Department of Gastroenterology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany,
Digestion. 2019;100(3):147-151. doi: 10.1159/000494428. Epub 2019 Feb 7.
Obesity and its metabolic sequelae are among the most serious challenges faced by health systems today and they are expected to pose a serious threat in the future as well. Therapy ranges from lifestyle modification to drug treatment to surgery. Metabolic endoscopy (ME) might close the gap between invasive "metabolic" surgery and conservative, less effective treatment. In recent years, several endoscopic approaches have emerged, promising a safe and effective approach to cope with obesity. Data on metabolic endpoints is scarce. This article will therefore highlight procedures with data on type 2 diabetes mellitus (T2DM) as the most prominent component of the metabolic syndrome.
Most procedures showed beneficial effects in terms of weight reduction. For gastric procedures, there were no systematic studies primarily addressing parameters of glucose metabolism or diabetes outcomes. Metabolic benefit, if there is any, is most likely a by-product of weight loss. By contrast, duodenal-jejunal bypass sleeve (DJBS) is conceptually an antidiabetic procedure. Although adverse events are frequent, recent data points to a positive benefit-risk ratio. Key Messages: ME has the potential to constitute a growing field in the treatment of obesity and associated T2DM. While data published on glycaemic parameters in restrictive approaches is not sufficient, there is strong evidence that malabsorptive DJBS has an antidiabetic "plus" effect. Further studies are necessary to define the role of ME within a lifelong concept of treating obesity and T2DM.
肥胖及其代谢后果是当今卫生系统面临的最严峻挑战之一，预计未来也将构成严重威胁。治疗方法包括生活方式改变、药物治疗到手术治疗。代谢内镜（ME）可能缩小侵入性“代谢”手术与保守、效果较差的治疗之间的差距。近年来，出现了几种内镜方法，有望为应对肥胖提供一种安全有效的方法。代谢终点的数据稀缺。因此，本文将重点介绍针对 2 型糖尿病（T2DM）作为代谢综合征最突出组成部分的数据的程序。
大多数程序在体重减轻方面显示出有益的效果。对于胃手术，没有系统的研究主要针对葡萄糖代谢或糖尿病结果的参数。如果存在代谢益处，很可能是减肥的副产品。相比之下，十二指肠空肠旁路袖套（DJBS）从概念上说是一种抗糖尿病手术。尽管不良事件频繁，但最近的数据表明其具有积极的获益风险比。
ME 有可能成为肥胖和相关 T2DM 治疗领域的一个不断发展的领域。虽然关于限制性方法中血糖参数的数据不足，但有强有力的证据表明，吸收不良的 DJBS 具有抗糖尿病的“附加”作用。需要进一步的研究来确定 ME 在治疗肥胖和 T2DM 的终身概念中的作用。
