Bariatric Surgery—from the Non-surgical Approach to the Post-Surgery Individual Care: Role of Endoscopy in Bariatric Therapy

Obesity is the underlying constant for the development of the most common modern diseases such as insulin resistance, high blood pressure, lipid metabolism disorders, non-alcoholic steatohepatitis (fatty liver), joint problems and various malignancies. The role of endoscopic diagnostic and therapy in obese patients is highlighted in this chapter. In this chapter all devices and methods used in flexible endoscopy for diagnostic and treatment in obese patients are introduced. Role of endoscopy is presented in three parts: in preoperative setting, in post-operative complication management and instead of surgery as endoscopic bariatric therapy. If possible presentation of the effectiveness is compiled with study data. Finally, the interaction between endoscopy and surgery in the treatment of obesity is complex, essential and promising. Endoscopy is indispensable in preoperative preparation, as a primary therapeutic approach, and also in the detection and treatment of acute complications and long-term complications of obesity surgery.

The First Endoscopic Sleeve Gastroplasty and Transoral Outlet Reduction in Thailand: Case Report and Literature Review

Obesity is becoming a universal healthcare problem. The role of endoscopic bariatric and metabolic therapies is emerging in the management of obesity and its related conditions. The endoscopic treatment can be used as a primary weight loss procedure and a revision procedure after bariatric surgery. While the prevalence of obesity has been rising over the past two decades in Thailand, the treatment options have been limited to diet and exercise, pharmacological treatment, and bariatric surgery until recently. In 2020, an endoscopic full-thickness suturing device was introduced to Thailand, leading to successful endoscopic bariatric therapy using a suturing device in Thai patients. This article intends to report the first successful endoscopic sleeve gastroplasty and transoral outlet reduction in Thailand with a mini-review focusing on these two procedures' outcomes.

Endobariatric procedures for obesity: clinical indications and available options

Obesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conservative interventions are largely ineffective at reducing body weight due to low adherence to the treatment regimen. Recently, endoscopic bariatric therapies have become an attractive alternative to traditional invasive bariatric surgeries due to their improved efficacy, safety, and cost-effectiveness. Endoscopic bariatric therapies include intragastric balloon placement, endoscopic sleeve gastroplasty, gastric bypass revision, and aspiration therapy. These procedures fall into two separate categories depending on the primary mechanism involved: restrictive or malabsorptive. Restrictive methods, such as the Orbera® and ReShape™ intragastric balloons, increase satiation and delay gastric emptying while decreasing the amount of food that can be ingested. In contrast, malabsorptive devices, such as the EndoBarrier®, interfere with the small intestine’s ability to absorb food while restoring normal gastrointestinal hormone levels regulating satiation. Together, these techniques provide useful alternatives for patients in whom pharmacological or lifestyle modifications have proven ineffective. Despite these advantages, the long-term effects of these procedures on metabolic changes remain to be studied. Furthermore, the management of complications from these procedures continues to evolve. In this review, we aim to elaborate on the clinical indications and efficacy of the endobariatric procedures, together with various types of available endoscopic bariatric therapy procedures.