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Intragastric botulinum toxin injection for weight loss: current trends, shortcomings and future perspective
Erfan Arabpour, Hadi Golmoradi, Parya Mozafari Komesh Tape, Amir Sadeghi, Mohammad Abdehagh, Pardis Ketabi Moghadam, Mohammad Reza Zali
Clin Endosc 2025;58(1):10-24.   Published online November 5, 2024
DOI: https://doi.org/10.5946/ce.2024.153
AbstractAbstract PDFPubReaderePub
The administration of botulinum toxin A (BTA) into the gastric wall has emerged as a novel endoscopic bariatric procedure. Although over 20 years have elapsed since the initial human trial of intragastric BTA injection, considerable debate remains surrounding the safety, efficacy, and procedural instructions of this approach. The current literature exhibits discrepancies in the methodologies employed across studies, including differences in the dosage of BTA administered, injection site, number and depth of injections, post-procedural dietary modifications, and follow-up duration. This study reviewed the state-of-the-art use of BTA for weight loss and focused on the clinical evidence of the therapeutic applications of BTA for obesity. Studies with consistent outcome measures and methodologies are necessary to thoroughly assess the potential effects of BTA on weight management.
  • 2,834 View
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Mechanism of action and selection of endoscopic bariatric therapies for treatment of obesity
Wissam Ghusn, Gerardo Calderon, Barham K. Abu Dayyeh, Andres Acosta
Clin Endosc 2024;57(6):701-710.   Published online August 29, 2024
DOI: https://doi.org/10.5946/ce.2024.005
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies (EBTs) are minimally invasive and safe procedures with favorable weight loss outcomes in obesity treatment. We aimed to present the weight loss mechanism of action of EBTs and an individualized selection method for patients with obesity. We searched PubMed, Medline, Scopus, Embase, and Google Scholar databases for studies on the topic from databases inception to July 1, 2023, written in English. We focused on EBTs potential mechanism of action to induce weight loss. We also present an expert opinion on a novel selection of EBTs based on their mechanism of action. EBTs can result in weight loss through variable mechanisms of action. They can induce earlier satiation, delay gastric emptying, restrict the accommodative response of the stomach, decrease caloric absorption, and alter the secretion of gastrointestinal hormones. Selecting EBTs may be guided through their mechanism of action by which patients with abnormal satiation may benefit more from tissue apposition devices and aspiration therapy while patients with fast gastric emptying may be better candidates for intragastric devices, endoscopic anastomosis devices, and duodenal mucosal resurfacing. Consequently, the selection of EBTs should be guided by the mechanism of action which is specific to each type of therapy.

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  • Advances in Metabolic Bariatric Surgeries and Endoscopic Therapies: A Comprehensive Narrative Review of Diabetes Remission Outcomes
    Wissam Ghusn, Jana Zeineddine, Richard S. Betancourt, Aryan Gajjar, Wah Yang, Andrew G. Robertson, Omar M. Ghanem
    Medicina.2025; 61(2): 350.     CrossRef
  • Duodenal mucosa resurfacing: the endoscopic silver bullet against metabolic disorders?
    Amedeo Lonardo, Ashwani K. Singal
    Metabolism and Target Organ Damage.2025;[Epub]     CrossRef
  • 2,911 View
  • 346 Download
  • 3 Web of Science
  • 2 Crossref
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The evolution and current state of bariatric endoscopy in Western countries
Maria Valeria Matteo, Vincenzo Bove, Valerio Pontecorvi, Loredana Gualtieri, Giorgio Carlino, Cristiano Spada, Ivo Boškoski
Clin Endosc 2024;57(6):711-724.   Published online May 24, 2024
DOI: https://doi.org/10.5946/ce.2023.253
AbstractAbstract PDFPubReaderePub
With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.

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  • Duodenal mucosa resurfacing: the endoscopic silver bullet against metabolic disorders?
    Amedeo Lonardo, Ashwani K. Singal
    Metabolism and Target Organ Damage.2025;[Epub]     CrossRef
  • Intragastric Balloon as a Bridge Before Metabolic and Bariatric Surgery: A Systematic Review and Meta-analysis
    Mohammad Kermansaravi, Ali Esparham, Chetan Parmar, Farah A. Husain, Ali Solouki, Mohammad Mahjoubi, Amir Hossein Davarpanah Jazi, Shahab Shahabi Shahmiri
    Obesity Surgery.2025;[Epub]     CrossRef
  • 4,598 View
  • 466 Download
  • 3 Web of Science
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Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
Clin Endosc 2024;57(3):309-316.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.217
AbstractAbstract PDFPubReaderePub
The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariat­ric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article compre­hensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern ex­ists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongo­ing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to sup­port its routine use in clinical practice.

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  • Bacteroides and NAFLD: pathophysiology and therapy
    Jun Zhang, Jing Zhou, Zheyun He, Hongshan Li
    Frontiers in Microbiology.2024;[Epub]     CrossRef
  • 4,837 View
  • 167 Download
  • 2 Web of Science
  • 1 Crossref
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Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review
Renato Medas, Eduardo Rodrigues-Pinto
Clin Endosc 2023;56(6):693-705.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.043
AbstractAbstract PDFPubReaderePub
Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.

Citations

Citations to this article as recorded by  
  • Intravaginal endoscopic vacuum therapy of a rectovaginal fistula: expanding boundaries
    Renato Medas, Guilherme Macedo, Eduardo Rodrigues-Pinto
    Endoscopy.2025; 57(S 01): E30.     CrossRef
  • Post-Surgical Leaks of the Upper Digestive Tract – The Importance of an Early Endoscopic Approach
    I Tarrio, A Andrade, A R Ribeiro, M Moreira, T Araújo, L Lopes
    Endoscopy.2025; 57(S 02): S298.     CrossRef
  • Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review
    Tan Minh Le, Van Huy Tran, Kyu Sung Chung, Seong Woo Jeon
    Clinical Endoscopy.2025; 58(2): 181.     CrossRef
  • RESULTS OF THE APPLICATION OF ENDOSURGICAL TECHNOLOGIES IN THE DIAGNOSIS AND TREATMENT OF EARLY INTRAABDOMINAL COMPLICATIONS IN POSTOPERATIVE PERIOD
    I. A. Yusubov, E. Y. Sharifov
    World of Medicine and Biology.2024; 20(89): 184.     CrossRef
  • 4,065 View
  • 364 Download
  • 3 Web of Science
  • 4 Crossref
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Original Article
Efficacy and safety of intragastric balloon for obesity in Korea
Kwang Gyun Lee, Seung-Joo Nam, Hyuk Soon Choi, Hang Lak Lee, Jai Hoon Yoon, Chan Hyuk Park, Kyoung Oh Kim, Do Hoon Kim, Jung-Wook Kim, Won Sohn, Sung Hoon Jung, Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity
Clin Endosc 2023;56(3):333-339.   Published online December 13, 2022
DOI: https://doi.org/10.5946/ce.2022.143
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Intragastric balloon (IGB) is the only available endoscopic bariatric and metabolic therapy in Korea. End-ball (Endalis) has the longest history of clinical use among the IGBs available in Korea. However, little clinical data on this system have been reported. In this study, we aimed to evaluate the efficacy and safety of End-ball in Korea.
Methods
We performed a retrospective cohort study of patients who underwent IGB insertion (End-ball) from 2013 to 2019. Demographic and anthropometric data were collected. The efficacy and safety of IGB treatment were analyzed.
Results
In total, 80 patients were included. Mean age was 33.7 years and 83.8% were female. Initial body mass index was 34.48±4.69 kg/m2. Body mass index reduction was 3.72±2.63 kg/m2 at the time of IGB removal. Percent of total body weight loss (%TBWL) was 10.76%±6.76%. Percentage excess body weight loss was 43.67%±27.59%. Most adverse events were minor, and 71.4% of participants showed nausea, vomiting, or abdominal pain.
Conclusions
IGB treatment showed good efficacy and safety profile in Korean patients with obesity. In terms of %TBWL and percentage excess body weight loss, the efficacy was similar to that in the Western population.

Citations

Citations to this article as recorded by  
  • Bariatric surgery for treatment of morbid obesity in adults
    Ki Bum Park, Kyong-Hwa Jun
    The Korean Journal of Internal Medicine.2025; 40(1): 24.     CrossRef
  • Intragastric Balloons
    D.T.H. de Moura, Sergio A. Sánchez-Luna, Adriana Fernandes Silva, Alexandre Moraes Bestetti
    Gastrointestinal Endoscopy Clinics of North America.2024; 34(4): 687.     CrossRef
  • Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis
    Adriana Fernandes Silva, Alexandre Moraes Bestetti, Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Matheus de Oliveira Veras, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
    Obesity Surgery.2024; 34(10): 3735.     CrossRef
  • Endoscopic treatment of obesity: A protocol of updated systematic review with network meta-analysis of randomized controlled trials
    Eun Jeong Gong, Chang Seok Bang, Gwang Ho Baik, Dong Keon Yon
    PLOS ONE.2024; 19(9): e0308410.     CrossRef
  • How effective is intragastric balloon insertion as an obesity treatment in Korea?
    Youngdae Kim
    Clinical Endoscopy.2023; 56(3): 310.     CrossRef
  • Laparoscopy-assisted trans-hiatal endoscopic removal of an intragastric balloon after placement-related esophageal perforation
    Pablo Cortegoso Valdivia, Giorgio Dalmonte, Marina Valente, Lucia Ballabeni, Federica Gaiani, Gian Luigi de' Angelis, Federico Marchesi
    Endoscopy.2023; 55(S 01): E1137.     CrossRef
  • 4,066 View
  • 235 Download
  • 5 Web of Science
  • 6 Crossref
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Review
Anesthesia for Advanced Endoscopic Procedures
Basavana Goudra, Monica Saumoy
Clin Endosc 2022;55(1):1-7.   Published online January 3, 2022
DOI: https://doi.org/10.5946/ce.2021.236
AbstractAbstract PDFPubReaderePub
The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review.

Citations

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  • Anestezistlerin bidirectional endoskopi işlemlerinde prosedür sırası tercihleri ve belirleyici faktörler
    Caner Genç, Sezgin Bilgin, Hasan Çetinkaya, Hatice Selçuk Kuşderci, Sevda Akdeniz, Esra Turunç, Burhan Dost, Özgür Kömürcü
    Turkish Journal of Clinics and Laboratory.2025; 16(1): 150.     CrossRef
  • Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    Gut and Liver.2024; 18(1): 10.     CrossRef
  • Optimizing perioperative anesthesia strategies for safety and high-quality during painless gastrointestinal endoscopy diagnosis and treatment
    Le Xu, Yanhong Li, Hong Zheng, Rurong Wang
    Anesthesiology and Perioperative Science.2024;[Epub]     CrossRef
  • Factors affecting patient satisfaction during endoscopic procedures
    Ghazala Maryam, Rashk E-Hinna, Saman Sardar, Jahangir Khan, Javaria Isram, Fayyaz Hassan
    Scripta Medica.2024; 55(6): 749.     CrossRef
  • Clinical practice guidelines for percutaneous endoscopic gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    Clinical Endoscopy.2023; 56(4): 391.     CrossRef
  • Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    The Korean Journal of Gastroenterology.2023; 82(3): 107.     CrossRef
  • Case of Concomitant Endoscopic Treatment of Achalasia with Superficial Esophageal Cancer
    Myung-Hun Lee, Kyoungwon Jung, Jae Hyun Kim, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
    The Korean Journal of Gastroenterology.2023; 82(5): 248.     CrossRef
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  • 383 Download
  • 4 Web of Science
  • 7 Crossref
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Case Report
A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection
Paraskevas Gkolfakis, Marc-André Bureau, Marianna Arvanitakis, Jacques Devière, Daniel Blero
Clin Endosc 2022;55(1):141-145.   Published online April 16, 2021
DOI: https://doi.org/10.5946/ce.2021.033
AbstractAbstract PDFPubReaderePub
A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

Citations

Citations to this article as recorded by  
  • Management of leakage and fistulas after bariatric surgery
    Stephen A. Firkins, Roberto Simons-Linares
    Best Practice & Research Clinical Gastroenterology.2024; 70: 101926.     CrossRef
  • Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
    Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
    Obesity Surgery.2022; 32(2): 342.     CrossRef
  • 4,685 View
  • 161 Download
  • 1 Web of Science
  • 2 Crossref
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FOCUSED REVIEW SERIES: Endoscopic Managements for Patients with Obesity and Its Related Comorbiditieses
Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments
Hee Kyong Na, Diogo Turiani Hourneaux De Moura, The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(1):25-31.   Published online January 29, 2021
DOI: https://doi.org/10.5946/ce.2021.021
AbstractAbstract PDFPubReaderePub
Obesity, along with its comorbidities, has become a significant public health concern worldwide. Bariatric surgery is considered the most effective treatment modality; however, only 2% of patients with obesity undergo bariatric surgery. Endoscopic bariatric and metabolic therapies (EBMTs) are emerging alternatives to traditional bariatric surgery for patients who are not eligible for or do not prefer surgical treatment. EBMTs are generally categorized as space-occupying, gastric restrictive, aspiration, and small bowel therapies. We aimed to review various non-balloon and non-gastroplasty devices with available clinical data and discuss the possible mechanisms of action, efficacy, and safety profile of these EMBTs.

Citations

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  • Current State of Endoscopic Bariatric Therapies
    Lee Ying, Samuel Butensky, Ysabel Ilang-Ying, Saber Ghiassi
    Surgical Clinics of North America.2025; 105(1): 159.     CrossRef
  • Nesidioblastosis post-bariatric surgery in an adult patient: a case report and review of literature
    Hamza A. Abdul-Hafez, Karam Rabi, Asmaa Sarama, Layan Melhem, Waddah Abed, Mohammed Maree
    Annals of Medicine & Surgery.2025; 87(5): 3006.     CrossRef
  • Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
    Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2024; 57(3): 309.     CrossRef
  • Intragastric Balloons
    D.T.H. de Moura, Sergio A. Sánchez-Luna, Adriana Fernandes Silva, Alexandre Moraes Bestetti
    Gastrointestinal Endoscopy Clinics of North America.2024;[Epub]     CrossRef
  • Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis
    Adriana Fernandes Silva, Alexandre Moraes Bestetti, Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Matheus de Oliveira Veras, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
    Obesity Surgery.2024; 34(10): 3735.     CrossRef
  • Endoscopic treatment of obesity: A protocol of updated systematic review with network meta-analysis of randomized controlled trials
    Eun Jeong Gong, Chang Seok Bang, Gwang Ho Baik, Dong Keon Yon
    PLOS ONE.2024; 19(9): e0308410.     CrossRef
  • The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials
    Erika Yuki Yvamoto, Diogo Turiani Hourneaux de Moura, Igor Mendonça Proença, Epifanio Silvino do Monte Junior, Igor Braga Ribeiro, Pedro Henrique Boraschi Vieira Ribas, Matheus Cândido Hemerly, Victor Lira de Oliveira, Sergio A. Sánchez-Luna, Wanderley Ma
    Obesity Surgery.2023; 33(2): 585.     CrossRef
  • A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going
    Aurelio Mauro, Francesca Lusetti, Davide Scalvini, Marco Bardone, Federico De Grazia, Stefano Mazza, Lodovica Pozzi, Valentina Ravetta, Laura Rovedatti, Carmelo Sgarlata, Elena Strada, Francesca Torello Viera, Letizia Veronese, Daniel Enrique Olivo Romero
    Medicina.2023; 59(3): 636.     CrossRef
  • Endoscopic Bariatric Therapy for Obesity and Metabolic Syndrome
    Sang Pyo Lee
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(4): 247.     CrossRef
  • The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease
    Su-Young Kim
    Medicina.2021; 57(8): 737.     CrossRef
  • 5,788 View
  • 183 Download
  • 7 Web of Science
  • 10 Crossref
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The Clinical and Metabolic Effects of Intragastric Balloon on Morbid Obesity and Its Related Comorbidities
Joon Hyun Cho, Mohammad Bilal, Min Cheol Kim, Jonah Cohen, The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(1):9-16.   Published online January 29, 2021
DOI: https://doi.org/10.5946/ce.2020.302
AbstractAbstract PDFPubReaderePub
Obesity is becoming increasingly prevalent worldwide, and its metabolic sequelae lead to a significant burden on healthcare resources. Options for the management of obesity include lifestyle modification, pharmacological treatment, surgery, and endoscopic bariatric therapies (EBTs). Among these, EBTs are more effective than diet and lifestyle modification and are less invasive than bariatric surgery. In recent years, there have been significant advances in technologies pertaining to EBTs. Of all the available EBTs, there is a significant amount of clinical experience and published data regarding intragastric balloons (IGBs) because of their comparatively long development period. Currently, the United States Food and Drug Administration (FDA) has approved three IGBs, including Orbera (Apollo Endosurgery, Austin, TX, USA), ReShape Duo (ReShape Medical, San Clemente, CA, USA), and Obalon (Obalon Therapeutics, Carlsbad, CA, USA). The aim of this review is to summarize the available literature on the efficacy of IGBs in weight loss and their impact on obesity-related metabolic diseases.

Citations

Citations to this article as recorded by  
  • Which type of obesity benefits most from endoscopic intragastric balloon application?
    Azad Gazi Şahin, Erman Alçı
    The European Research Journal.2025; 11(2): 412.     CrossRef
  • Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
    Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2024; 57(3): 309.     CrossRef
  • Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion’s Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker
    Danut Dejeu, Paula Dejeu, Paula Bradea, Anita Muresan, Viorel Dejeu
    Clinics and Practice.2024; 14(3): 765.     CrossRef
  • Mechanism of action and selection of endoscopic bariatric therapies for treatment of obesity
    Wissam Ghusn, Gerardo Calderon, Barham K. Abu Dayyeh, Andres Acosta
    Clinical Endoscopy.2024; 57(6): 701.     CrossRef
  • Efficacy and safety of intragastric balloon for obesity in Korea
    Kwang Gyun Lee, Seung-Joo Nam, Hyuk Soon Choi, Hang Lak Lee, Jai Hoon Yoon, Chan Hyuk Park, Kyoung Oh Kim, Do Hoon Kim, Jung-Wook Kim, Won Sohn, Sung Hoon Jung
    Clinical Endoscopy.2023; 56(3): 333.     CrossRef
  • How effective is intragastric balloon insertion as an obesity treatment in Korea?
    Youngdae Kim
    Clinical Endoscopy.2023; 56(3): 310.     CrossRef
  • Overview on the endoscopic treatment for obesity: A review
    Maheeba Abdulla, Nafeesa Mohammed, Jehad AlQamish
    World Journal of Gastroenterology.2023; 29(40): 5526.     CrossRef
  • Endoscopic Bariatric Therapy for Obesity and Metabolic Syndrome
    Sang Pyo Lee
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(4): 247.     CrossRef
  • Status of bariatric endoscopy–what does the surgeon need to know? A review
    Diogo Turiani Hourneaux de Moura, Anna Carolina Batista Dantas, Igor Braga Ribeiro, Thomas R McCarty, Flávio Roberto Takeda, Marco Aurelio Santo, Sergio Carlos Nahas, Eduardo Guimarães Hourneaux de Moura
    World Journal of Gastrointestinal Surgery.2022; 14(2): 185.     CrossRef
  • Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments
    Hee Kyong Na, Diogo Turiani Hourneaux De Moura
    Clinical Endoscopy.2021; 54(1): 25.     CrossRef
  • 6,083 View
  • 223 Download
  • 9 Web of Science
  • 10 Crossref
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Original Article
Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis
Pichamol Jirapinyo, Diogo T. H. de Moura, Laura C. Horton, Christopher C. Thompson
Clin Endosc 2020;53(6):686-697.   Published online February 28, 2020
DOI: https://doi.org/10.5946/ce.2019.181
AbstractAbstract PDFPubReaderePub
Background
/Aims: Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
Methods
A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Results
Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 – -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 – 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 – -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7–6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 – -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 – -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 – -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5–16.7) %TWL and 25.6 (16.0–35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8–1.8) % and 9.0 (3.9–14.0) U/L. The pooled SAE rate was 4.1%.
Conclusions
Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.

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Focused Review Series: Updates on endoscopic bariatric and metabolic therapieses
Training in Bariatric and Metabolic Endoscopic Therapies
Pichamol Jirapinyo, Christopher C. Thompson
Clin Endosc 2018;51(5):430-438.   Published online September 30, 2018
DOI: https://doi.org/10.5946/ce.2018.148
AbstractAbstract PDFPubReaderePub
Bariatric endoscopy is an emerging subspecialty for gastroenterologists encompassing a broad array of procedures including primary endoscopic bariatric and metabolic therapies and the treatment of complications of bariatric surgery. In addition, comprehensive understanding of lifestyle intervention and pharmacotherapy are essential to successful outcomes. This review summarizes goals and steps of training for this emerging field.

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Small Bowel Endoscopic Bariatric Therapies
Eun Jeong Gong, Do Hoon Kim
Clin Endosc 2018;51(5):425-429.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.153
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies that emulate some of the principles of bariatric surgery have been developed as a less invasive option for the treatment of obesity and related comorbidities. Small bowel endoscopic bariatric therapies include bypass sleeves, incisionless anastomosis systems, and duodenal mucosal resurfacing. Clinical experience with small bowel devices suggests that endoscopic bariatric procedures can be safely implemented and that these devices are effective for both weight loss and metabolic improvement. Although the mechanisms behind these effects should be further elucidated, endoscopic bariatric therapies may be more effective and safer adjunctive interventions than lifestyle modifications and pharmacological regimens for patients with obesity or obesity-related comorbidities.

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Experimental Gastric Non-Balloon Devices
Youn I Choi, Kyoung Oh Kim
Clin Endosc 2018;51(5):420-424.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.150
AbstractAbstract PDFPubReaderePub
Endoscopic bariatric therapies (EBTs) are promising alternatives to the conventional surgeries used to treat obesity and related metabolic conditions, targeting gastrointestinal anatomical and physiological processes. Many EBTs are at various stages of development and are aimed at promoting an early sense of satiety via anatomical and physiological mechanisms. In the present study, we focused on relevant clinical issues and future perspectives with regard to gastric non-balloon methods treating obesity.

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Various Intragastric Balloons Under Clinical Investigation
Seong Ji Choi, Hyuk Soon Choi
Clin Endosc 2018;51(5):407-415.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.140
AbstractAbstract PDFPubReaderePub
Obesity is a chronic disease with an exponentially increasing incidence rate, and its negative effects are well documented in numerous studies. As a result, the importance of bariatric therapy cannot be overemphasized, and many bariatric treatment methods with varying mechanisms have been developed. Of the available treatment methods, intragastric balloons, introduced in the 1980s, have been shown to be a safe and effective treatment modality; various intragastric balloon products have been developed and are currently being widely used in clinical settings. However, the disadvantages of intragastric balloons, such as unclear long-term weight loss benefits and complications experienced during insertion and removal, preclude their wider use. In this review, we discuss different intragastric balloon products, focusing on those under clinical investigation, and suggest future research directions.

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Review
Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity
Deepanshu Jain, Bharat Singh Bhandari, Ankit Arora, Shashideep Singhal
Clin Endosc 2017;50(6):552-561.   Published online June 13, 2017
DOI: https://doi.org/10.5946/ce.2017.032
AbstractAbstract PDFPubReaderePub
Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant (p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies.

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Focused Review Series: Endoscopic Accessories Used for ESD
Endoscopic Accessories Used for More Advanced Endoluminal Therapeutic Procedures
Hyunsoo Chung
Clin Endosc 2017;50(3):234-241.   Published online May 31, 2017
DOI: https://doi.org/10.5946/ce.2017.079
AbstractAbstract PDFPubReaderePub
Endoscopic accessories describe an extensive variety of auxiliary instruments used for diagnostic and therapeutic endoscopy. Various endoscopic accessories have been developed over the previous few decades and are mostly used for treating neoplastic lesions, such as early gastrointestinal (GI) carcinomas and premalignant lesions. Because of extensive research on natural orifice endoluminal surgery (NOTES) in the early 2000s and recent technological developments, new devices have been developed for various advanced endoluminal therapeutic procedures. In particular, a remarkable development of endoscopic management was achieved in the field of gastroesophageal reflux disease (GERD) and obesity. In both conditions, there is treatment gap between medical and surgical therapy. A large proportion of the patients who do not respond to medical treatment and lifestyle modification, still hesitate to directly undergo surgical treatment. To bridge this gap, endoscopic management has been receiving increasing attention. In this article, I review endoscopic and/or endoluminal devices used for the treatment of GERD and obesity with proposed mechanisms of their function.
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Focused Review Series: Roleses of Bariatric Endoscopy in Obesity Treatment
Recent Clinical Results of Endoscopic Bariatric Therapies as an Obesity Intervention
Fateh Bazerbachi, Eric J. Vargas Valls, Barham K. Abu Dayyeh
Clin Endosc 2017;50(1):42-50.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2017.013
AbstractAbstract PDFPubReaderePub
Despite advances in lifestyle interventions, anti-obesity medications, and metabolic surgery, the issue of health burden due to obesity continues to evolve. Interest in endoscopic bariatric techniques has increased over the years, as they have been shown to be efficacious, reversible, relatively safe, and cost effective. Further, these techniques offer a therapeutic window for some patients who may otherwise be unable to undergo bariatric surgery. This article aims to review the literature on the safety and efficacy of currently offered endoscopic bariatric techniques, as well as those that are in the pipeline of end-development and regulatory approval.

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Recent Trends in Endoscopic Bariatric Therapies
Hyuk Soon Choi, Hoon Jai Chun
Clin Endosc 2017;50(1):11-16.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2017.007
AbstractAbstract PDFPubReaderePub
Obesity and its associated metabolic diseases including diabetes mellitus are severe medical problems that are increasing in prevalence worldwide and result in significant healthcare expenses. While behavioral and pharmacological treatment approaches are partly effective in the short term, their effects are not long-lasting. Although previous studies have described bariatric surgery as the most effective treatment for obesity, it is associated with morbidity, mortality, and economic burden. Endoluminal interventions performed entirely using gastrointestinal flexible endoscopy offer alternative approaches to the treatment of obesity that are safer and more cost-effective than current surgical approaches. The use of endoluminal techniques in the field of metabolic obesity disease has diverse promising applications including endoscopic gastroplasty, intragastric balloon, endoluminal malabsorptive bariatric procedures, and gastric electrical stimulation (GES) for the modulation of gastric emptying. This review discusses recent trends and roles in endoscopic bariatric therapies using the currently available endoluminal and transgastric technologies.

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Role of Endoscopic Gastroplasty Techniques in the Management of Obesity
Yunho Jung
Clin Endosc 2017;50(1):21-25.   Published online January 30, 2017
DOI: https://doi.org/10.5946/ce.2016.147
AbstractAbstract PDFPubReaderePub
Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up.

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Endoscopic Approach for Major Complications of Bariatric Surgery
Moon Kyung Joo
Clin Endosc 2017;50(1):31-41.   Published online December 23, 2016
DOI: https://doi.org/10.5946/ce.2016.140
AbstractAbstract PDFPubReaderePub
As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

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Case Report
Asymptomatic Gastric Band Erosion Detected during Routine Gastroduodenoscopy
Gee Young Yun, Woo Sub Kim, Hye Jin Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2016;49(3):294-297.   Published online February 11, 2016
DOI: https://doi.org/10.5946/ce.2016.001
AbstractAbstract PDFPubReaderePub
The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up, thus eliminating the possibility of serious complications.

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Review
Novel Endoscopic Management of Obesity
Jerome Dargent
Clin Endosc 2016;49(1):30-36.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.30
AbstractAbstract PDFPubReaderePub
Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory.

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Obesity and Endoscopic Treatment
Sung Soo Kim, M.D.
Korean J Gastrointest Endosc 2011;42(5):275-282.   Published online May 28, 2011
AbstractAbstract PDF
Obese patients have been increasing with the development of a social economy. Obesity is a disease with high mortality rates due to associated cardiovascular disease and diabetes. Diet or exercise therapy, medications, bariatric surgery are used for treating obesity. However, although bariatric surgery is safe and effective, it is expensive, and reoperation is a burden if patients fail to lose weight. Operative complications are also a problem. The recent development of endoluminal techniques may permit obesity treatment and many endoscopic procedures have been attempted. The role of endoscopy for treating obesity is treating the postoperative complications of bariatric surgery, for example, a stricture or widening of the anastomosis, fistula, or leaks. Second, endoscopic applications could be used for weight reduction to temporarily bridge surgery for high-risk patients with obesity, and for reducing weight in patients unable to undergo surgery. This article provides a brief overview of bariatric surgery and its complications and introduces several endoscopic applications to treat obesity. (Korean J Gastrointest Endosc 2011;42:275-282)
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