Endoscopic Bariatric Interventions

Endoscopic bariatric interventions or endoscopic and metabolic therapies (EMBTs) are minimally invasive procedures performed to modify the structure and function of the gastrointestinal system, thereby facilitating to control metabolic diseases, such as diabetes, obesity and diabesity.

Earlier gastric bypass surgeries were used as an effective treatment for obesity and other metabolic disorders. But they have their disadvantages and may result in post-operative complications. Endoscopic bariatric interventions hold the advantage of being less invasive than bariatric surgeries, and also are associated with better outcomes when compared to lifestyle interventions and pharmacotherapy.

There are different kinds of procedures that can be performed to control obesity, diabetes mellitus, and diabesity. A list of procedures is given below:

For Obesity

Following are the endoscopic procedures performed to control and treat obesity.

Intragastric Balloon

Intragastric balloons, as the name suggests, are balloon-like devices, made usually of silicon, placed inside the stomach. These balloons once placed in the stomach decreases the capacity or delays the gastric emptying in the stomach and limits the food intake. It can also make the person feel fuller quickly. Different types of intragastric balloons are available that may vary in their type of placement and removal. They may be filled with air or fluid. The number of balloons placed in the stomach may also vary ranging from one to three.

A patient may undergo endoscopic intragastric balloon therapy if he or she has a body mass index (BMI) between 30 and 40, is agreeing to commit to permanent lifestyle changes, and has no previous stomach or esophageal surgery.

Intragastric balloon is usually done as an outpatient procedure, and require minimal anesthesia. During the procedure, an endoscope (a flexible tube mounted with a camera) loaded with the balloon device is inserted through the mouth and guided to the stomach. The balloon device is placed in the stomach and inflated in position, and the endoscope is removed.

The patient may be able to go home after a few hours with specific instruction provided for food and other lifestyle changes.

Endoscopic Sleeve Gastroplasty (ESG)

Endoscopic sleeve gastroplasty is a minimally invasive technique that facilitates weight loss. In this technique, an endoscope is inserted into the stomach through the mouth. The stomach is sutured along the outer curve to fold itself leading to a banana-sized tube. The stomach size is reduced by 70% approximately. This promotes early satiety and reduces food intake.

Endoscopic sleeve gastroplasty may be done in patients who have a body mass index (BMI) above 30, have failed in losing weight despite lifestyle modification, and do not wish to undergo traditional bariatric surgeries. However, any patient who underwent hiatal hernia surgery, or has a history of stomach problems that may cause bleeding, are not appropriate candidates for the procedure.

The procedure can be performed as an outpatient procedure, with minimal anesthesia, and the patient can go home the same day. However, the patient needs to commit to dietary modifications and regular follow-ups for the best outcome.

Endoluminal Suturing Devices (ENDOMINA)
The Endomina system is a suturing device used for gastroplasty. The endoscope has a triangulation platform that allows insertion of different tools for suturing the stomach. During the procedure, an endoscope is inserted through the mouth to the stomach, and the one by one different tools are worked up to perform a gastroplasty alongside the greater curvature of the stomach. This suturing reduces the stomach volume, thus improving satiety and eventually weight loss. As it is an endoscopic procedure, it can be done on an outpatient basis, with minimal side effects and complications.

Primary Obesity Surgery Endoluminal
The incisionless operating platform for primary obesity surgery endolumenal (POSE) creates full-thickness plications in the stomach. A flexible tube is inserted through the mouth that has four working channels. Special instruments are passed through the channels for visualization, grabbing the tissue and performing plications (anchoring). The procedure reduces the stomach capacity by multiple anchoring.
This endoscopic procedure has the same eligibility criteria as the others and requires lifelong commitment by the patient regarding lifestyle modifications. The procedure is carried out on an outpatient basis.

For Diabetes Mellitus

Following are the endoscopic procedures performed to control and treat diabetes mellitus.

Duodenal-jejunal bypass liner

Also called as duodenal sleeve, the procedure helps to promote weight loss and control blood sugar levels. An impermeable sleeve is inserted endoscopically, and the sleeve is positioned to extends through the stomach directly into the small bowel. This causes the food to directly pass from the esophagus to the intestine bypassing stomach, duodenum, and jejunum. The nutrient absorption is lost throughout the bypassed parts that in turn helping in weight reduction.

The procedure is associated with better compliance, reduced cost, and better patient outcomes in terms of diabetes control.

Duodenal Mucosal Resurfacing (DMR)

Duodenal mucosal resurfacing involves doing deliberate changes in the duodenum (the proximal part of the small intestine) so that the innermost ling of the duodenum becomes healthy enough for preventing metabolic imbalances. 

The procedure, insertion of an endoscope, followed by the circumferential saline lifting of duodenal mucosa after which thermal ablation of the mucosa is done using an inflated balloon with heated water. This process results in subsequent regeneration of the mucosa. The regenerated mucosa is healthier with improved metabolic parameters. Thus, it helps to regulate the blood sugar levels, keeping diabetes under control.

For Diabesity

Following are the endoscopic procedures performed to control and treat diabesity (diabetes and obesity).

Duodenal-jejunal bypass sleeve liner

It is also referred as duodenal sleeve. The procedure helps to promote weight loss and control blood sugar levels. An impermeable sleeve is inserted endoscopically, and the sleeve is positioned to extends through the stomach directly into the small bowel. This causes the food to pass directly from the esophagus to the intestine bypassing stomach, duodenum, and jejunum. The nutrient absorption is lost throughout the bypassed parts that in turn helping in weight reduction.

Intragastric Balloon

Intragastric balloons, as the name suggests, are balloon-like devices, made usually of silicon, placed inside the stomach. These balloons once placed in the stomach decreases the capacity or delays the gastric emptying in the stomach and limits the food intake. It can also make the person feel fuller quickly, resulting in weight loss and control of blood glucose levels. Different types of intragastric balloons are available that may vary in their type of placement and removal. They may be filled with air or fluid. The number of balloons placed in the stomach may also vary ranging from one to three.

A patient may undergo endoscopic intragastric balloon therapy if he or she has a body mass index (BMI) between 30 and 40, is agreeing to commit to permanent lifestyle changes, and has no previous stomach or esophageal surgery.

Intragastric balloon is usually done as an outpatient procedure, and require minimal anesthesia. During the procedure, an endoscope (a flexible tube mounted with a camera) loaded with the balloon device is inserted through the mouth and guided to the stomach. The balloon device is placed in the stomach and inflated in position, and the endoscope is removed.

The patient may be able to go home after a few hours with specific instruction provided for food and other lifestyle changes.

Endoscopic Sleeve Gastroplasty (ESG)

Endoscopic sleeve gastroplasty is a minimally invasive technique that facilitates weight loss. In this technique, an endoscope is inserted into the stomach through the mouth. The stomach is sutured along the outer curve to fold itself leading to a banana-sized tube. The stomach size is reduced by 70% approximately. This promotes early satiety and reduces food intake, resulting in weight loss and regulation of blood sugar levels.

Endoscopic sleeve gastroplasty may be done in patients who have a body mass index (BMI) above 30, have failed in losing weight despite lifestyle modification, and do not wish to undergo traditional bariatric surgeries. However, any patient who underwent hiatal hernia surgery, or has a history of stomach problems that may cause bleeding, are not appropriate candidates for the procedure.

The procedure can be performed as an outpatient procedure, with minimal anesthesia, and the patient can go home the same day. However, the patient needs to commit to dietary modifications and regular follow-ups for the best outcome.