Endoscopic Bariatric Therapies

Bariatric surgery is a very effective weight loss treatment. Non-surgical weight loss approaches, including pharmacotherapy, diet, exercise and lifestyle modification, are, many times, less effective than weight loss surgery. But weight loss surgery has more associated complications than non-surgical methods. Fortunately, experts are exploring treatment options that mimic bariatric surgery while reducing the associated complications. Some of these options could prove to be good weight loss approaches.

Many of the options can be classified as endoscopic bariatric therapies or EBTs. A task force was formed to investigate these options. Members comprising the taskforce are drawn from two well known organizations. These organizations are The American Society for Gastrointestinal Endoscopy (ASGE) and The American Society for Metabolic and Bariatric Surgery (ASMBS). EBTs are "performed entirely through the gastrointestinal (GI) tract using flexible endoscopes." Usually there is no surgical incision associated with EBTs. Many EBTs mimic the functions of bariatric surgery.

Bariatric surgical procedures can be put into two broad categories. The procedures are either restrictive or malabsorptive. For example, the adjustable lap band is restrictive since it restricts the amount of food that can pass through the band. And gastric bypass surgery is both restrictive and malabsorptive. It is restrictive since it shrinks the size of the stomach, reducing the amount of food one needs to eat to feel full. And bypass surgery is malabsorptive, since the surgery reroutes the small intestine in a way to cause food to bypass parts of the small intestine, allowing fewer calories (and other nutrients) to be digested.

EBTs may be put into three categories. They may be restrictive, malabsorptive , or neuro-hormonal. An example of an EBT that fits into the restrictive category is the gastric balloon. This device is first placed in the stomach, endoscopically, then filled with a liquid or air. When the gastric balloon is filled, an individual’s stomach feels full with less food. A complex version of this EBT is in research at ReShape Medical, Inc, headquartered in San Clemente, California.

An example of an EBT device that may be classified as malabsorptive is the Endobarrier. Produced by Lexington, MA based GI Dynamics, the Endobarrier is a liner for a segment of the small intestine. Similar to the gastric balloon, the Endobarrier is placed in the small intestine endoscopically. The device is engineered to create a barrier between the food one eats and the intestinal walls. After insertion, food digestion is delayed in a fashion similar to gastric bypass surgery.

And finally, an example of a potential EBT that can be classified as neuro-hormonal is VBLOC. VBLOC was developed by Minnesota based EnteroMedics Inc. VBLOC is a system placed in the digestive system, laparoscopically, to block signals sent from the digestive system, via the vagus nerve, to the brain. The signals include messages associated with hunger, satisfaction and fullness.

As EBTs are developed, tested, and proven effective, medical weight loss options might be enhanced. Both patients and weight loss service providers could benefit. Medical and surgical weight loss service providers should monitor the progress made in EBT research, so that the providers will know when they might offer the EBT as part of their services, or give advice regarding appropriate EBT application.

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Tags: environmental scanning, endoscopic bariatric therapies, strategic management, strategic planning, endobarrier, vbloc