CentraCare, Interventional Endoscopy Program, St. Cloud Hospital, 1406 6th Ave N, St. Cloud, MN, 56303, USA.
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA.
Indian J Gastroenterol. 2024 Oct;43(5):916-926. doi: 10.1007/s12664-024-01632-z. Epub 2024 Aug 10.
The escalating obesity pandemic and its comorbidities necessitate adaptable and versatile treatment strategies. Endobariatric and metabolic therapies (EBMTs) can be strategically employed in a multipronged approach to obesity management, analogous to the way chess systems are employed to seize opportunities and thwart threats. In this review, we explore the spectrum of established and developing EBMTs, examining their efficacy in weight loss and metabolic improvement and their importance for a tailored, patient-centric approach. The complexity of obesity management mirrors the intricate nature of a chess game, with an array of tactics and strategies available to address the opponent's moves. Similarly, the bariatric endoscopist employs a range of EBMTs to alter the gastrointestinal tract landscape, targeting critical anatomical regions to modify physiological reactions to food consumption and nutrient assimilation. Gastric-focused EBMTs aim to reduce stomach capacity and induce satiety. Intestinal-focused EBMTs target hormonal regulation and nutrient absorption to improve metabolic profiles. EBMTs offer unique advantages of reversibility, adjustability and minimal invasiveness, allowing them to be used as primary treatments, adjuncts to pharmacotherapy or tools to address post-bariatric surgery weight recidivism. However, sub-optimal adoption of EBMTs due to lack of awareness, perceived costs and limited training opportunities hinders their integration into standard obesity management practices. By strategically integrating EBMTs into the broader landscape of obesity care, leveraging their unique advantages to enhance outcomes, clinicians can offer a more dynamic and personalized treatment paradigm. This approach, akin to employing chess systems to adapt to evolving challenges, allows for a comprehensive, patient-centric management of obesity as a chronic, complex and relapsing disease.
肥胖症的流行及其合并症不断加剧,需要灵活多变的治疗策略。内视镜减重与代谢治疗(Endobariatric and metabolic therapies,EBMTs)可以作为肥胖管理的多管齐下策略的一部分,以类似下国际象棋系统利用机会和挫败威胁的方式,进行战略性应用。在这篇综述中,我们探讨了已确立和正在发展的 EBMT 范围,研究了它们在减肥和代谢改善方面的疗效,以及它们对个体化、以患者为中心的方法的重要性。肥胖管理的复杂性反映了国际象棋游戏的复杂性质,有一系列策略和战术可用于应对对手的行动。同样,减重内镜医生也使用各种 EBMT 来改变胃肠道的地貌,针对关键的解剖区域,改变对食物摄入和营养吸收的生理反应。以胃为中心的 EBMT 旨在减少胃容量并诱导饱腹感。以肠为中心的 EBMT 则针对激素调节和营养吸收,以改善代谢特征。EBMT 具有可逆转性、可调节性和微创性等独特优势,可作为主要治疗方法、药物治疗的辅助手段,或解决减重手术后体重再次增加的工具。然而,由于缺乏认识、感知成本和有限的培训机会,EBMT 的采用不理想,阻碍了它们纳入肥胖管理标准实践。通过将 EBMT 战略性地整合到肥胖护理的更广泛领域中,利用它们的独特优势来提高治疗效果,临床医生可以提供更具活力和个性化的治疗方案。这种方法类似于采用国际象棋系统来适应不断变化的挑战,可以对肥胖症作为一种慢性、复杂和易复发的疾病进行全面、以患者为中心的管理。