Metabolic Endoscopy: Development and Perspectives

Abstract

Background: Obesity and its metabolic sequelae are among the most serious challenges faced by health systems today and they are expected to pose a serious threat in the future as well. Therapy ranges from lifestyle modification to drug treatment to surgery. Metabolic endoscopy (ME) might close the gap between invasive "metabolic" surgery and conservative, less effective treatment. In recent years, several endoscopic approaches have emerged, promising a safe and effective approach to cope with obesity. Data on metabolic endpoints is scarce. This article will therefore highlight procedures with data on type 2 diabetes mellitus (T2DM) as the most prominent component of the metabolic syndrome.

Summary: Most procedures showed beneficial effects in terms of weight reduction. For gastric procedures, there were no systematic studies primarily addressing parameters of glucose metabolism or diabetes outcomes. Metabolic benefit, if there is any, is most likely a by-product of weight loss. By contrast, duodenal-jejunal bypass sleeve (DJBS) is conceptually an antidiabetic procedure. Although adverse events are frequent, recent data points to a positive benefit-risk ratio. Key Messages: ME has the potential to constitute a growing field in the treatment of obesity and associated T2DM. While data published on glycaemic parameters in restrictive approaches is not sufficient, there is strong evidence that malabsorptive DJBS has an antidiabetic "plus" effect. Further studies are necessary to define the role of ME within a lifelong concept of treating obesity and T2DM.

Keywords: Aspiration therapy; Duodenal mucosal resurfacing; Duodenal-jejunal bypass sleeve; Endoscopic sleeve gastroplasty; Endoscopy; Intragastric balloon; Obesity; Primary obesity surgery endoluminal; Type 2 diabetes mellitus.