Endoscopic Accessories Used for More Advanced Endoluminal Therapeutic Procedures

Endoscopic accessories describe an extensive variety of auxiliary instruments used for diagnostic and therapeutic endoscopy. Various endoscopic accessories have been developed over the previous few decades and are mostly used for treating neoplastic lesions, such as early gastrointestinal (GI) carcinomas and premalignant lesions. Because of extensive research on natural orifice endoluminal surgery (NOTES) in the early 2000s and recent technological developments, new devices have been developed for various advanced endoluminal therapeutic procedures. In particular, a remarkable development of endoscopic management was achieved in the field of gastroesophageal reflux disease (GERD) and obesity. In both conditions, there is treatment gap between medical and surgical therapy. A large proportion of the patients who do not respond to medical treatment and lifestyle modification, still hesitate to directly undergo surgical treatment. To bridge this gap, endoscopic management has been receiving increasing attention. In this article, I review endoscopic and/or endoluminal devices used for the treatment of GERD and obesity with proposed mechanisms of their function.

Novel Endoscopic Management of Obesity

Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory.

ENDOSCOPIC SLEEVE GASTROPLASTY - MINIMALLY INVASIVE THERAPY FOR PRIMARY OBESITY TREATMENT / GASTROPLASTIA VERTICAL ENDOSCÓPICA - TERAPÊUTICA MINIMAMENTE INVASIVA PARA TRATAMENTO PRIMÁRIO DA OBESIDADE

ABSTRACT Background: Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature. Aim: Present technical details of the procedure and its surgical/ endoscopic preliminary outcome. Method: The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrectomy. Result: A male patient with a BMI of 35.17 kg/m2 underwent the procedure, with successful achievement of four plications, and preservation of gastric fundus. The procedure was successfully performed in 50 minutes, time without bleeding or other complications. The patient presented mild abdominal pain and good acceptance of liquid diet. Conclusions: The endoscopic gastroplasty procedure was safe, with acceptable technical viability, short in duration and without early complications.

RESUMO Racional: Procedimentos menos invasivos e complexos têm sido desenvolvidos para o tratamento da obesidade. A gastroplastia vertical endoscópica com uso de OverStitch(r) (Apollo Endosurgery, Austin, TX, EUA) já foi relatada com sucesso na literatura. Objetivo: Apresentar detalhes técnicos do procedimento e seu resultado cirúrgico/endoscópico preliminar. Método: O equipamento foi utilizado para realizar plicaturas ao longo da grande curvatura gástrica, objetivando tubulização do estômago semelhante a gastrectomia vertical. Resultado: O método foi aplicado em paciente com IMC 35,17 kg/m2, sendo realizadas quatro plicaturas, preservando o fundo gástrico. O procedimento foi realizado com sucesso em 50 min, sem sangramento ou outras complicações. O paciente evoluiu com dor abdominal leve, e teve boa aceitação de dieta líquida. Conclusão: A realização da gastroplastia endoscópica foi segura, com viabilidade técnica aceitável e reprodutível, com curto tempo de procedimento, sem complicações precoces.