Obesity has become a global health concern, with various treatment options available to individuals seeking weight loss. While bariatric surgery has traditionally been a popular choice, endoscopic therapies have emerged as a less invasive alternative for patients with a body mass index (BMI) ranging from 30 to 40. This article delves into the world of endoscopic therapies for obesity, exploring their efficacy, benefits, and potential side effects.
Endoscopic Therapies: A Viable Option for Weight Loss:
Endoscopic therapies for obesity have shown promising results, with an average weight loss of approximately 20%, compared to the 30% achieved through bariatric surgery. These therapies are typically performed on an outpatient basis, and the devices used are often left in place for up to a year to maximize their effectiveness. When combined with pharmaceutical interventions, such as medications that aid in weight loss, endoscopic therapies have demonstrated even better outcomes.
Gastric Balloons: An Effective Approach:
One commonly used endoscopic therapy involves the placement of gastric balloons, which serve to reduce the stomach's capacity. Several types of gastric balloons exist, but the adjustable volume balloon has shown the best weight loss results. This balloon allows for the adjustment of its volume, ranging from 300cc to 800cc. On average, patients experience a 15% total body weight loss, with approximately 92% achieving at least a 5% weight reduction. However, it is important to note that some patients may experience side effects such as nausea, vomiting, pain, and food retention.
Swallowed Capsule Balloon: A Promising Innovation:
Another type of gastric balloon that is currently under FDA review is the swallowed capsule balloon. This non-invasive method involves swallowing a deflated balloon, which is then inflated in the stomach. This approach eliminates the need for an endoscopic procedure. However, further research is needed to determine its efficacy and safety.
Gastric Aspiration: A Unique Technique:
Gastric aspiration is an endoscopic therapy where a device similar to a G-tube is used to allow patients to remove food from their stomach after ingestion. This method enables the removal of approximately 30% of the calories consumed, leading to a total weight loss of around 14.2%. While it has shown some success, careful patient selection and monitoring are essential due to the risk of complications.
Transpyloric Shuttle: Modifying Gastric Emptying:
The transpyloric shuttle is a device that is delivered into the stomach and positioned at the duodenum. By delaying gastric emptying, it aims to promote a feeling of fullness and reduce caloric intake. Research regarding its effectiveness and long-term outcomes is still ongoing.
Additional Endoscopic Therapies:
In addition to gastric balloons and gastric aspiration, other endoscopic therapies are being explored. Botox injections into the stomach have shown potential in inducing satiety, while external magnets with magnetic balls inside have also been utilized to create a sense of fullness. Swallowed capsules with hydrogel beads, taken before meals, can swell in the stomach, inducing a feeling of satiety. Some hydrogel technologies are designed to degrade and be excreted naturally, making them convenient options for patients.
Novel Approaches: Small Bowel Targets and Duodenal Mucosal Resurfacing:
Researchers are actively investigating endoscopic therapies that target the small bowel, such as duodenal-jejunal bypass liners. These liners mimic the effects of gastric bypass surgery, resulting in weight loss and improvements in metabolic markers. Duodenal mucosal resurfacing devices are also being developed, reducing the surface area of the duodenum and leading to significant improvements in A1C levels in insulin-dependent type 2 diabetics.
Conclusion:
Endoscopic therapies have emerged as a less invasive option for individuals seeking weight loss, particularly those with a BMI of 30 to 40. Gastric balloons, gastric aspiration, and other innovative approaches offer varying degrees of weight loss and metabolic improvements. However, it is crucial for patients to work closely with healthcare professionals to select the most appropriate therapy and to monitor their progress effectively. As research in this field continues, the range of endoscopic therapies for obesity is expected to expand, providing individuals with a broader range of options to address their weight loss goals.
Comentarios