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Background and study aims Gastro-gastric fistulae (GGF) occur in 1.3 % to 6 % of Rouxy-en-Y gastric bypass (RYGB) patients and can be associated with abdominal pain, reflux, weight regain and onset of diabetes. Endoscopic and surgical treatments are available without prior comparisons. The study aim was to compare endoscopic and surgical treatment methods in RYGB patients with GGF. Patients and methods A retrospective matched cohort study of RYGB patients who underwent endoscopic closure (ENDO) or surgical revision (SURG) for GGF. One-to-one matching was performed based on age, sex, body mass index and weight regain. Patient demographics, GGF size, procedural details, symptoms and treatment-related adverse events (AEs) were collected. A comparison of symptom improvement and treatment-related AEs was performed. Fisher’s Exact, t-test and Wilcoxon Rank Sum tests were performed. Results Ninety RYGB patients with GGF (45 ENDO, 45 matched SURG) were included. GGF symptoms included weight regain (80 %), gastroesophageal reflux disease (71 %) and abdominal pain (67 %). At 6 months, the ENDO and SURG groups experienced 0.59 % and 5.5 % total weight loss (TWL) (P = 0.0002). At 12 months, the ENDO and SURG groups experienced 1.9 % and 6.2 % TWL (P = 0.007). Abdominal pain improved in 12 (52.2 %) ENDO and 5 (15.2 %) SURG patients at 12 months (P = 0.007). Diabetes and reflux resolution rates were similar between groups. Treatment-related AEs occurred in four (8.9 %) ENDO and 16 (35.6 %) SURG patients (P = 0.005), of which none and eight (17.8%), respectively, were serious (P = 0.006). Conclusions Endoscopic GGF treatment produces greater improvement in abdominal pain and fewer overall and serious treatment-related AEs. However, surgical revision appears to yield greater weight loss.

BackgroundThe AspireAssist is the first Food and Drug Administration-approved endoluminal device indicated for treatment of class II and III obesity.ObjectivesWe earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes.SettingUnited States-based, 10-center, randomized controlled trial involving 171 participants with the treatment arm receiving Aspiration Therapy (AT) plus Lifestyle Therapy and the control arm receiving Lifestyle Therapy (2:1 randomization).MethodsAT participants were permitted to continue in the study for an additional year up to a maximum of 5 years providing they maintained at least 10% total weight loss (TWL) from baseline at each year end. For AT participants who continued the study, 5 medical monitoring visits were provided at weeks 60, 68, 76, 90, and 104 and thereafter once every 13 weeks up to week 260. Exclusion criteria were a history of eating disorder or evidence of eating disorder on a validated questionnaire. Follow-up weight, quality of life, and co-morbidities were compared with the baseline levels. In addition, rates of serious adverse event, persistent fistula, withdrawal, and A-tube replacement were reported. All analyses were performed using a per-protocol analysis.ResultsOf the 82 AT participants who completed 1 year, 58 continued to this phase of the trial. Mean baseline body mass index of these 58 patients was 41.6 ± 4.5 kg/m2. At the end of first year (at the beginning of the follow-up study), these 58 patients had a body mass index of 34.1 ± 5.4 kg/m2 and had achieved an 18.3 ± 8.0% TWL. On a per protocol basis, patients experienced 14.2%, 15.3%, 16.6%, and 18.7% TWL at 1, 2, 3, and 4 years, respectively (P < .01 for all). Forty of 58 patients (69%) achieved at least 10% TWL at 4 years or at time of study withdrawal. Improvements in quality of life scores and select cardiometabolic parameters were also maintained through 4 years. There were 2 serious adverse events reported in the second through fourth years, both of which resolved with removal or replacement of the A tube. Two persistent fistulas required surgical repair, representing approximately 2% of all tube removals. There were no clinically significant metabolic or electrolytes disorders observed, nor any evidence for development of any eating disorders.ConclusionsThe results of this midterm study have shown that AT is a safe, effective, and durable weight loss alternative for people with class II and III obesity and who are willing to commit to using the therapy and adhere to adjustments in eating behavior.

Background and Aims: Esophageal function testing is an integral component of the evaluation of refractory GERD and esophageal motility disorders. This review summarizes the current technologies available for esophageal function testing, including the functional luminal imaging probe (FLIP), high-resolution esophageal manometry (HRM), and multichannel intraluminal impedance (MII) and pH monitoring. Methods: We performed a MEDLINE, PubMed, and MAUDE database literature search to identify pertinent clinical studies through March 2021 using the following key words: esophageal manometry, HRM, esophageal impedance, FLIP, MII, and esophageal pH testing. Technical data were gathered from traditional and web-based publications, proprietary publications, and informal communications with pertinent vendors. The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy. Results: FLIP is a high-resolution impedance planimetry system used for pressure and dimension measurement in the esophagus, pylorus, and anal sphincter. FLIP provides complementary information to HRM for esophageal motility disorders, especially achalasia. The Chicago classification, based on HRM data, is a widely adopted algorithmic scheme used to diagnose esophageal motility disorders. MII detects intraluminal bolus movement and, combined with pH measurement or manometry, provides information on acid and non-acid gastroesophageal reflux and bolus transit in patients with refractory GERD and for preoperative evaluation for anti-reflux procedures. Conclusions: Esophageal function testing techniques (FLIP, HRM, and MII-pH) have diagnostic and prognostic value in the evaluation of esophageal motility disorders and refractory GERD. Newer technologies and classification systems have enabled an increased understanding of these diseases.

Background and study aims Given the sizable number of patients with symptomatic gastroesophageal reflux disease (GERD) despite proton pump inhibitor (PPI) therapy, non-pharmacologic treatment has become increasingly utilized. The aim of this study was to analyze the cost-effectiveness of medical, endoscopic, and surgical treatment of GERD. Patients and methods A deterministic Markov cohort model was constructed from the US healthcare payer’s perspective to evaluate the cost-effectiveness of three competing strategies: 1) omeprazole 20 mg twice daily; 2) transoral incisionless fundoplication (TIF 2.0); and 3) laparoscopic Nissen fundoplication [LNF]. Cost was reported in US dollars with health outcomes recorded in quality-adjusted life years (QALYs). Ten-year and lifetime time horizons were utilized with 3 % discount rate and half-cycle corrections applied. The main outcome was incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $ 100,000 per QALY. Probabilistic sensitivity analyses were also performed. Results In our base-case analysis, the average cost of TIF 2.0 was $ 13,978.63 versus $ 17,658.47 for LNF and $ 10,931.49 for PPI. Compared to the PPI strategy, TIF 2.0 was cost-effective with an incremental cost of $ 3,047 and incremental effectiveness of 0.29 QALYs, resulting in an ICER of $ 10,423.17 /QALY gained. LNF was strongly dominated by TIF 2.0. Over a lifetime horizon, TIF 2.0 remained the cost-effective strategy for patients with symptoms despite twice-daily 20-mg omeprazole. TIF 2.0 remained cost-effective after varying parameter inputs in deterministic and probabilistic sensitivity analyses and for scenario analyses in multiple age groups. Conclusions Based upon this study, TIF 2.0 was cost-effective for patients with symptomatic GERD despite low-dose, twice-daily PPI.

Background/Aims Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities. Methods A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs). Results Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 – -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 – 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 – -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7–6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 – -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 – -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 – -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p

Background/Aims Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling. Methods This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events. Results A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort. Conclusions Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.

Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) requires a unique skill set. Currently, there is no objective methodology to assess and train a professional to perform ERCP. This study aimed to develop and validate a novel ERCP simulator. Methods The simulator consists of papillae presenting different anatomy and positioned in varied locations. Deep cannulation of the pancreatic duct, followed by the bile duct, was performed. The time allotted was 5 minutes. The content validity indexes (CVIs) for realism, relevance, and representativeness were calculated. Correlation between ERCP experience and simulator score was determined. Results Twenty-three participants completed the simulation. The CVIs for realism were orientation of duodenoscope to papilla (1.00), angulation of papillotome to achieve cannulation (0.71), and haptic feedback during cannulation (0.80). The CVIs for relevance were use of elevator (1.00), wheels to achieve en face orientation (1.00), and papillotome for selective cannulation (1.00). Regarding CVI for representativeness, the results were as follows: basic cannulation (0.83), papilla locations (0.83), and papilla anatomies (0.80). The novice, intermediate, and experienced groups scored 6.7±8.7, 30.0±16.3, and 74.4±43.9, respectively (p

Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported. We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management. A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups. The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.

Obesity is becoming a universal healthcare problem. The role of endoscopic bariatric and metabolic therapies is emerging in the management of obesity and its related conditions. The endoscopic treatment can be used as a primary weight loss procedure and a revision procedure after bariatric surgery. While the prevalence of obesity has been rising over the past two decades in Thailand, the treatment options have been limited to diet and exercise, pharmacological treatment, and bariatric surgery until recently. In 2020, an endoscopic full-thickness suturing device was introduced to Thailand, leading to successful endoscopic bariatric therapy using a suturing device in Thai patients. This article intends to report the first successful endoscopic sleeve gastroplasty and transoral outlet reduction in Thailand with a mini-review focusing on these two procedures' outcomes.

Familial hypercholesterolemia (FH) is inherited as an autosomal dominant. It is an important clinical condition leading to hypertension, atherosclerosis, and premature coronary artery disease. Atherosclerosis is rarely reported in children. We report here 2 children with familial hypercholesterolemia and early atherosclerosis. The first case is a 4 year-old Thai boy who presented with yellowish papules in the skin creases which had been present for 2 years. His grandfather and father had been diagnosed with diabetes mellitus and hypercholesterolemia, respectively. Physical examination revealed his weight for height to be 125% and planar xanthomas. The remaining examination was unremarkable. Plasma lipid profiles showed a total cholesterol level of 674 mg/dl, a triglyceride level of 261 mg/dl, a high-density lipoprotein cholesterol (HDL-C) level of 39 mg/dl, and a low-density lipoprotein cholesterol (LDL-C) level of 583 mg/dl. The results of a carotid duplex scan showed atherosclerotic plaques in both carotid arteries. The second case is a 10 year-old Thai boy who had no symptoms, but his mother and uncle had been diagnosed with coronary heart disease and diabetes mellitus, respectively. Physical examination revealed a weight for height of 112%, but the remaining examination was unremarkable. Plasma lipid profiles showed a total cholesterol level of 328 mg/dl, a triglyceride level of 59 mg/dl, and HDL-C level of 54 mg/dl, and an LDL-C level of 262 mg/dl. A carotid duplex scan showed atherosclerotic plaques in both carotid arteries. Atherosclerosis is rarely reported in children and it usually correlates with ischemic heart disease. The finding of atherosclerotic plaques in the large arteries may reflect deposition of atheroma in their coronary arteries. We suggest that this investigation is an important procedure in the screening of early atherosclerosis in order to primarily and secondarily prevent premature coronary artery disease.

Background and study aims Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is traditionally considered a first-line strategy for diagnosing pancreatic lesions; however, given less than ideal accuracy rates, fine-needle biopsy (FNB) has been recently developed to yield histological tissue. The aim of this study was to compare diagnostic yield and safety between EUS-FNA and EUS-FNB in sampling of pancreatic masses. Patients and methods This was a multicenter retrospective study to evaluate efficacy and safety of EUS-FNA and EUS-FNB for pancreatic lesions. Baseline characteristics including sensitivity, specificity, and accuracy, were evaluated. Rapid on-site evaluation (ROSE) diagnostic adequacy, cell-block accuracy, and adverse events were analyzed. Subgroup analyses comparing FNA versus FNB route of tissue acquisition and comparison between methods with or without ROSE were performed. Multivariable logistic regression was also performed. Results A total of 574 patients (n = 194 FNA, n = 380 FNB) were included. Overall sensitivity, specificity, and accuracy of FNB versus FNA were similar [(89.09 % versus 85.62 %; P = 0.229), (98.04 % versus 96.88 %; P = 0.387), and 90.29 % versus 87.50 %; P = 0.307)]. Number of passes for ROSE adequacy and cell-block accuracy were comparable for FNA versus FNB [(3.06 ± 1.62 versus 3.04 ± 1.88; P = 0.11) and (3.08 ± 1.63 versus 3.35 ± 2.02; P = 0.137)]. FNA + ROSE was superior to FNA alone regarding sensitivity and accuracy [91.96 % versus 70.83 %; P

Bariatric endoscopy is an emerging subspecialty for gastroenterologists encompassing a broad array of procedures including primary endoscopic bariatric and metabolic therapies and the treatment of complications of bariatric surgery. In addition, comprehensive understanding of lifestyle intervention and pharmacotherapy are essential to successful outcomes. This review summarizes goals and steps of training for this emerging field.

Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.

Objective: To evaluate the estrogenic effect on the maturation index of hormonal replacement therapy (HRT) in postmenopausal women (PMW). Methods: The maturation indexes (MI) were evaluated based on vaginal cytology which was classified into no, low, moderate and high MI. Results: There were 70 PMW who were not on HRT evaluated for controls. There were 66%, 23%, 7% and 4% of them had no, low, moderate and high MI. There were 18 PMW who used transdermal estrogen patch or gel. It was found that 0%, 66%, 17% and 17% of them had no, low, moderate and high MI. There were 42 PMW who were given oral hormonal tablets. It was found that 7%, 33%, 53% and 7% of them had no, low, moderate and high MI. Conclusion: Hormonal replacement therapy whether via patch, gel or oral intake resulted in changes in maturation index in postmenopausal women.

Objective: This study was to compare the pulmonary function, respiratory muscle strength, and physical activity level between obese and non-obese children and to determine the correlation between pulmonary function, respiratory muscle strength and physical activity level in both child groups. Methods: Thai healthy children aged between 10-12 years participated in this study. They were classified into an obese group with body weight > +3 standard deviations and a non-obese group with body weight between ± 1.5 standard deviations of children who have the same height. Children in both groups were measured for pulmonary function, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1 ), FEV1 /FVC ratio, vital capacity (VC), inspiratory muscle strength (MIP), expiratory muscle strength (MEP), and physical activity level. Results: The results showed that FVC, FEV1 and VC of the obese group were statistically higher than the non-obese group (p 0.05). Physical activity levels were not significantly different between the groups (p>0.05). Moreover, the results demonstrated that physical activity level in the obese group had no correlation with FVC, FEV1 , FEV1 /FVC ratio and VC (r = 0.203, 0.170, -0.067 and 0.133 respectively; p > 0.05) and similarly the non-obese group showed no correlation with FVC, FEV1 , FEV1 /FVC ratio and VC (r = 0.225, 0.168, -0.207 and 0.168 respectively; p > 0.05). Additionally, the results demonstrated that physical activity level in the obese group had no correlation with MIP and MEP (r = 0.151 and 0.355 respectively; p > 0.05) and similarly the non-obese group showed no correlation with MIP and MEP (r = 0.202 and 0.006 respectively; p > 0.05). Conclusion: This study provides information about the pulmonary function and respiratory muscle strength in Thai obese children. FVC, FEV1 and VC of the obese group were higher than the non-obese group. In addition, FEV1 /FVC ratio of the obese group was lower than the non-obese group. Although, all parameters including pulmonary function of both groups were in the normal range. However, obese children tend to observe airway obstruction higher than non-obese children. Moreover, respiratory muscle strength and physical activity level were not different between groups. Additionally, physical activity level had no correlation with pulmonary function and respiratory muscle strength in both groups.

Objective: To study dietary patterns of secondary-school students at Grade VII and Grade X. Methods: Students both male and female at Grade VII and Grade X were taught about food exchange lists. Then the investigators asked them to fill their food intakes during the past 7 days by using food frequency. Also, the investigators measured their bodyweight and heights, then classified them by BMI into 3 groups which were normal weight (group I) overweight (group II) and obese (group III). Results: The male students in normal bodyweight groups at Grade VII drank more milk than the females of the same group. The energy, carbohydrate, protein and fat intakes were not different between male and female students and among the 3 groups at Grade VII. In contrast, the male students at Grade X in normal bodyweight group and overweight group had more intakes of energy, protein and fat. Also the boys of the normal bodyweight group at Grade X drank more milk. Conclusion: There were no differences in energy intakes among students of the same Grade of different BMI. Female students drank less milk than male students in the normal weight group. The male students in normal bodyweight and overweight groups at Grade X consumed more foods than the female students.

Objective: Familial hypercholesterolemia (FH) is associated with atherosclerosis coronary artery disease (CAD). The aim of this study is to identify a mutation in the LDL receptor gene that underlined the FH phenotype in a female patient and her family. Methods: The LDL receptor gene was screened by Polymerase Chain Reaction-Single Strand Conformation Polymorphism (PCR-SSCP), direct DNA sequencing and was subsequently confirmed by PCR-RFLP. Results: The screening of the entire LDL receptor gene revealed a 5' donor splice site mutation of the first base of intron 3, i.e., 313+1G➔T mutation in one allele. This mutation was previously reported in a Danish patient with severe hypercholesterolemia. Conclusion: This case report illustrates the use of DNA diagnosis of a female heterozygous FH case and her family members, which is more accurate than clinical diagnosis especially when clinical phenotype is variable or when the individual who is at high risk is still a normolipidemic at his/ her young age. DNA diagnosis is now used as a tool to find or diagnose FH. Accurate and/or early diagnosis is important for prevention and treatment of FH patients in order to avoid the development of CAD in these patients.

Objective: To determine the association between reductions of fat from subcutaneous, intermuscular and subfascial compartment at thighs and improvement of serum insulin level. Methods: A longitudinal, clinical intervention study of restricted energy with exercise was performed in 20 healthy, overweight teenagers (age: 10-15 y, BMI: 26-40 kg/m2). Fat distribution parameter (by dual-energy X-ray absorptiometry and computerized axial tomography at thigh), serum insulin, body weight were assessed at baseline and after 4 weeks. Results: There are significant reductions in bodyweight, BMI, serum insulin, FGIR subfascial fat and intermuscular fat after 4 weeks. Loss of subfascial fat at thighs is significantly associated with decreasing levels of serum insulin in those who have initially abnormal high levels. Conclusion: Losses of subfascial fat at thighs is associated with improvement of insulin levels in obese teenagers who are on 4 weeks of dietary restriction and moderate exercise.Â

Obesity is a condition that can play a very significant role on the health of children who are growing up into maturity. The effects of obesity include increased risk of heart disease, diabetes, and hypertension. Its major causes are excessive eating, lack of restraint, and easily gratifying their desire for tasty food. If an adjustment can be made to their perception and behavior so that they can define the volume of food consumed then these obese children are capable of monitoring their weight and are able to reduce the risk of illness as a consequence of obesity without needing weight control pills which can be detrimental to their health. The most important factor that can help to change obese children's behavior is their perceived self-efficiency in monitoring their weight by self-control practiced by dieting and balanced exercise using the support of other members of the obese children group. Â Â Â Participation in the summer camp for obese children has the following objectives to promote their perceived self-efficacy; to make an adjustment to their consumption and exercise behavior, and to make them aware of the effects of obesity. The activities of the project comprised of education relating to obese children and their parents, restriction of energy intake to 800 Kcal/d, participation in group activities and exercise e.g. swimming, aerobics, and visual education without administration of weight control tablets for 4 weeks, 5 days/week. After completing of the summer camp, group meetings were held occasionally to assess their perceived self-efficacy. The results of monitoring the behavior of 20 obese children participating in project with BMI ranging from 26-41 Kg/m2, with age range of 10-15 years, were assessed by data collection by questionnaires concerning perceived self-efficacy, a BMI Assessment Form, and the data analysed using paired t-test. The results of the assessment on the last day of the summer camp and 12 weeks after the late day found that obese children had an increased perceived self-efficacy at a statistically significant level of P

Obesity is a worsening pandemic with numerous related comorbid illnesses. Conservative management including lifestyle modification and medications have limited efficacy. In contradistinction, bariatric surgery is effective, however, with substantial cost and non-negligible morbidity and mortality. As such, a small percentage of eligible patients undergo surgery. Over the past decade, endoscopic bariatric and metabolic therapies have been introduced as a less invasive option for the treatment of obesity and its related comorbid illnesses. This article reviews major endoscopic bariatric and metabolic therapies, their surgical analogues, and proposed mechanisms of action. Clinical trial data for each device also are discussed. [ABSTRACT FROM AUTHOR]