Department of Internal Medicine, University of Connecticut, Farmington, CT, USA.
Surg Endosc. 2013 Jul;27(7):2305-11. doi: 10.1007/s00464-012-2765-7. Epub 2013 Jan 24.
Gastroenterologists are expected to play a pivotal role in the management of the global obesity epidemic in coming years as novel endoscopic approaches become more widely available, safe, and effective. This review focuses on the recent advances in the field of endoluminal therapy as a primary approach to obesity management with the aim of providing the interventional endoscopist an overview of currently available evidence along with an insight into upcoming devices and techniques. The intragastric balloon appears to be safe and effective in the short term, especially as a bridge to bariatric surgery. Although early trials support the safety and feasibility of endoscopic gastroplasty, it is technically demanding and staple-line dehiscence continues to be a problem. Moreover, with ongoing technical innovations, most devices that have been used in published trials are no longer manufactured and results of studies using newer endoscopic suturing systems are currently awaited. The duodenojejunal bypass sleeve mimics the physiology of intestinal bypass and shares the metabolic advantages of intestinal diversion. A high rate of premature device withdrawal has been its major limiting factor. Therapeutic endoscopy may be the next paradigm of bariatric care. Combining restrictive and barrier endoscopic techniques can potentially improve efficacy and should be evaluated in the setting of appropriate clinical trials.
在未来几年，随着新型内镜治疗方法变得更加广泛、安全和有效，预计胃肠病学家将在全球肥胖症管理中发挥关键作用。本综述重点介绍了内镜治疗领域的最新进展，作为肥胖症管理的主要方法，旨在为介入内镜医生提供当前可用证据的概述，并深入了解即将推出的设备和技术。胃内球囊在短期内似乎是安全有效的，特别是作为减肥手术的桥梁。尽管早期试验支持内镜胃成形术的安全性和可行性，但该技术要求较高，吻合口裂开仍然是一个问题。此外，随着技术的不断创新，大多数在已发表试验中使用的设备已不再生产，目前正在等待使用新型内镜缝合系统的研究结果。十二指肠空肠旁路袖套模拟了肠旁路的生理学，具有肠道分流的代谢优势。早期设备撤回率高是其主要限制因素。治疗性内镜可能是肥胖症治疗的下一个范例。联合限制和屏障内镜技术有可能提高疗效，应在适当的临床试验中进行评估。
