Endoscopic management of obesity involves accessing the stomach and intestines through the mouth to perform bariatric procedures. This is done by using an endoscope which is a flexible tube that has a camera, light source, and several channels through which special instruments can be passed.
Endoscopic procedures have significant advantages over traditional bariatric surgery:
- No external skin incisions
- Less blood loss
- Less risk of complications
- Less pain after surgery
- Possible discharge on the same day.
The different endoscopic treatment modalities include:
SPACE OCCUPYING METHODS:
Intra-Gastric Balloon: The balloon is inserted endoscopically into the stomach and it is then filled with normal saline/ methylene blue solution. This creates a sense of fullness. The balloon is used for a period of 6 months after which it must be removed.
Transpyloric Shuttle: It is a large spherical bulb connected to a smaller cylindrical bulb by a flexible catheter. It is composed of silicone and causes satiety by producing intermittent obstruction.
GASTRIC RESTRICTIVE METHODS:
Transoral Gastroplasty: A part of the stomach is stapled or stitched endoscopically to reduce the capacity to hold food.
Transoral Endoscopic Restrictive Implant System: An implant is introduced into the stomach via an endoscope that has a narrow channel for food passage, creating a restrictive pouch.
MALABSORPTIVE ENDOSCOPIC PROCEDURES:
Part of the intestine is bypassed using an endoscopically placed liner which reduces food absorption. It also prevents the action of biliary and pancreatic enzymes that help in digestion. Certain implants can also be used to delay the passage of food through the duodenum, causing malabsorption.
REGULATING GASTRIC EMPTYING:
Endoscopic intragastric botulinum toxin injections may be used to delay gastric emptying and reduce hunger pangs. Another approach is the use of gastric electrical stimulation which has been shown to reduce gastric accommodation, delay gastric emptying, and increase intestinal transit, causing weight loss.
A gastrostomy tube is placed endoscopically to aspirate stomach contents a short time after a meal.
The most common side effect of endoscopic obesity management is nausea. This can usually be controlled with oral medications. Usually, patients are discharged on the same day as the procedure and can return to work in a few days.