Current endoscopic techniques in the treatment of obesity.

BACKGROUND: in recent years new endoscopic strategies and techniques for the treatment of obesity have emerged and developed. AIM OF THE STUDY: in this article we will review and analyze the current state of the following techniques and the basic differential characteristics between each of them: balloons and prosthesis, injection of substances, systems of sutures, malabsorptives techniques and others currently in research. METHODS: we will evaluate the endoscopic technique and their main indications, results, tolerances, complications and adverse effects observed, reporting our personal experience and in relation with an extensive literature review. RESULTS: comparatively with the most widespread technique of the Bioenterics balloon, the Spatz balloon can provide greater weight loss but with worse tolerance and more complications and the Heliosphere Bag gets a similar weight loss but with greater technical difficulty. Other balloons and prosthesis (Ullorex, Semistationary, Silimed, Endogast) still require technical improvements and higher studies. The injection of botulinum toxin, although secure, seems to offer a smaller and more transient efficacy. Suture systems (TOGa, endoluminal vertical gastroplasty and POSE) appear to be effective but are technically more laborious. Malabsorptives procedures (Endobarrier, ValenTX) are somewhat laborious but effective, particularly indicated in obese patients with type 2 diabetes mellitus. CONCLUSIONS: the development of new endoscopic techniques and improvement in existing designs, suggest an increasingly important role of the endoscopist in the treatment of obesity. We consider it important to individually select and use the endoscopic technique, depending on the desirable outcomes (efficacy, tolerance, safety, adverse effects and risks) and the experience of each hospital. We believe that these techniques should be applied by specifically trained endoscopists in specialized hospitals.

Técnicas endoscópicas actuales en el tratamiento de la obesidad / Current endoscopic techniques in the treatment of obesity

Background: in recent years new endoscopic strategies and techniques for the treatment of obesity have emerged and developed. Aim of the study: in this article we will review and analyze the current state of the following techniques and the basic differential characteristics between each of them: balloons and prosthesis, injection of substances, systems of sutures, malabsorptives techniques and others currently in research. Methods: we will evaluate the endoscopic technique and their main indications, results, tolerances, complications and adverse effects observed, reporting our personal experience and in relation with an extensive literature review. Results: comparatively with the most widespread technique of the Bioenterics balloon, the Spatz balloon can provide greater weight loss but with worse tolerance and more complications and the Heliosphere Bag gets a similar weight loss but with greater technical difficulty. Other balloons and prosthesis (Ullorex, Semistationary, Silimed, Endogast) still require technical improvements and higher studies. The injection of botulinum toxin, although secure, seems to offer a smaller and more transient efficacy. Suture systems (TOGa, Endoluminal vertical gastroplasty and POSE) appear to be effective but are technically more laborious. Malabsorptives procedures (Endobarrier, ValenTX) are somewhat laborious but effective, particularly indicated in obese patients with type 2 diabetes mellitus. Conclusions: the development of new endoscopic techniques and improvement in existing designs, suggest an increasingly important role of the endoscopist in the treatment of obesity. We consider it important to individually select and use the endoscopic technique, depending on the desirable outcomes (efficacy, tolerance, safety, adverse effects and risks) and the experience of each hospital. We believe that these techniques should be applied by specifically trained endoscopists in specialized hospitals(AU)

Antecedentes: en los últimos años han surgido y se han ido desarrollando nuevas estrategias y técnicas endoscópicas para el tratamiento de la obesidad. Propósito del estudio: en este artículo revisamos y analizamos el estado actual de estas técnicas y las características básicas diferenciales entre cada una de ellas: balones y prótesis, inyección de sustancias, sistemas de suturas, técnicas malabsortivas y otras actualmente en investigación. Métodos: se evalúa tanto la técnica endoscópica como sus principales indicaciones, resultados, tolerancias, complicaciones y efectos adversos observados, aportando nuestra experiencia personal y en relación con una revisión bibliográfica extensa. Resultados: comparativamente con la técnica más extendida del balón Bioenterics, el Spatz puede ofrecer mayor pérdida de peso pero con peor tolerancia y más complicaciones y el Heliosphere Bag consigue una pérdida parecida de peso pero con mayor dificultad técnica. Otros balones y prótesis (Ullorex, Semiestacionario, Silimed, Endogast) requieren todavía mejorías técnicas y mayores estudios. La inyección de toxina botulínica, aunque segura, parece ofrecer una eficacia menor y más transitoria. Los sistemas de sutura (TOGa, gastroplastia vertical endoluminal y POSE) parecen eficaces pero son técnicamente más laboriosos. Los procedimientos malabsortivos (Endobarrier, ValenTX) son algo laboriosos pero eficaces, especialmente indicados en pacientes que asocien diabetes mellitus del adulto. Conclusiones: el desarrollo de nuevas técnicas endoscópicas y las mejorías en los diseños de las existentes condicionan un papel cada vez más importante del endoscopista en el tratamiento de la obesidad. Consideramos importante seleccionar la técnica endoscópica individualmente, en función de los resultados deseables (eficacia, tolerancia, seguridad, efectos adversos y riesgos) y de la experiencia propia de cada centro. Creemos que estas técnicas deben aplicarse por endoscopistas específicamente entrenados en centros especializados(AU)