.

    Google Scholar 

  69. Schouten R, Rijs CS, Bouvy ND, et al. A multicenter, randomized, efficacy study of the endobarrier gastrointestinal liner for pre-surgical weight loss prior to bariatric surgery. Ann Surg. 2010;251:236–43.

    Article  PubMed  Google Scholar 

  70. Sandler BJ. A unique endoluminal approach for the treatment of morbid obesity. Chicago, IL: American College of Surgeons Clinical Congress; 2009.

    Google Scholar 

  71. BAROnova communication to author. 30 Oct 2012 and BAROnova website: http://www.baronova.com/. Accessed 10 Nov 2012.

Download references

Author information

Authors and Affiliations

  1. ATK Clinical Consulting, LLC, 1989 Pierce Street, Daniel Island, SC, 29492, USA

    Andrea True Kelly PhD

  2. Medical University of South Carolina, DeLegge Medical, 2832 Stay Sail Way, Mount Pleasant, SC, 29466, USA

    Mark DeLegge MD

Authors
  1. Andrea True Kelly PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark DeLegge MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark DeLegge MD .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

    Gerard E. Mullin

  2. Weight Management Center, Johns Hopkins Hospital, Baltimore, Maryland, USA

    Lawrence J. Cheskin

  3. Division of Gastroenterology and Hepatology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA

    Laura E. Matarese

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kelly, A.T., DeLegge, M. (2014). Endoscopic Approaches to Obesity. In: Mullin, G., Cheskin, L., Matarese, L. (eds) Integrative Weight Management. Nutrition and Health. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0548-5_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0548-5_23

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-0547-8

  • Online ISBN: 978-1-4939-0548-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation