Primary endoscopic obesity procedures

Primary endoscopic obesity treatments include a variety of restrictive and malabsorptive procedures that are emerging as alternatives to bariatric surgery. Although bariatric surgery is extremely effective and generally considered safe, there is a small, albeit significant, morbidity and mortality. This makes less invasive treatments attractive. In addition to being less invasive and perhaps safer, endoscopic treatments may be more cost-effective and reversible. Additionally, endoscopic treatments may prove to be a viable alternative in poor surgical candidates, or as a method to induce weight loss in super obese patients before definitive surgical bariatric procedures, and may be an option for the nonmorbidly obese who have failed diet and exercise. Experience with these emerging endoscopic technologies, however, is limited to feasibility and safety studies and small prospective trials with minimal long-term follow-up. There have been no large, prospective, randomized, or sham-controlled trials evaluating the long-term durability of endoscopic obesity treatments, and there have been no such trials comparing endoscopic treatments with traditional bariatric surgery. In this article, we will review these emerging primary endoscopic obesity treatments with a focus on procedural techniques.