Kaplan Lee M
Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, 149 13th Street, Room 8219, Boston, MA 02129, USA.
Gastrointest Endosc Clin N Am. 2017 Apr;27(2):213-231. doi: 10.1016/j.giec.2017.01.004.
Bariatric surgical procedures, including gastric bypass, vertical sleeve gastrectomy, and biliopancreatic diversion, are the most effective and durable treatments for obesity. In addition, These operations induce metabolic changes that provide weight-independent improvement in type 2 diabetes, fatty liver disease and other metabolic disorders. Initially thought to work by mechanical restriction of food intake or malabsorption of ingested nutrients, these procedures are now known to work through complex changes in neuroendocrine and immune signals emanating from the gut, including peptide hormones, bile acids, vagal nerve activity, and metabolites generated by the gut microbiota, all collaborating to reregulate appetite, food preference, and energy expenditure. Development of less invasive means of achieving these benefits would allow much greater dissemination of effective, gastrointestinal (GI)-targeted therapies for obesity and metabolic disorders. To reproduce the benefits of bariatric surgery, however, these endoscopic procedures and devices will need to mimic the physiological rather than the mechanical effects of these operations.
减肥手术，包括胃旁路手术、垂直袖状胃切除术和胆胰分流术，是治疗肥胖最有效且持久的方法。此外，这些手术会引发代谢变化，从而在不依赖体重减轻的情况下改善2型糖尿病、脂肪性肝病和其他代谢紊乱。这些手术最初被认为是通过机械性限制食物摄入或摄入营养物质的吸收不良来起作用的，现在已知它们是通过肠道发出的神经内分泌和免疫信号的复杂变化来起作用的，这些信号包括肽类激素、胆汁酸、迷走神经活动以及肠道微生物群产生的代谢物，所有这些共同协作来重新调节食欲、食物偏好和能量消耗。开发实现这些益处的侵入性较小的方法将使针对肥胖和代谢紊乱的有效胃肠道（GI）靶向疗法得到更广泛的应用。然而，为了重现减肥手术的益处，这些内镜手术和器械需要模拟这些手术的生理效应而非机械效应。
