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Bariatric Therapy pp 85–176Cite as

Current Endoscopic/Laparoscopic Bariatric Procedures

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Abstract

The obesity epidemic requires an active involvement of the gastroenterologist for three reasons. The first reason is that many of the comorbidities associated with obesity involve the gastrointestinal tract and the gastroenterologist will meet these patients at the outpatient department. He/she should know that weight losses may ameliorate symptoms and, with substantial weight loss, promote cure of obesity-associated diseases. Secondly, a small proportion of severely obese patients will need bariatric surgery and may suffer from surgical complications that may be solved by minimally invasive endoscopic techniques. And finally, the majority will not be eligible for bariatric surgery and will need some other form of treatment. The first approach should consist of an energy-restricted diet, physical exercise and behaviour modification, followed by pharmacotherapy. For patients who do not respond to medical therapy but are not or not yet surgical candidates, an endoscopic treatment might look attractive. So, endoscopic bariatric therapy has a role to play either as an alternative or as an adjunct to medical treatment. The different endoscopic modalities may vary in mechanisms of action: in the stomach by gastric distension and space occupation, delayed gastric emptying, gastric restriction and decreased distensibility, impaired gastric accommodation, stimulation of antroduodenal receptors or vagal blockade, and in the small intestine by duodenal exclusion, diversion of the nutrient flow to lower intestinal regions and malabsorption. Minimally invasive procedures that need the assistance of laparoscopy will be discussed by the surgeon to conclude this chapter.

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Abbreviations

ABS:

Adjustable balloon system

ACC:

American College of Cardiology

ACE:

Articulating circular endoscopic

AE:

Adverse event

AHA:

American Heart Association

ANGPTL:

Angiopoietin-like protein

ASGE:

American Society for Gastrointestinal Endoscopy

ASMBS:

American Society for Metabolic and Bariatric Surgery

ATIIP:

Adjustable totally implanted intragastric prosthesis

BED:

Binge-eating disorder

BIB:

BioEnterics Intragastric Balloon

BMI:

Body mass index

BTA:

Botulinum toxin A

CA:

Completers’ analysis

CCK:

Cholecystokinin

CI:

Confidence interval

CLGES:

Closed-loop gastric electrical stimulation

CRP:

C-reactive protein

DEXA:

Dual-energy X-ray absorptiometry

DJBL:

Duodenojejunal bypass liner

DJBS:

Duodenojejunal bypass sleeve

DMR:

Duodenal mucosal resurfacing

EBMIL:

Excess BMI loss

EBMT:

Endoscopic bariatric and metabolic therapy

EBT:

Endoscopic bariatric therapy

EDNOS:

Eating disorders not otherwise specified

EMA:

European Medicines Agency

ESG:

Endoscopic sleeve gastroplasty

EVG:

Endoluminal vertical gastroplasty

EWL:

Excess weight loss

FDA:

Food and Drugs Administration

FGF:

Fibroblast growth factor

GEGB:

Garren-Edwards gastric bubble

GI:

GastroIntestinal

GIP:

Gastric inhibitory peptide or glucose-dependent insulinotropic polypeptide

GJBS:

Gastroduodenojejunal bypass sleeve

GLP-1:

Glucagon-like peptide-1

H. pylori :

Helicobacter pylori

HbA1c:

Glycated haemoglobin

HDL:

High density lipoprotein

HIV:

Human immunodeficiency virus

HTG:

High triglycerides

ICU:

Intensive care unit

IFN-γ:

Interferon-γ

IGB:

Intragastric balloon

IL:

Interleukin

IMAS:

Incisionless magnetic anastomotic systems

IOP:

Incisionless operating platform

ITT:

Intention-to-treat

IU:

International unit

LA(S)GB:

Laparoscopic adjustable (silicone) gastric banding

LDL:

Low-density lipoprotein

LS:

Long segment

MAO:

Monoamine oxidase

MCP-1:

Monocyte chemoattractant protein-1

mITT:

Modified intention-to-treat

mL:

Millilitre

NAFLD:

Non-alcoholic fatty liver disease

NICE:

National Institute for Health and Clinical Excellence

NIH:

National Institute of Health

NTG:

Normal Triglycerides

OSAS:

Obstructive sleep apnoea syndrome

PEG:

Percutaneous endoscopic gastrostomy

PIVI:

Preservation and Incorporation of Valuable endoscopic Innovations

POSE:

Primary obesity surgery endolumenal

PP:

Pancreatic polypeptide

PP:

Per-protocol

PPI:

Proton pump inhibitor

PYY:

Peptide YY

RCT:

Randomised controlled trial

RYGB:

Roux-en-Y gastric bypass

SAB:

Semistationary antral balloon

SAE:

Serious adverse event

SAGES:

Society of American Gastrointestinal and Endoscopic Surgeons

SG:

Sleeve gastrectomy

SGB:

Silimed gastric balloon

SMC:

Standard medical care

SS:

Short segment

T2DM:

Type 2 diabetes mellitus

TAPES:

Transmural antero-posterior endoscopic suture

TBWL:

Total body weight loss

TERIS:

Transoral endoscopic restrictive implant system

TGF-1:

Transforming growth factor-1

TGVR:

Transoral gastric volume reduction

TNF-α:

Tumour necrosis factor-α

TOGa:

Transoral gastroplasty

TOS:

The Obesity Society

TPS:

Transpyloric shuttle

VBloc:

Vagal blocking

WHO:

World Health Organization

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Acknowledgments

The author acknowledges J. Dargent for his help with the laparoscopic minimally invasive techniques.

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  1. Amsterdam UMC (University Medical Centres), Amsterdam, The Netherlands

    Elisabeth M. H. Mathus-Vliegen

  2. Polyclinique Lyon Nord, Lyon, France

    Jérôme Dargent

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Mathus-Vliegen, E.M.H., Dargent, J. (2018). Current Endoscopic/Laparoscopic Bariatric Procedures. In: Bariatric Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-90074-2_2

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