Department of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States.
Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, TX 75216, United States.
World J Gastroenterol. 2019 Aug 28;25(32):4567-4579. doi: 10.3748/wjg.v25.i32.4567.
The prevalence of obesity continues to rise, and along with it comes a multitude of health-related consequences. The healthcare community has consistently struggled with providing treatment options to obese patients, in part due to the reluctance of patients in pursuing the more effective (yet invasive) surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric bypass. On the other hand, the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy (Orlistat, Phenteramine, Phentermine/Topiramate, Locaserin, Naltrexon/Buproprion, and Liraglutide) have very limited efficacy, especially in the morbidly obese patients. Despite our best efforts, the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and society. Bariatric endoscopy is an evolving field generated to combat this epidemic through minimally invasive techniques. These procedures can be performed in an ambulatory setting, are potentially reversible, repeatable, and pose less complications than their invasive surgical counterparts. These modalities are designed to alter gut metabolism by means of space occupation, malabsorption, or restriction. In this review we will discuss different bariatric endoscopic options (such as intragastric balloons, endoscopic sleeve gastroplasty, endoscopic aspiration therapies and gastrointestinal bypass sleeves), their advantages and disadvantages, and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.
肥胖的患病率持续上升，随之而来的是众多与健康相关的后果。医疗保健界一直在努力为肥胖患者提供治疗方案，部分原因是患者不愿意接受更有效的（但具有侵入性）手术方法，如袖状胃切除术和 Rou-en-Y 胃旁路术。另一方面，侵入性较小的方法，如生活方式/行为干预和药物治疗（奥利司他、苯丁胺、苯丙胺/托吡酯、洛卡西林、纳曲酮/安非他酮和利拉鲁肽），疗效非常有限，尤其是在病态肥胖患者中。尽管我们尽了最大努力，但肥胖症的流行仍在继续上升，并给我们的医疗保健系统和社会带来巨大的成本。减肥内镜是一个不断发展的领域，旨在通过微创技术来对抗这一流行。这些程序可以在门诊环境中进行，具有潜在的可逆转性、可重复性，并且比其侵入性手术方法并发症更少。这些方法旨在通过占位、吸收不良或限制来改变肠道代谢。在这篇综述中，我们将讨论不同的减肥内镜选择（如胃内球囊、内镜袖状胃成形术、内镜抽吸治疗和胃肠旁路袖套），它们的优缺点，并提出一个新的范例，提供者可以开始将这种模式纳入肥胖患者的治疗方法中。
