Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.
Curr Gastroenterol Rep. 2020 Nov 17;22(12):60. doi: 10.1007/s11894-020-00798-8.
Obesity is a chronic relapsing disease that results in cardiovascular disease, diabetes mellitus, and non-alcoholic fatty liver disease. Currently, surgery represents the most effective treatment. However, the advent of minimally invasive endoscopic bariatric therapy (EBT) has shifted the treatment paradigm to less invasive, cost-effective procedures with minimal complications and recovery time that are preferred by patients. In this review, we will describe current and future EBTs, focusing on outcomes and safety.
The endoscope has provided an incisionless portal into the gastrointestinal tract for placement of space-occupying devices and intraluminal procedures. EBTs are no longer solely manipulating anatomic alterations; instead, they aim to improve metabolic parameters such as glycated hemoglobin, low-density lipoprotein, cholesterol, and hepatic indices by targeting the mucosal layer of the gastrointestinal tract. The endoscope has succeeded in facilitating clinically meaningful weight loss and improvement of metabolic parameters. Future, solutions to the obesity epidemic will likely entail genetic testing, evaluation of the microbiome, and delivery of personalized therapy, utilizing combination endoscopic modalities that change the anatomy and physiology of individual patients, with new targets such as the abnormal metabolic signal.
肥胖是一种慢性复发性疾病，可导致心血管疾病、糖尿病和非酒精性脂肪性肝病。目前，手术是最有效的治疗方法。然而，微创内镜减重治疗（EBT）的出现已经将治疗模式转变为创伤更小、成本效益更高、并发症和恢复时间更短的方法，这些方法更受患者的青睐。在这篇综述中，我们将描述当前和未来的 EBT，重点关注其结果和安全性。
内镜为胃肠道提供了一个无切口的门户，用于放置占位性设备和腔内手术。EBT 不再仅仅是改变解剖结构；相反，它们通过靶向胃肠道的黏膜层，旨在改善糖化血红蛋白、低密度脂蛋白、胆固醇和肝指数等代谢参数。内镜成功地促进了有临床意义的体重减轻和代谢参数的改善。未来，解决肥胖症流行问题可能需要进行基因测试、评估微生物组，并提供个性化治疗，利用改变个体患者解剖结构和生理学的联合内镜方式，以异常代谢信号等新靶点为目标。
