New advances in endoscopic weight loss and metabolic therapy

doi:10.3877/cma.j.issn.2095-2015.2025.03.001

Abstract

Abstract:

Obesity is a worldwide public health challenge and its traditional treatments include lifestyle changes, drugs and surgery.Endoscopic bariatric and metabolic therapy (EBMT) has attracted much attention due to its advantages of being more minimally invasive and higher safety.This article reviews a variety of endoscopic weight loss techniques, which achieve weight loss through different mechanisms, such as restricting stomach space, promoting clearance of stomach contents, and reducing intestinal absorption.In addition, the combined application mode of endoscopic weight loss therapy with drugs or surgery was discussed.Overall, EBMT is effective and less invasive, but further research is needed to investigate its long-term effects and improve patient access to treatment.

Key words: Obesity, Endoscope, Bariatric surgery, Combined modality therapy

Zhen Guo Wu, Yan Bo Yu, Yan Qing Li. New advances in endoscopic weight loss and metabolic therapy[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(03): 193-198.

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References 63

[1]	Salminen P, Kow L, Aminian A, et al.IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management-an International Delphi Study[J].Obes Surg, 2024, 34(1): 30-42.
[2]	Global burden of 87 risk factors in 204 countries and territories,1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J].Lancet, 2020, 396(10258): 1223-1249.
[3]	Heitmann B L, Køster-Rasmussen R, Meyer L B, et al.Debating Weight Loss vs.Weight Neutral Strategies for Improvements of Health[J].Curr Obes Rep, 2024, 13(4): 832-842.
[4]	Lee M, Lauren BN, Zhan T, et al.The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity[J].Obes Sci Pract, 2020, 6(2): 162-170.
[5]	Jirapinyo P, Hadefi A, Thompson C C, et al.American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity[J].Gastrointest Endosc, 2024, 99(6):867-885.e64.
[6]	Wiggins T, Sharma O, Sarfaraz Y, et al.Safety and Efficacy of 12-Month Intra-gastric Balloon-Series of over 1100 Patients[J].Obes Surg, 2024, 34(1): 176-182.
[7]	叶宁.ReShape 胃内双球囊系统[J].中国医疗设备, 2015, 30(10):183-184.
[8]	Fittipaldi-Fernandez R J, Zotarelli-Filho I J, Diestel C F, et al.Randomized Prospective Clinical Study of Spatz3® Adjustable Intragastric Balloon Treatment with a Control Group: a Large-Scale Brazilian Experiment[J].Obes Surg, 2021, 31(2): 787-796.
[9]	Swei E, Almuhaidb A, Sullivan S, et al.Comparison of the Efficacy and Safety of the FDA-approved Intragastric Balloon Systems in a Clinical Setting[J].J Clin Gastroenterol, 2023, 57(6): 578-585.
[10]	Machytka E, Gaur S, Chuttani R, et al.Elipse, the first procedureless gastric balloon for weight loss: a prospective, observational,open-label, multicenter study[J].Endoscopy, 2017, 49(2): 154-160.
[11]	Dejeu D, Dejeu P, Bradea P, et al.Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion's Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker[J].Clin Pract, 2024, 14(3): 765-778.
[12]	Jense MTF, Palm-Meinders IH, Sanders B, et al.The Swallowable Intragastric Balloon Combined with Lifestyle Coaching: Short-Term Results of a Safe and Effective Weight Loss Treatment for People Living with Overweight and Obesity[J].Obes Surg, 2023, 33(6):1668-1675.
[13]	Vašura A, Machytka E, Urban O, et al.Effect of bariatric endoscopy on liver fibrosis and steatosis and the course of NAFLD-a prospective interventional study[J].Ann Hepatol, 2024, 30(1):101765.
[14]	Van Dijk A M, De Vries M, El-Morabit F, et al.Intra-gastric balloon with lifestyle modification: a promising therapeutic option for overweight and obese patients with metabolic dysfunction-associated steatotic liver disease[J].Intern Emerg Med, 2023, 18(8): 2271-2280.
[15]	Soroceanu RP, Timofte DV, Maxim M, et al.Twelve-Month Outcomes in Patients with Obesity Following Bariatric Surgery-A Single Centre Experience[J].Nutrients, 2023, 15(5): 1134.
[16]	Shah RH, Vedantam S, Kumar S, et al.Intragastric Balloon Significantly Improves Metabolic Parameters at 6 Months: a Meta-Analysis[J].Obes Surg, 2023, 33(3): 725-732.
[17]	Moore RL, Eaton L, Ellner J.Safety and Effectiveness of an Intragastric Balloon as an Adjunct to Weight Reduction in a Post-Marketing Clinical Setting[J].Obes Surg, 2020, 30(11):4267-4274.
[18]	Berger ME, Løve US.Gastric perforation during second intragastric balloon treatment: a case report[J].AME Case Rep, 2022, 6: 15.
[19]	Brizuela L, Samarah H, Cardona N.Small Bowel Obstruction Following Dislodgement of an Intragastric Balloon: A Case Report[J].Cureus, 2024, 16(8): e67738.
[20]	Yahia Y, Abuodeh J, Chandra P, et al.Risk Factors for Acute Pancreatitis Following Intragastric Balloon Insertion: A 7-Year Retrospective Cohort Study[J].Obes Surg, 2025, 35(2): 496-504.
[21]	Choo A, Lim E, Eng A, et al.Predictors of early removal of intragastric balloon due to intolerance: Insights from a multiethnic Asian cohort[J].Ann Acad Med Singap, 2024, 53(9): 551-561.
[22]	Mohapatra S, Mirza MA, Hilles AR, et al.Biomedical Application,Patent Repository, Clinical Trial and Regulatory Updates on Hydrogel: An Extensive Review[J].Gels, 2021, 7(4): 207.
[23]	Tang R C, Chen TC, Lin FH.Design Strategy for a Hydroxide-Triggered pH-Responsive Hydrogel as a Mucoadhesive Barrier to Prevent Metabolism Disorders[J].ACS Appl Mater Interfaces, 2021, 13(49): 58340-58351.
[24]	Ard JD, Ryan DH, O'neil PM, et al.Efficacy and safety of a novel oral hydrogel capsule in adults with overweight or obesity: the pivotal randomized RESET study[J].Obesity(Silver Spring), 2025,33(3): 500-511.
[25]	Giruzzi N.Plenity(Oral Superabsorbent Hydrogel)[J].Clin Diabetes,2020, 38(3): 313-314.
[26]	Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al.Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity(MERIT): a prospective, multicentre, randomised trial[J].Lancet, 2022,400(10350): 441-451.
[27]	Dayyeh BKA, Stier C, Alqahtani A, et al.IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management[J].Obes Surg, 2024, 34(12): 4318-4348.
[28]	Abu Dayyeh BK, Rajan E, Gostout CJ.Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity[J].Gastrointest Endosc, 2013,78(3): 530-535.
[29]	Gala K, Brunaldi V, Abu Dayyeh BK.Novel Devices for Endoscopic Suturing: Past, Present, and Future[J].Gastrointest Endosc Clin N Am, 2024, 34(4): 733-742.
[30]	Kantsevoy SV.The Development of the Overstitch System and Its Potentials[J].Gastrointest Endosc Clin N Am, 2020, 30(1): 107-114.
[31]	Keihanian T, Othman MO.OverStitch Sx Endoscopic suturing system in minimally invasive endoscopic procedures: overview of its safety and efficacy and comparison to oversticth(TM)[J].Expert Rev Med Devices, 2022, 19(1): 11-23.
[32]	Maselli R, Palma R, Traina M, et al.Endoscopic suturing for GI applications: initial results from a prospective multicenter European registry[J].Gastrointest Endosc, 2022, 96(5): 780-786.
[33]	Matteo MV, Pontecorvi V, Bove V, et al.Prospective, single-arm multicenter, international, observational postmarket study to assess the safety and efficacy of a triangulation platform for treating patients requiring endoscopic gastroplasty[J].Gastrointest Endosc,2025, 101(1): 106-116.e1.
[34]	Gudur AR, Geng C, Radlinski M, et al.Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity(BMI > 40)[J].Obes Surg, 2023, 33(4): 1133-1142.
[35]	Brunaldi VO, Galvao Neto M, Sharaiha RZ, et al.Endoscopic sleeve gastroplasty as an early tool against obesity: a multicenter international study on an overweight population[J].Gastrointest Endosc, 2024, 99(3): 371-376.
[36]	Verrastro O, Panunzi S, Castagneto-Gissey L, et al.Bariatricmetabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis(BRAVES): a multicentre, open-label,randomised trial[J].Lancet, 2023, 401(10390): 1786-1797.
[37]	Samarasinghe SNS, Leca B, Alabdulkader S, et al.Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial[J].Lancet, 2024, 403(10443): 2489-2503.
[38]	Joseph S, Vandruff VN, Amundson JR, et al.Comparable improvement and resolution of obesity-related comorbidities in endoscopic sleeve gastroplasty vs laparoscopic sleeve gastrectomy:single-center study[J].Surg Endosc, 2024, 38(10): 5914-5921.
[39]	Singh S, Bazarbashi AN, Khan A, et al.Primary obesity surgery endoluminal(POSE) for the treatment of obesity: a systematic review and meta-analysis[J].Surg Endosc, 2022, 36(1): 252-266.
[40]	Lopez-Nava G, Asokkumar R, Turró Arau R, et al.Modified primary obesity surgery endoluminal(POSE-2) procedure for the treatment of obesity[J].VideoGIE, 2020, 5(3): 91-93.
[41]	Jense MTF, Hodde T, Palm-Meinders IH, et al.The POSE-2 Procedure for People with Obesity: A Safe and Effective Treatment Option[J].Obes Surg, 2024, 34(10): 3686-3693.
[42]	Jirapinyo P, Thompson CC.Comparison of distal primary obesity surgery endolumenal techniques for the treatment of obesity(with videos)[J].Gastrointest Endosc, 2022, 96(3): 479-486.
[43]	Sullivan S, Stein R, Jonnalagadda S, et al.Aspiration therapy leads to weight loss in obese subjects: a pilot study[J].Gastroenterology,2013, 145(6): 1245-1252.e1-5.
[44]	Swei EC, Sullivan SA.Aspiration Therapy[J].Tech Vasc Interv Radiol, 2020, 23(1): 100659.
[45]	Thompson CC, Abu Dayyeh BK, Kushnir V, et al.Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial[J].Surg Obes Relat Dis, 2019, 15(8): 1348-1354.
[46]	Rothstein RI, Kopjar B, Woodman GE, et al.Randomized Double-blind Sham-controlled Trial of a Novel Silicone-filled Endoscopically Placed Device for Weight Loss[J].Techniques and Innovations in Gastrointestinal Endoscopy, 2024, 26(1): 21-29.
[47]	Richard IR, George W, James S, et al.Transpyloric Shuttle Treatment Improves Cardiometabolic Risk Factors and Quality of Life in Patients with Obesity: Results from a Randomized, Double-Blind,Sham-Controlled Trial[J].Gastroenterology, 2019(6): 1108.
[48]	Ryder R EJ, Laubner K, Benes M, et al.Endoscopic Duodenal-Jejunal Bypass Liner Treatment for Type 2 Diabetes and Obesity: Glycemic and Cardiovascular Disease Risk Factor Improvements in 1, 022 Patients Treated Worldwide[J].Diabetes Care, 2023, 46(4): E89-E91.
[49]	Ruban A, Miras AD, Glaysher MA, et al.Duodenal-Jejunal Bypass Liner for the management of Type 2 Diabetes Mellitus and Obesity:A Multicenter Randomized Controlled Trial[J].Ann Surg, 2022,275(3): 440-447.
[50]	Boonchaya-Anant P, Bueter M, Gubler C, et al.Sustained weight loss after duodenal-jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m(2): A retrospective cohort study[J].Clin Obes, 2023, 13(1): e12561.
[51]	Emini M, Bhargava R, Aldhwayan M, et al.Satiety Hormone LEAP2 After Low-Calorie Diet With/Without Endobarrier Insertion in Obesity and Type 2 Diabetes Mellitus[J].J Endocr Soc, 2024, 9(1):bvae214.
[52]	Machytka E, Bužga M, Zonca P, et al.Partial jejunal diversion using an incisionless magnetic anastomosis system: 1-year interim results in patients with obesity and diabetes[J].Gastrointest Endosc, 2017,86(5): 904-912.
[53]	Biertho L, Marceau S, Nadeau M, et al.Magnetic duodenoileal anastomosis with sleeve gastrectomy: a prospective multicenter study[J].Surg Obes Relat Dis, 2025, 21(2): 166-174.
[54]	Gagner M, Abuladze D, Buchwald JN, et al.First-in-Human Side-to-Side Duodeno-Ileal Bipartition for Weight Loss and Type 2 Diabetes with the Swallowable Biofragmentable Magnetic Anastomosis System[J].J Am Coll Surg, 2025.
[55]	Rajagopalan H, Cherrington AD, Thompson CC, et al.Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes: 6-Month Interim Analysis From the First-in-Human Proof-of-Concept Study[J].Diabetes Care, 2016, 39(12): 2254-2261.
[56]	Van Baar ACG, Holleman F, Crenier L, et al.Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective,multicentre study[J].Gut, 2020, 69(2): 295-303.
[57]	Busch CBE, Meiring S, Van Baar ACG, et al.Insulin sensitivity and beta cell function after duodenal mucosal resurfacing: an open-label,mechanistic, pilot study[J].Gastrointest Endosc, 2024, 100(3):473-480.e1.
[58]	Mingrone G, Van Baar AC, Devière J, et al.Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial[J].Gut, 2022, 71(2): 254-264.
[59]	Imam A, Alim H, Binhussein M, et al.Weight Loss Effect of GLP-1 RAs With Endoscopic Bariatric Therapy and Bariatric Surgeries[J].J Endocr Soc, 2023, 7(12): bvad129.
[60]	Jirapinyo P, Jaroenlapnopparat A, Thompson CC.Efficacy of anti-obesity medication(AOM) and endoscopic gastric remodeling(EGR): Analysis of combination therapy with optimal timing and agents[J].Endosc Int Open, 2024, 12(12): E1458-e1464.
[61]	Martines G, Dezi A, Giove C, et al.Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients[J].Obes Facts, 2023, 16(5): 457-464.
[62]	Clapp B, Wynn M, Martyn C, et al.Long term(7 or more years)outcomes of the sleeve gastrectomy: a meta-analysis[J].Surg Obes Relat Dis, 2018, 14(6): 741-747.
[63]	Maselli DB, Alqahtani AR, Abu Dayyeh BK, et al.Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy:an international, multicenter study[J].Gastrointest Endosc, 2021,93(1): 122-130.

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