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Endoluminal Treatments for Obesity and Related Hypertension: Updates, Review, and Clinical Perspective

  • Hypertension and Obesity (E Reisin, Section Editor)
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Abstract

Purpose of Review

Obesity is a global epidemic that continues to grow and results in related conditions such as hypertension and diabetes despite established interventions, thus suggesting the importance of new technologies.

Recent Findings

Endoscopic interventions are vast in scope and effectiveness. Intra-gastric balloons appear to dominate the field at this time, but a recent FDA-approved technique, the Aspire device, may soon cause a shift in the treatment paradigm. Short-term studies demonstrate optimistic results, yet long-term studies have not been performed. In addition, complications from these procedures are severe, resulting in significant morbidity when they occur. Treatment of bariatric surgery complications with endoscopic techniques is an expanding field that relies heavily on new innovation.

Summary

The next few years in bariatric endoscopy promise to be turbulent and controversial. Endoscopic procedures for obesity will undoubtedly increase but are anticipated to do so at a slower rate than many projects. Bariatric surgery complications will continue to be treated by endoscopic means, and optimization of these procedures is on the horizon. This review will provide those who treat obesity-related hypertension on the current state of bariatric endoluminal procedures.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. James WP. WHO recognition of the global obesity epidemic. Int J Obes. 2008;32 Suppl 7:S120–6.

    Article  Google Scholar 

  2. • Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313:62–7. A study demonstrating that obese patients receiving care in the VA health system who underwent bariatric surgery compared with matched control patients who did not have surgery had lower all-cause mortality at 5 years following the procedure.

    Article  CAS  PubMed  Google Scholar 

  3. Yang XW, Li PZ, Zhu LY, et al. Effects of bariatric surgery on incidence of obesity related cancers: a meta-analysis. Med Sci Monit. 2015;21:1350–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149:275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  5. •• Petroni R, Di Mauro M, Altorio SF, et al. The role of bariatric surgery for improvement of hypertension in obese patients: a retrospective study. J Cardiovasc Med (Hagerstown). 2016. doi:10.2459/JCM.0000000000000424. A retrospective study demonstrating that bariatric surgery improves systolic and diastolic blood pressure most effectively when significant weight loss occurs in the first year following the procedure.

    Google Scholar 

  6. Benaiges D, Sagué M, Flores-Le Roux JA, et al. Predictors of hypertension remission and recurrence after bariatric surgery. Am J Hypertens. 2016;5:653–9. A non-randomized prospective cohort study demonstrating that hypertension remission is dependent upon weight loss in the first year following the procedure.

    Article  Google Scholar 

  7. •• Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  8. Kolata GM. That lost weight? The body finds it. New York Times. 2016.

  9. •• Fothergil E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. 2016;24:1612–9. Metabolic adaptation persists over time following bariatric surgery, but is incomplete and related to efforts to reduce body weight more than surgery alone.

    Article  Google Scholar 

  10. Nieben OG, Harboe H. Intragastric balloon as an artificial bezoar for treatment of obesity. Lancet. 1982;1:198–9.

    Article  CAS  PubMed  Google Scholar 

  11. Dillon JG, Hughes MK. Degradation of five polyurethane gastric bubbles following in vivo use: SEC, ATR-IR and DSC studies. Biomaterials. 1992;13:240–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hogan RB, Johnston JH, Long BW, et al. A double-blind, randomized, sham-controlled trial of the gastric bubble for obesity. Gastrointest Endosc. 1989;35:381–5.

    Article  CAS  PubMed  Google Scholar 

  13. Kirby DF, Wade JB, Mills PR, et al. A prospective assessment of the Garren-Edwards gastric bubble and bariatric surgery in the treatment of morbid obesity. Am Surg. 1990;56:575–80.

    CAS  PubMed  Google Scholar 

  14. Benjamin SB, Maher KA. Double-blind controlled trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous obesity. Gastroenterology. 1988;95:581–8.

    Article  CAS  PubMed  Google Scholar 

  15. Benjamin SB. Small bowel obstruction and the Garren-Edwards gastric bubble: an iatrogenic bezoar. Gastrointest Endosc. 1988;34:463–7.

    Article  CAS  PubMed  Google Scholar 

  16. Ulicny Jr KS, Goldberg SJ, Harper WJ, et al. Surgical complication of the Garren-Edwards gastric bubble. Surg Gynecol Obstet. 1988;166:535–40.

    PubMed  Google Scholar 

  17. Ginsberg GG, Chand B, Cote GA, et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc. 2011;74:943–53.

    Article  PubMed  Google Scholar 

  18. ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy. A pathway to endoscopic bariatric therapies. Surg Obes Relat Dis. 2011;7:672–82.

    Article  Google Scholar 

  19. • ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc. 2015;82(3):425–38. Recommendations regarding safety and effectiveness of current endoluminal treatments as outlined by the American Society for Gastrointestinal Endoscopy.

    Article  Google Scholar 

  20. Genco A, Bruni T, Doldi SB, et al. BioEnterics intragastric balloon: the Italian experience with 2,515 patients. Obes Surg. 2005;15(8):1161–4.

    Article  CAS  PubMed  Google Scholar 

  21. Imaz I, Martínez-Cervell C, García-Alvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18(7):841–6.

    Article  PubMed  Google Scholar 

  22. Kotzampassi K, Grosomanidis V, Papakostas P, et al. 500 intragastric balloons: what happens 5 years thereafter? Obes Surg. 2012;22(6):896–903.

    Article  PubMed  Google Scholar 

  23. Lopez-Nava G, Bautista-Castaño I, Jimenez-Baños A, et al. Dual intragastric balloon: single ambulatory center Spanish experience with 60 patients in endoscopic weight loss management. Obes Surg. 2015;25(12):2263–7.

    Article  CAS  PubMed  Google Scholar 

  24. • Ponce J, Woodman G, Swain J, REDUCE Pivotal Trial Investigators, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis. 2015;11(4):874–81. A randomized study comparing safety and effectiveness of a dual balloon system versus diet and exercise in the treatment of obesity showing effective weight loss and an acceptable safety profile of the dual balloon system.

    Article  PubMed  Google Scholar 

  25. Kumar N, Sahdala HN, Shaikh S, et al. Endoscopic sleeve gastroplasty for primary therapy of obesity: initial human cases. Gastroenterology. 2014;146:S571–2.

    Article  Google Scholar 

  26. Espinós JC, Turró R, Mata A, et al. Early experience with the Incisionless Operating Platform™ (IOP) for the treatment of obesity: the Primary Obesity Surgery Endolumenal (POSE) procedure. Obes Surg. 2013;23(9):1375–83.

    Article  PubMed  Google Scholar 

  27. Sandler BJ, Rumbaut R, Swain CP, et al. Human experience with an endoluminal, endoscopic, gastrojejunal bypass sleeve. Surg Endosc. 2011;25(9):3028–33.

    Article  PubMed  Google Scholar 

  28. Sullivan S, Stein R, Jonnalagadda S, et al. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology. 2013;145(6):1245–52.

    Article  PubMed  PubMed Central  Google Scholar 

  29. de Jonge C, Rensen SS, Verdam FJ, et al. Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes. Obes Surg. 2013;23(9):1354–60.

    Article  PubMed  Google Scholar 

  30. de Moura EG, Martins BC, Lopes GS, et al. Metabolic improvements in obese type 2 diabetes subjects implanted for 1 year with an endoscopically deployed duodenal-jejunal bypass liner. Diabetes Technol Ther. 2012;14(2):183–9.

    Article  PubMed  Google Scholar 

  31. • Betzel B, Koehestanie P, Aarts EO, et al. Safety experience with the duodenal-jejunal bypass liner: an endoscopic treatment for diabetes and obesity. Gastrointest Endosc. 2015;82(5):845–52. An observational study of the duodenal-jejunal bypass liner demonstrating improved glycemic control, weight loss, and reasonable safety profile.

    Article  PubMed  Google Scholar 

  32. Galvao NM. Duodenal mucosal resurfacing (DMR)—a new endoscopic treatment for Type 2 Diabetes (T2DM)—a safety and proof-of-principle cohort study. Presented in the 14th International Congress of International Federation for the Surgery of Obesity and Metabolic Diseases held in Montreal.

  33. • Praveenraj P, Gomes RM, Kumar S, et al. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: a tertiary care experience and design of a management algorithm. J Minim Access Surg. 2016;12:342–9. Post-bariatric surgery complications may be better managed with intervention than expectant management, but therapy should be individualized according to clinical presentation.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Courtney Cripps.

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Conflict of Interest

Dr. Roslin serves on the advisory board for ValenTx and consults for Johnson and Johnson, Medtronic, and Gore. Dr. Cripps declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hypertension and Obesity

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Cripps, C., Roslin, M. Endoluminal Treatments for Obesity and Related Hypertension: Updates, Review, and Clinical Perspective. Curr Hypertens Rep 18, 79 (2016). https://doi.org/10.1007/s11906-016-0691-0

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