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Current Endoscopic/Laparoscopic Bariatric Procedures

  • Elisabeth M. H. Mathus-Vliegen
  • Jérôme Dargent
Chapter

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.

Keywords

Overweight Obesity Endoscopic bariatric therapy Intragastric balloon Pharmacotherapy Anti-obesity drug Orlistat Orbera balloon ReShape Duo balloon Swallowable balloon Obalon balloon Endoscopic aspiration therapy AspireAssist Botulinum injection Gastric suturing Gastric plication POSE OverStitch Endoscopic sleeve gastroplasty Gastric stapling Duodenojejunal bypass liner Duodenojejunal bypass sleeve EndoBarrier Duodenal mucosal resurfacing Incisionless magnetic anastomotic system Gastric pacing Ability system Tantalus system Vagal blockade 

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

Notes

Acknowledgments

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

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Elisabeth M. H. Mathus-Vliegen
    • 1
  • Jérôme Dargent
    • 2
  1. 1.Amsterdam UMC (University Medical Centres)AmsterdamThe Netherlands
  2. 2.Polyclinique Lyon NordLyonFrance

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