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Obesity among adults in the U.S. remains high at 35% of the population. Obesity is associated with numerous health problems, including diabetes and heart disease. It has many other ramifications as well, such as preventing patients from having lifesaving organ transplants.
Treatment options for patients with obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery. Very recently, endoscopic bariatric therapies (EBTs) have become available. These may be a recommended option for patients within certain BMI ranges for whom diet and behavior changes are not working sufficiently, who are not good candidates for surgery, or who are not willing to undergo surgery. Endoscopic bariatric therapies are performed without surgery, so they are considered less invasive.
The components of lifestyle intervention include diet, exercise, and behavior modification and should be considered the cornerstone of any obesity treatment. However, as a stand-alone therapy, even intensive lifestyle intervention is only modestly effective, with 5 to 10 percent total body weight loss at one year. Weight regain typically occurs after one year, but some health benefits do persist.
In 2015, ASGE launched the Association for Bariatric Endoscopy (ABE), with a focus on providing the latest education and training to endoscopists with an interest in providing EBTs to help improve the health of patients with obesity. This education includes not only the technical aspects of performing EBT procedures. It also includes an understanding of obesity medicine and metabolic conditions; how to set up a team of health professionals to support the bariatric patient; and how to follow up EBTs with medications, lifestyle support and other ongoing support.
ASGE and ABE are working collaboratively with societies representing bariatric surgeons, metabolic specialists, dietitians and other members of the healthcare team to ensure that emerging technologies and therapies can be provided to patients safely and effectively.
ASGE and ABE organized the EndoVators Summit on Obesity in November 2016, bringing together thought leaders in this treatment area as well as experts representing regulators, technology companies and payers. A white paper reporting on this summit was published in November 2017. There are four current endoscopic therapies approved by the FDA. Each involves a non-surgical approach.
Saline balloon systems (two are on the market) involve placing balloons into the patient’s stomach using an endoscope, then inflating the balloons with saline solution. The balloons take up some of the space in the stomach, creating a feeling of fullness. They are approved for patients with body mass index (BMI) in the 30-40 range, and are left in the stomach for about six months.
A swallowable balloon system allows the patient to swallow the balloon, and once it reaches the stomach, the physician inflates it with gas via a tube inserted endoscopically.
An aspiration device uses a PEG tube (placed by an endoscopist) leading from the patient’s stomach to the outside of the body. Through the tube, the patient can aspirate (draw out) a portion of food from the stomach at each meal before it can be further digested, thus eliminating a portion of the patient’s caloric intake.
Each of these systems is put into place accompanied by nutritional support, and each is designed to help the patient become used to eating smaller amounts of food (and more slowly), which helps to develop better long-term eating habits.
Patients with obesity need a multidisciplinary approach to achieve a healthy weight. Dietary changes, lifestyle changes (including exercise) and pharmacotherapy are considered before any type of endoscopic or surgical procedure is recommended. GI endoscopists who provide endoscopic bariatric therapies typically do so in a setting where there is access to experts in nutrition, behavioral therapy and exercise physiology.
Patients should be evaluated for any physical or psychological issues to determine whether they are good candidates for any given procedure. Once a patient starts on the path of an endoscopic bariatric therapy with his or her medical team, counseling and support are provided along the way to ensure proper nutrition and to support long-term improvement of lifestyle and nutritional habits.
Gastroenterologists are in a unique position to lead the care team to achieve a patient’s weight loss goal. They are medical internists, with training in the broad range of medical issues. At the same time, they are specialists in digestive disorders and endoscopy. Obesity is a digestive disorder, and is related to many other conditions that gastroenterologists treat.
ASGE and ABE members are committed to the safe and effective integration of endoscopic bariatric therapies into practice as this field evolves, in order to offer patients more options in the range of treatments available for obesity.
Updated October 2017