Chiang Austin L, Ryou Marvin
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Curr Opin Gastroenterol. 2016 Nov;32(6):487-491. doi: 10.1097/MOG.0000000000000307.
Obesity and its comorbid illnesses affect millions worldwide and are one of the major causes of preventable death in the world. Bariatric surgery is currently offered to individuals with a BMI greater than 40 kg/m or greater than 35 kg/m with obesity-related comorbidities such as hypertension or diabetes. Endoscopic bariatric therapies, with their reduced invasiveness and potential reversibility, may complement surgical approaches for achieving weight loss.
At the time of this writing, two endoscopically placed intragastric balloons and an endoscopically placed aspiration tube have been approved by the Food and Drug Administration for weight loss purposes. Some devices employ a suturing platform to create plications or to appose two surfaces. Other endoscopic strategies under investigation to treat obesity-related comorbidities such as diabetes include duodenal mucosal resurfacing and creation of a partial jejunoileal diversion using self-assembling magnets.
Current endoscopic methods for the treatment of obesity utilize various mechanisms, including occupying gastric volume, reducing gastric capacity, altering caloric absorption, or aspirating gastric contents. The long-term outcomes and cost-effectiveness of these strategies remain to be fully elucidated. The landscape of endoscopic bariatric therapies continues to evolve.
肥胖及其合并症影响着全球数百万人，是全球可预防死亡的主要原因之一。目前，体重指数（BMI）大于40kg/m²或大于35kg/m²且患有肥胖相关合并症（如高血压或糖尿病）的个体可接受减重手术。内镜下减肥疗法因其侵入性较低且具有潜在可逆性，可能会补充手术方法以实现体重减轻。
在撰写本文时，两种内镜下放置的胃内球囊和一种内镜下放置的抽吸管已获得美国食品药品监督管理局批准用于减肥。一些设备采用缝合平台来形成褶皱或贴合两个表面。正在研究的其他治疗肥胖相关合并症（如糖尿病）的内镜策略包括十二指肠黏膜重塑和使用自组装磁体创建部分空肠回肠分流术。
目前用于治疗肥胖的内镜方法利用了多种机制，包括占据胃容积、减少胃容量、改变热量吸收或抽吸胃内容物。这些策略的长期效果和成本效益仍有待充分阐明。内镜下减肥疗法的前景在不断发展。
