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Endoscopic Approaches to Obesity

  • Andrea True Kelly
  • Mark DeLeggeEmail author
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

The prevalence of obesity is on the rise and is associated with significant morbidity, mortality, and health-related costs to both patients and society. Investigations for safe and effective treatments for obesity have significantly increased. Current treatments are generally divided into two categories: (1) conservative (e.g., diet, exercise, drugs) and (2) surgical management (e.g., gastric bypass). Long-term success via conservative means is low. While surgical gastric bypass leads to significantly greater and sustained weight loss in obese patients, it is often associated with serious adverse events and high costs. Many patients in need are also not suitable candidates for these more invasive procedures due to comorbidities.

In an effort to capitalize on the efficacy of surgical weight loss treatments while reducing medical risks and costs, investigation into endoscopic and transoral approaches for the treatment of obesity has intensified. Endoscopic approaches primarily include restrictive (e.g., intragastric balloons, gastric stapling) or malabsorptive (e.g., duodenal-jejunal sleeve) devices and procedures. These less invasive approaches allow for outpatient or short-stay procedures and allow for treatment of individuals with comorbidities, older age, and super or mild obesity that are often excluded from surgical procedures. Efficacy observed with endoscopic methods typically lies between that observed for conservative and surgical approaches, with an improved safety profile over surgical procedures. Several of these endoscopic approaches are available worldwide but not in the USA, partly due to high regulatory hurdles for efficacy imposed by the Food and Drug Administration (FDA). Reimbursement coverage for these devices and procedures also remains a challenge.

Keywords

Obesity Endoscopy Minimally invasive Gastric balloon Duodenal sleeve Gastric plication 

Abbreviations

BMI

Body mass index

CCK

Cholecystokinin

CDC

Centers for Disease Control and Prevention

CDRH

Centers for Devices and Radiological Health

EVG

Endoluminal vertical gastroplasty

EWL

Excess weight loss

FDA

US Food and Drug Administration

GERD

Gastroesophageal reflux disease

GES

Gastric electrical stimulation

GI

Gastrointestinal

HbA1c

Hemoglobin A1c

HDL

High-density lipoprotein

IGB

Intragastric balloon

LDL

Low-density lipoprotein

LGBP

Laparoscopic gastric bypass

T2DM

Type 2 diabetes mellitus

WHO

World Health Organization

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.ATK Clinical Consulting, LLCDaniel IslandUSA
  2. 2.Medical University of South Carolina, DeLegge MedicalMount PleasantUSA

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