Advances in obesity and endoscopic bariatric treatment

doi:10.3877/cma.j.issn.2095-9605.2024.02.005

Abstract

Abstract:

Obesity has become a major public health problem in China. Diet and exercise interventions in patients with moderate to severe obesity have limited effect and is difficult to adhere to for a long time. The clinical application of bariatric surgery is limited due to the surgical risk and high cost. Endoscopic bariatric therapy (EBT) has the advantages of being more minimally invasive, faster recovery, reversible, repeatable, and less complications. It is constantly developing in terms of equipment, technology, and concept, and is expected to become a parallel and complementary treatment for bariatric and metabolic surgery. According to the principle, EBT can be divided into three categories: restriction of stomach volume, reduction of intestinal absorption, and endoscopic revisional surgery. EBT can be combined with drugs and bariatric surgery for comprehensive treatment, which will become an important link in the multidisciplinary comprehensive treatment of obesity.

Key words: Obesity, Endoscopic bariatric therapy, Multidisciplinary, Comprehensive treatment, Metabolic and bariatric surgery

Biao Zhou, Zhengqi Li, Hua Meng. Advances in obesity and endoscopic bariatric treatment[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2024, 10(02): 100-107.

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References 63

[1]	Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China [J]. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
[2]	中华医学会肠外肠内营养学分会营养与代谢协作组, 北京协和医院减重多学科协作组.减重手术的营养与多学科管理专家共识 [J]. 中华外科杂志, 2018, 56(2): 81-90.
[3]	Sandoval DA, Patti ME. Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia [J]. Nat Rev Endocrinol, 2023, 19(3): 164-176.
[4]	Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes [J]. N Engl J Med, 2017, 376(7): 641-651.
[5]	Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review [J]. JAMA, 2020, 24(9): 879-887.
[6]	Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) study [J]. JAMA Surg, 2018, 153(5): 427-434.
[7]	Acosta A, Streett S, Kroh MD, et al. White paper AGA: POWER—practice guide on obesity and weight management, education, and resources [J]. Clin Gastroenterol Hepatol, 2017, 15(5): 631-649. e10.
[8]	Nieben OG, Harboe H. Intragastric balloon as an artificial bezoar for treatment of obesity [J]. Lancet, 1982, 1(8265): 198-199.
[9]	Phillips RJ, Powley TL. Gastric volume rather than nutrient content inhibits food intake [J]. Am J Physiol, 1996, 271(3 Pt 2): R766-769.
[10]	Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery [J]. N Engl J Med, 2002, 346(21): 1623-1630.
[11]	Vargas EJ, Pesta CM, Bali A, et al. Single Fluid-Filled Intragastric Balloon Safe and Effective for Inducing Weight Loss in a Real-World Population. Clin Gastroenterol Hepatol [J]. 2018, 16(7): 1073-1080.
[12]	Wiggins T, Sharma O, Sarfaraz Y, et al. Safety and Efficacy of 12-Month Intra-gastric Balloon-Series of over 1100 Patients [J]. Obes Surg, 2024, 34 (1): 176-182.
[13]	Fittipaldi-Fernandez RJ, Zotarelli-Filho IJ, Diestel CF, et al. Intragastric Balloon: a Retrospective Evaluation of 5874 Patients on Tolerance, Complications, and Efficacy in Different Degrees of Overweight [J]. Obes Surg, 2020, 30(12): 4892-4898.
[14]	Swei E, Almuhaidb A, Sullivan S, et al. Comparison of the Efficacy and Safety of the FDA-approved Intragastric Balloon Systems in a Clinical Setting [J]. J Clin Gastroenterol, 2023, 57(6): 578-585.
[15]	Abu Dayyeh BK, Maselli DB, Rapaka B, et al. Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial [J]. Lancet, 2021, 398(10315): 1965-1973.
[16]	Fittipaldi-Fernandez RJ, Zotarelli-Filho IJ, Diestel CF, et al. Randomized Prospective Clinical Study of Spatz3® Adjustable Intragastric Balloon Treatment with a Control Group: a Large-Scale Brazilian Experiment [J]. Obes Surg, 2021, 31(2): 787-796.
[17]	Bazerbachi F, Vargas EJ, Rizk M, et al. Intragastric Balloon Placement Induces Significant Metabolic and Histologic Improvement in Patients with Nonalcoholic Steatohepatitis [J]. Clin Gastroenterol Hepatol, 2021, 19(1): 146-154.
[18]	Trang J, Lee SS, Miller A, et alc. Incidence of nausea and vomiting after intragastric balloon placement in bariatric patients - A systematic review and meta-analysis [J]. Int J Surg, 2018, 57: 22-29.
[19]	陈笑梅, 陈文辉, 赵宛鄂, 等. 可吞咽自吸收新型胃内球囊治疗轻度肥胖症：一例病例报告 [J/CD]. 中华肥胖与代谢病电子杂志, 2023, 9(3): 215-217.
[20]	李滢旭, 方登华, 刘天锡, 等. 6例胃内球囊减重的短期效果分析 [J/CD]. 中华肥胖与代谢病电子杂志, 2020, 6(3): 208-210.
[21]	Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity [J]. Gastrointest Endosc, 2013, 78(3): 530-5.
[22]	Kurian M, Kroh M, Chand B, et al. SAGES review of endoscopic and minimally invasive bariatric interventions: a review of endoscopic and non-surgical bariatric interventions [J]. Surg Endosc, 2018, 32(10): 4063-4067.
[23]	Wang JW, Chen CY. Current status of endoscopic sleeve gastroplasty: An opinion review [J]. World J Gastroenterol, 2020, 26(11):1107-1112.
[24]	Vargas EJ, Rizk M, Gomez-Villa J, et al. Effect of endoscopic sleeve gastroplasty on gastric emptying, motility and hormones: a comparative prospective study [J]. Gut, 2023, 72(6): 1073-1080.
[25]	haraiha RZ, Hajifathalian K, Kumar R, et al. Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity [J]. Clin Gastroenterol Hepatol, 2021, 19(5): 1051-1057.
[26]	Lopez-Nava G, Laster J, Negi A, et al. Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it? [J]. Surg Endosc, 2022, 36(1): 352-360.
[27]	Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial [J]. Lancet, 2022, 400(10350): 441-451.
[28]	Jain D, Bhandari BS, Arora A, et al. Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity [J]. Clin Endosc, 2017, 50(6): 552-561.
[29]	Fayad L, Cheskin LJ, Adam A, et al. Endoscopic sleeve gastroplasty versus intragastric balloon insertion: efficacy, durability, and safety [J]. Endoscopy, 2019, 51 (6): 532-539.
[30]	Beran A, Matar R, Jaruvongvanich V, et al. Comparative Effectiveness and Safety Between Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: a Meta-analysis of 6775 Individuals with Obesity [J]. Obes Surg, 32(11): 3504-3512.
[31]	Weitzner ZN, Phan J, Begashaw MM, et al. Endoscopic therapies for patients with obesity: a systematic review and meta-analysis [J]. Surg Endosc, 2023, 37(11): 8166-8177.
[32]	Alqahtani AR, Elahmedi M, Aldarwish A, et al. Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study [J]. Gastrointest Endosc, 2022, 96(1): 44-50.
[33]	Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients [J]. Clin Gastroenterol Hepatol, 2017, 15(4): 504-510.
[34]	Lee SY, Lai H, Chua YJ, et al. Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis [J]. Front Med (Lausanne), 2022, 9: 880749.
[35]	Hajifathalian K, Mehta A, Ang B, et al. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty [J]. Gastrointest Endosc, 2021, 93(5):1110-1118.
[36]	Alqahtani A, Al-Darwish A, Mahmoud AE, et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients [J]. Gastrointest Endosc, 2019, 89(6): 1132-1138.
[37]	Hedjoudje A, Abu Dayyeh BK, Cheskin LJ, et al. Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis [J]. Clin Gastroenterol Hepatol, 2020, 18(5): 1043-1053.
[38]	彭磊, 姜柳琴, 张伟锋, 等. 内镜下袖状胃成形术减重初探 [J]. 中华消化内镜杂志, 2019, 36(7): 509-511.
[39]	Verlaan T, Paulus GF, Mathus-Vliegen EM, et al. Endoscopic gastric volume reduction with a novel articulating plication device is safe and effective in the treatment of obesity (with video) [J]. Gastrointest Endosc, 2015, 81(2): 312-320.
[40]	Lopez-Nava G, Asokkumar R, Turró Arau R, et al. Modified primary obesity surgery endoluminal (POSE-2) procedure for the treatment of obesity [J]. VideoGIE, 2020, 5(3): 91-93.
[41]	Lopez Nava G, Arau RT, Asokkumar R, et al. Prospective Multicenter Study of the Primary Obesity Surgery Endoluminal (POSE 2.0) Procedure for Treatment of Obesity [J]. Clin Gastroenterol Hepatol, 2023, 21(1): 81-89.
[42]	Lopez Nava G, Asokkumar R, Laster J, et al. Primary obesity surgery endoluminal (POSE-2) procedure for treatment of obesity in clinical practice [J]. Endoscopy, 2021, 53(11): 1169-1173.
[43]	AlKhatry M, Rapaka B, Maselli DB, et al. Improvements in hepatic steatosis, obesity, and insulin resistance in adults with nonalcoholic fatty liver disease after the primary obesity surgery endoluminal 2.0 procedure [J]. Endoscopy, 2023, 55(11): 1028-1034.
[44]	Singh S, Bazarbashi AN, Khan A, et al. Primary obesity surgery endoluminal （POSE） for the treatment of obesity: a systematic review and meta-analysis [J]. Surg Endosc, 2022, 36(1): 252-266.
[45]	Rodriguez-Grunert L, Galvao Neto MP, Alamo M, et al. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve [J]. Surg Obes Relat Dis, 2008, 4(1): 55-59.
[46]	Ruban A, Miras AD, Glaysher MA, et al. Duodenal-Jejunal Bypass Liner for the management of Type 2 Diabetes Mellitus and Obesity: A Multicenter Randomized Controlled Trial [J]. Ann Surg, 2022, 275(3): 440-447.
[47]	Yvamoto EY, de Moura DTH, Proença IM, et al. The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials [J]. Obes Surg, 33(2): 585-599.
[48]	Jirapinyo P, Haas AV, Thompson CC. Effect of the Duodenal-Jejunal Bypass Liner on Glycemic Control in Patients With Type 2 Diabetes With Obesity: A Meta-analysis With Secondary Analysis on Weight Loss and Hormonal Changes [J]. Diabetes Care, 2018, 41(5): 1106-1115.
[49]	McLennan S, Verhoeff K, Purich K, et al. Duodenal-jejunal bypass liners are superior to optimal medical management in ameliorating metabolic dysfunction: A systematic review and meta-analysis [J]. Obes Rev, 2023, (8): e13572.
[50]	Ren M, Zhou X, Yu M, et al. Prospective study of a new endoscopic duodenal-jejunal bypass sleeve in obese patients with nonalcoholic fatty liver disease (with video) [J]. Dig Endosc, 2023, 35(1): 58-66.
[51]	周艳华, 张倩, 张澍田, 等. 内镜下胃转流支架系统治疗肥胖的疗效和安全性分析 [J]. 中华消化内镜杂志, 2024, 41(1): 18-24.
[52]	Rajagopalan H, Cherrington AD, Thompson CC, et al. Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes: 6-Month Interim Analysis From the First-in-Human Proof-of-Concept Study [J]. Diabetes Care, 2016, 39(12): 2254-2261.
[53]	van Baar ACG, Devière J, Hopkins D, et al. Durable metabolic improvements 2 years after duodenal mucosal resurfacing (DMR) in patients with type 2 diabetes (REVITA-1 Study) [J]. Diabetes Res Clin Pract, 2022, 184: 109194.
[54]	Mingrone G, van Baar AC, Devière J, et at. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial [J]. Gut, 2022, 71(2): 254-264.
[55]	van Baar ACG, Holleman F, Crenier L, et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study [J]. Gut,2020,69(2):295-303.
[56]	Kumar N, Thompson CC. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up [J]. Gastrointest Endosc, 2016, 83(4): 776-779.
[57]	Vansteenbrugge L, Strypstein S, Biglari M, et al. Transoral Outlet Reduction to Tackle Weight Regain After Roux-en-Y Gastric Bypass: a Single Center Initial Experience [J]. Obes Surg, 2023, 33(6): 1646-1651.
[58]	Pontecorvi V, Matteo MV, Bove V, et al. Long-term Outcomes of Transoral Outlet Reduction （TORe） for Dumping Syndrome and Weight Regain After Roux-en-Y Gastric Bypass [J]. Obes Surg, 2023, 33(4): 1032-1039.
[59]	Martines G, Dezi A, Giove C, et al. Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients [J]. Obes Facts, 2023, 16(5): 457-464.
[60]	Maselli DB, Alqahtani AR, Abu Dayyeh BK, et al. Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study [J]. Gastrointest Endosc, 2021, 93(1): 122-130.
[61]	Zhang L, Zhou B, Li ZQ, et al. Gastric bypass—stent treatment for postoperative obesity after laparoscopic sleeve gastrectomy [J]. Asian J Surg, 2024, 47(6): 2822-2823.
[62]	Badurdeen D, Hoff AC, Barrichello S, et al. Efficacy of Liraglutide to Prevent Weight Regain After Retrieval of an Adjustable Intra-gastric Balloon-a Case-Matched Study [J]. Obes Surg, 2021, 31(3): 1204-1213.
[63]	van Baar ACG, Meiring S, Smeele P, et al. Duodenal mucosal resurfacing combined with glucagon-like peptide-1 receptor agonism to discontinue insulin in type 2 diabetes: a feasibility study [J]. Gastrointest Endosc, 2021, 94(1): 111-120.e3.

内镜下减重治疗类型	原理	操作
胃内球囊置入术（IGB）	限制胃容量、延迟排空	通过胃镜置入或直接吞咽将球囊置入胃内，球囊充盈后占据胃内容积，包括单球囊或多球囊
内镜下袖状胃成型术（ESG）	限制胃容量、延迟排空	利用Overstich内镜下全层缝合系统从胃腔内对胃壁进行一系列间断或连续缝合形成胃大弯侧折叠以减少胃容量
腔内减重手术（POSE）	限制胃容量、延迟排空	在胃腔内进行大弯侧全层间断缝合完成胃大弯折叠，同时沿大弯侧皱襞纵向间断缝合缩小胃长径，以减少胃容量，原理与ESG类似
内镜下十二指肠-空肠旁路套管置入术（EDJBL）	减少肠道吸收、调整肠道激素释放	将长约60 cm的套管膜置入十二指肠和近段空肠，隔绝食物和相应部位肠粘膜接触，影响与胰岛素抵抗相关激素释放
十二指肠黏膜重建术（DMR）	减少肠道吸收、调整肠道激素释放	将一球囊导管置入十二指肠降段，将热水注入球囊以消融十二指肠黏膜，达到限制吸收，调整胃肠激素分泌
内镜下经口输出道缩小术（TORe）	缩小RYGB手术的胃肠吻合口	利用OverStitch设备对RYGB手术的胃肠吻合口处进行全层缝合以缩小吻合口

内镜下减重治疗类型	原理	操作
胃内球囊置入术（IGB）	限制胃容量、延迟排空	通过胃镜置入或直接吞咽将球囊置入胃内，球囊充盈后占据胃内容积，包括单球囊或多球囊
内镜下袖状胃成型术（ESG）	限制胃容量、延迟排空	利用Overstich内镜下全层缝合系统从胃腔内对胃壁进行一系列间断或连续缝合形成胃大弯侧折叠以减少胃容量
腔内减重手术（POSE）	限制胃容量、延迟排空	在胃腔内进行大弯侧全层间断缝合完成胃大弯折叠，同时沿大弯侧皱襞纵向间断缝合缩小胃长径，以减少胃容量，原理与ESG类似
内镜下十二指肠-空肠旁路套管置入术（EDJBL）	减少肠道吸收、调整肠道激素释放	将长约60 cm的套管膜置入十二指肠和近段空肠，隔绝食物和相应部位肠粘膜接触，影响与胰岛素抵抗相关激素释放
十二指肠黏膜重建术（DMR）	减少肠道吸收、调整肠道激素释放	将一球囊导管置入十二指肠降段，将热水注入球囊以消融十二指肠黏膜，达到限制吸收，调整胃肠激素分泌
内镜下经口输出道缩小术（TORe）	缩小RYGB手术的胃肠吻合口	利用OverStitch设备对RYGB手术的胃肠吻合口处进行全层缝合以缩小吻合口

产品名称	置入方式	球囊数量（个）	容量	置入时间（月）	取出方式	减重效果
Orbera球囊/Orbera 365球囊	胃镜下置入	1	450~700 mL	6~12	经胃镜取出	11.8%~18.42%（%TWL）
Obalon可吞咽球囊	吞咽	1~3	单个球囊250 mL	6	经胃镜取出	约40%（%EWL）
Spatz3可调节球囊	胃镜下置入	1	600 mL	12	经胃镜取出	15%（%TWL）

产品名称	置入方式	球囊数量（个）	容量	置入时间（月）	取出方式	减重效果
Orbera球囊/Orbera 365球囊	胃镜下置入	1	450~700 mL	6~12	经胃镜取出	11.8%~18.42%（%TWL）
Obalon可吞咽球囊	吞咽	1~3	单个球囊250 mL	6	经胃镜取出	约40%（%EWL）
Spatz3可调节球囊	胃镜下置入	1	600 mL	12	经胃镜取出	15%（%TWL）

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