Obesity is a complex metabolic disease of excessive fat accumulation associated with an in-creased risk to health. One measure of the degree of obesity is the body mass index (BMI), a per-son’s weight in kilograms divided by the square of his or her height in meters. A person with BMI of 30Kg/m2 or more is considered obese. Over the past few decades obesity has evolved into a global epidemic , and it is now more prevalent than malnutrition from hunger.
Current treatment modalities for obesity and associated metabolic co-morbidities include lifestyle modification , diet and pharmacologic agents. However these have shown to have limited effec-tiveness , with high rates of attrition . Surgical intervention is the most effective to date, resulting in sustainable and significant weight loss along with resolution of metabolic co-morbidities in upto 80% .
While effective , these laparoscopic and open bariatric procedures have morbidity rates of 3% to 20% and mortality rates 0.1% to 0.5% . In particular , cardiopulmonary events and anastomotic leaks are sources of severe morbidity. For these and other reasons , including limited access to care , only 1 in 400 class III obese individuals undergo bariatric surgery.
Given that all current surgical procedures require general anaesthesia and have procedure related complications , there is need for less invasive weight loss interventions to partially reduce morbidity and improve access. A range of novel endoscopic modalities may fit this profile.
Endoscopic bariatric and metabolic therapies (EBMT) are a new addition to the treatment arsenal for obesity. These include devices that are placed or removed via flexible endoscopy , and proce-dures that utilise instruments that require flexible endoscopy for the indications of weight loss and treatment of glucose intolerance ( from pre diabetes to diabetes).
EBMTs are generally divided into gastric and small bowel categories, endoscopic therapies appear to lie in the middle of spectrum., offering efficacy with a risk profile similar to other therapeutic en-doscopic procedures. Because endoscopic procedures are less invasive and have less risk than surgery , and are more efficacious than currently available medical interventions , they are applic-able to a large group of patients
Clinically available endogariatric procedures that use FDA approved devices include
1.Intragastric balloons (IGBs)
2.Gastric aspiration therapy
3.Endoscopic sleeve gastroplasty
Reversibility, repeatability and cost effectiveness of endoscopic bariatric procedures make them an attractive options to fill the gap in obesity therapy between medications and bariaric surgery
occupy space in stomach . Research suggests that an IGB volume of atlas 400ml is needed for weight loss. In addition to occupying space in the stomach , some IGBs also alter the gastric motility.
involves endoscopic placement of a specialised 26F percutaneous gas-trostomy tube that is used to flush a quantity of water into the stomach and then aspirate and dis-card gastric contents 20 to 30 minutes after meals.
ESG is accomplished by endoscopic placement of sutures or plications along the gastric greater curvature, decreasing gastric volume by 70%. Although this technique mimics sleeve gastrectomy anatomically, it induces early satiety and body weight loss in part by delaying gastric emptying
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