Mild to moderate obesity is an entity with associated complex morbidity. However, these patients may not be candidates for surgical treatment. In these cases, endoscopic procedures such as intragastric balloons, gastric remodeling/plication, gastric aspiration therapy, bypass devices, bile diversion, or balloon occluded gastrojejunostomy may be considered.
Balloons may result in greater weight loss versus placebo when supported by an adequate follow-up and dietary recommendations. The national registry of use of balloons in the United States is presented, as well as the international data. Sequential balloon placement results are also discussed.
The gastric remodeling or plication involves an endoscopic sleeve gastroplasty, created with a suturing endoscopic instrument in an outpatient setting. Results show that it is a quick and safe procedure based on the prospective studies. In cases of weight regain, it can be repeated endoscopically.
Gastric aspiration therapy is applied following the same technique as PEG placement, and it can stay for up to 5 years. It achieves weight loss and also helps patients change their eating behavior..
Another newer technique involves creating an endoscopic anastomosis, building a partial biliopancreatic diversion, or a gastrojejunostomy created endoscopically.