Track 7: Bariatric Endoscopy

Bariatric Endoscopy

Bariatric endoscopy is a minimally invasive, non-surgical approach used in the treatment of obesity and obesity-related conditions. It employs endoscopic techniques to modify the gastrointestinal (GI) tract to aid in weight loss and improve metabolic health. This innovative field bridges the gap between lifestyle interventions and bariatric surgery, offering an effective alternative for individuals who may not qualify for or prefer to avoid surgery.

How Bariatric Endoscopy Works

• An endoscope (a thin, flexible tube with a camera) is inserted through the mouth into the stomach.
• Specialized tools are used to perform procedures that alter the structure or function of the GI tract to promote weight loss.
• The procedures aim to reduce the size of the stomach, alter its functionality, or delay digestion and absorption. 

Common Bariatric Endoscopic Procedures

• 1. Endoscopic Sleeve Gastroplasty (ESG)

     • The stomach size is reduced using sutures, creating a sleeve-like shape.
     • This limits food intake and slows gastric emptying, promoting early satiety.
     • Typically performed in outpatient settings.

  2. Intragastric Balloon Placement

     • A balloon is inserted into the stomach and inflated with saline or gas.
     • The balloon occupies space in the stomach, reducing hunger and food intake.
     • The balloon is usually removed after 6 months.

  3. Aspiration Therapy

     • A device is implanted to allow partial stomach contents to be emptied after eating.
     • Encourages portion control and calorie reduction.

  4. Duodenal Mucosal Resurfacing (DMR)

     • The duodenal lining is altered using heat to improve glucose metabolism and manage obesity-related conditions like type 2 diabetes.

  5. Endoscopic Revision of Bariatric Surgery

     • Used to correct or enhance the results of previous bariatric surgeries, such as gastric bypass or sleeve gastrectomy.

Indications for Bariatric Endoscopy

• 1. • • Patients with a Body Mass Index (BMI) between 30 and 40 kg/m² who have not achieved weight loss through diet and exercise.
       • Those with obesity-related health conditions (e.g., diabetes, hypertension) needing weight loss.
       • Individuals who are not candidates for or prefer to avoid traditional bariatric surgery.
       • Patients requiring revision or enhancement of previous bariatric procedures.

Advantages

• 1. • • 1. Minimally Invasive:
            • No incisions are required, leading to faster recovery and fewer complications.
         2. Outpatient Procedure:
            • Many bariatric endoscopy techniques can be performed on the same day, reducing hospital stays.
         3. Lower Risk:
            • Associated with fewer risks compared to bariatric surgery.
         4. Reversible:
            • Some procedures, like intragastric balloons, are temporary and can be reversed.
         5. Improved Quality of Life:
            • Facilitates weight loss and improves obesity-related health conditions.

Bariatric Endoscopy

• 1. • • 1. • Bariatric endoscopy is a minimally invasive, non-surgical approach used in the treatment of obesity and obesity-related conditions. It employs endoscopic techniques to modify the gastrointestinal (GI) tract to aid in weight loss and improve metabolic health. This innovative field bridges the gap between lifestyle interventions and bariatric surgery, offering an effective alternative for individuals who may not qualify for or prefer to avoid surgery.

              ---

How Bariatric Endoscopy Works

• 1. • • 1. • • An endoscope (a thin, flexible tube with a camera) is inserted through the mouth into the stomach.
              • Specialized tools are used to perform procedures that alter the structure or function of the GI tract to promote weight loss.
              • The procedures aim to reduce the size of the stomach, alter its functionality, or delay digestion and absorption.

              ---

Common Bariatric Endoscopic Procedures

• 1. • • 1. • 1. Endoscopic Sleeve Gastroplasty (ESG)

                 • The stomach size is reduced using sutures, creating a sleeve-like shape.
                 • This limits food intake and slows gastric emptying, promoting early satiety.
                 • Typically performed in outpatient settings.

              2. Intragastric Balloon Placement

                 • A balloon is inserted into the stomach and inflated with saline or gas.
                 • The balloon occupies space in the stomach, reducing hunger and food intake.
                 • The balloon is usually removed after 6 months.

              3. Aspiration Therapy

                 • A device is implanted to allow partial stomach contents to be emptied after eating.
                 • Encourages portion control and calorie reduction.

              4. Duodenal Mucosal Resurfacing (DMR)

                 • The duodenal lining is altered using heat to improve glucose metabolism and manage obesity-related conditions like type 2 diabetes.

              5. Endoscopic Revision of Bariatric Surgery

                 • Used to correct or enhance the results of previous bariatric surgeries, such as gastric bypass or sleeve gastrectomy.

              ---

Indications for Bariatric Endoscopy

• 1. • • 1. • • Patients with a Body Mass Index (BMI) between 30 and 40 kg/m² who have not achieved weight loss through diet and exercise.
              • Those with obesity-related health conditions (e.g., diabetes, hypertension) needing weight loss.
              • Individuals who are not candidates for or prefer to avoid traditional bariatric surgery.
              • Patients requiring revision or enhancement of previous bariatric procedures.

              ---

Advantages

• 1. • • 1. • 1. Minimally Invasive:
                 • No incisions are required, leading to faster recovery and fewer complications.
              2. Outpatient Procedure:
                 • Many bariatric endoscopy techniques can be performed on the same day, reducing hospital stays.
              3. Lower Risk:
                 • Associated with fewer risks compared to bariatric surgery.
              4. Reversible:
                 • Some procedures, like intragastric balloons, are temporary and can be reversed.
              5. Improved Quality of Life:
                 • Facilitates weight loss and improves obesity-related health conditions.

              ---

Expected Outcomes

• 1. • • 1. • • Weight loss varies by procedure but can range from 10% to 25% of total body weight within 6–12 months.
              • Improved management of obesity-related conditions, such as type 2 diabetes, hypertension, and sleep apnea.
              • Enhanced physical and psychological well-being.

Risks and Limitations

• 1. • • 1. • • While generally safe, bariatric endoscopy may carry some risks:

                • Nausea or vomiting (common with intragastric balloons).
                • Abdominal discomfort or bloating.
                • Rare complications, such as bleeding, perforation, or infection.
                • Weight regain if lifestyle changes are not maintained.
                • Requires significant commitment to dietary and behavioral modifications for long-term success.

Conclusion

• 1. • • 1. • • • Bariatric endoscopy is an exciting advancement in obesity treatment, offering a less invasive, effective alternative to surgery. It is ideal for individuals seeking significant weight loss with reduced risks and recovery time. When combined with lifestyle modifications and medical management, bariatric endoscopy can help patients achieve sustainable weight loss and improved overall health.

                  Sub topic: Definition and overview of bariatric endoscopic procedures, Comparison of bariatric endoscopy with traditional surgical approaches (e.g., gastric bypass, sleeve gastrectomy), Endoscopic Procedures for Weight Loss, Mechanisms of Action in Bariatric Endoscopy, Indications for Bariatric Endoscopy, Role of bariatric endoscopy in patients who are not candidates for traditional surgery, Potential cost-effectiveness compared to surgical alternatives, Endoscopic Bariatric Procedures in Special Populations, Pediatric and adolescent considerations for bariatric endoscopy, Comparison of bariatric endoscopy outcomes with traditional surgical options, Innovations and Future Trends in Bariatric Endoscopy.