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Obesity is a pandemic affecting approximately 700 million adults worldwide, with an additional 2 billion overweight. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric therapy that involves remodeling of the greater curvature in an effort to reduce gastric capacity and delay gastric emptying. A variety of ESG suture patterns has been reported. This study is the first to use a uniform "U" stitch pattern across all centers to simplify technical aspects of the procedure and limit cost. This also uniquely assessed outcomes in all body mass index (BMI) categories and changes in metabolic rate, lean body mass, and adipose tissue composition.This is a multicenter analysis of prospectively collected data from 7 centers including patients with overweight and obesity who underwent ESG. Primary outcomes included absolute weight loss, percent total body weight loss (%TWL), change in BMI, and percent excess weight loss (%EWL) at 6 and 12 months in overweight and obese classes I, II, and III. Secondary outcomes included adipose tissue, lean body mass reduction, and metabolic rate analyzed by bioimpedance. Additionally, immediate or delayed adverse events (AEs) were analyzed. Clinical success was defined as achieving ≥25% EWL at 1 year with ≤5% serious AE (SAE) rate following the American Society for Gastrointestinal Endoscopy (ASGE)/American Society for Metabolic and Bariatric Surgery (ASMBS) threshold.A total of 193 patients underwent ESG during the study period. All groups had10% TWL and25% EWL at 6 months of follow-up. On average, %TWL was 14.25% ± 5.26% and 15.06% ± 5.22% and the %EWL 56.15% ± 22.93% and 59.41% ± 25.69% at 6 months and 1 year of follow-up, respectively. %TWL was 8.91% ± .3%, 13.92% ± 5.76%, 16.22% ± 7.69%, and 19.01% ± .95% and %EWL 56.21% ± 2.0%, 62.03% ± 27.63%, 54.13% ± 23.46%, and 46.78% ± 2.43% for overweight and obesity classes I, II, and III, respectively, at 1 year. Male sex, age 41 years, and higher BMI were predictors of achieving a TWL ≥10% at 1-year follow-up. There was a significant reduction in adipose tissue from baseline. SAEs occurred in 1.03%, including 2 perigastric collections needing surgery.ESG appears to be feasible, safe, and effective in the treatment of patients with overweight and obesity according to ASGE/ASMBS thresholds.

To analyze the results regarding weight loss and complications related to the Spatz3® adjustable intragastric balloon (IGB) in Brazil. This randomized prospective study covered patients who had undergone treatment using a Spatz3® adjustable IGB between October 2016 and June 2018 at a private clinic in Rio de Janeiro, Brazil. The patients had a minimum body mass index (BMI) of 27 kg/m2. The study examined complications of Spatz3® treatment and BMI reduction, percentage of total weight loss (%TWL), and % of excess weight loss (%EWL). One hundred eighty patients underwent a Spatz3® balloon implant in the period. The patients were randomly divided into one group in which the Spatz balloon was kept at the same volume (600 mL) throughout treatment (Control Group), and another adjustment group with 250 mL greater volume. The complication rate was 16.14%. No death or major complication occurred during the study. Mean BMI decreased from 39.51 to 32.84 kg/m2 (p

Obesity is an important risk factor for several chronic diseases and also is associated with worse quality of life. Intragastric balloon (IGB) is an effective method for weight loss. Although changes in lifestyle are critical to weight loss during and after IGB therapy, only a few studies evaluated dietary intake and none evaluated changes in physical activity with a validated questionnaire during the treatment. The aim of this study was to evaluate changes in total and central body adiposity, dietary intake, physical activity, and quality of life of patients with obesity submitted to IGB treatment for 6 months. Prospective observational study involving 42 patients with obesity using IGB for 6 months. The patients were evaluated, on the day of insertion and withdrawal or adjustment of IGB for total and central body adiposity (anthropometry and bioelectrical impedance), dietary intake, physical activity (Baecke questionnaire), and quality of life (SF-36 questionnaire). There was a significant decrease in total and central body adiposity. The mean % total weight loss and % excess weight loss were 15.88 ± 1.42 and 56.04 ± 4.90, respectively and waist circumference decreased 13.33 ± 1.39 cm. There was a reduction in energy intake, an increase in physical activity, and an improvement of quality of life during IGB treatment. The present study suggests that IGB treatment during 6 months in individuals with obesity is effective for decreasing total and central body adiposity being associated with reduction in energy intake, increase in physical activity, and improvement in quality of life.

Background and study aims Obesity is a serious disease, resulting in significant morbidity and mortality. Intragastric balloons (IGBs) have been in use since the 1980s. After the insertion of an IGB, complications such as migration of the device and even severe gastric perforation can occur, requiring laparoscopic surgery. Here, we report three cases of gastric perforation after IGB insertion. In all three cases, the perforation was successfully repaired through an exclusively endoscopic approach.

The adjustable intragastric balloon (Spatz® – Spatz Medical, Great Neck, NY, USA) is a water-filled device that may indwell in the stomach for 1 Year. It is an attractive device, but implantation, adjustment, and removal procedures have some particularities. This chapter describes the standard and alternative techniques to handle these procedures and thus help overcome any potential troublesome situation that may arise during the treatment.

Obesity is accompanied by adipose tissue remodeling characterized by increased production of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, leptin and resistin and reduced secretion of adiponectin, which favors inflammation, metabolic disorders, and cardiovascular diseases. Although intragastric balloon (IGB) can be considered safe and effective for weight loss, its effect on serum levels of these biomarkers has been evaluated only in a few studies, while no previous study evaluated its effect on circulating levels of resistin, TNF-α, and IL-6. The aim of this study was to evaluate the changes in serum levels of metabolic and inflammatory biomarkers in obese patients submitted to IGB treatment. A prospective observational study involving 42 patients with obesity using IGB for 6 months. The patients were evaluated, on the day of insertion and withdrawal or adjustment of IGB, for the following: anthropometric measures and serum levels of adiponectin, leptin, resistin, TNF-α, IL-6, high-sensitivity C-reactive protein (hs-CRP), glucose, insulin, uric acid, triglycerides, and total cholesterol and fractions. The body mass index decreased from 35.15 ± 0.41 to 29.50 ± 0.54 kg/m2. There was a reduction (p

Background and Aims Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe). Methods A literature search of publication databases was performed from their inception to February 2020 for relevant studies. The outcomes of interest were percentage total body weight loss, gastrojejunal anastomosis (GJA) diameter, and adverse events (AEs). The pooled effect estimates were analyzed using a random-effects model. Meta-regression was conducted to identify associations between GJA diameter and weight loss. Results Nine ft-TORe (n = 737) and 7 APMC-TORe (n = 888) studies were included. APMC-TORe was performed as a series of sessions (mean number of sessions ranging from 1.2 to 3), whereas ft-TORe was mostly performed as a single session. Percentage total body weight loss was 8.0% (95% confidence interval [CI], 6.3%-9.7%), 9.5% (95% CI, 8.1%-11.0%), and 5.8% (95% CI, 4.3%-7.1%) after ft-TORe and 9.0% (95% CI, 4.1%-13.9%), 10.2% (95% CI, 8.4%-12.1%), and 9.5% (95% CI, 5.7%-13.2%) after APMC-TORe at 3, 6, and 12 months, respectively, with no weight-loss difference at 3 and 6 months (P > .05). Only one severe AE was observed after APMC-TORe and none after ft-TORe. Stricture formation was the most common AE (ft-TORe 3.3% and APMC-TORe 4.8%, P = .38). All were successfully treated by endoscopic dilation or conservative treatment. Smaller aperture of the post-TORe GJA and greater change in the GJA diameter correlated with greater weight loss in APMC-TORe and numerical trends in ft-TORe. Conclusions This meta-analysis demonstrates that both ft-TORe and APMC-TORe offer significant and comparable weight-loss outcomes with a high and comparable safety profile. However, APMC-TORe typically required multiple endoscopic sessions. Identifying a goal for the final and change in GJA diameter could be useful treatment targets.

Several studies conducted in adults suggest that intragastric balloon (IGB) is an effective and safe method for weight loss. Although the prevalence of obesity in adolescents has increased in recent years, the outcomes of IGB treatment in this age group are not known. The aim of this study was to evaluate the safety and efficacy of IGB treatment for weight loss in adolescents followed up for 6 months. This is a retrospective longitudinal study including 27 adolescents (14–19 years; 23 female). All participants were referred to IGB treatment by their attending physician, presented body mass index (BMI) ≥ 29 kg/m2 (>p97 BMI/age index) and failed to lose weight in clinical treatments. A liquid-filled nonadjustable IGB with a volume of 600 to 700 ml was used for 6 months. All patients were included in a multidisciplinary program, and adherence to this program was evaluated as the number of attended appointments. There were no serious complications or deaths. The BMI decreased from 37.04 to 31.18 kg/m2 (p

A1c (HgbA1c) were reduced by 6cm (p o 0.01) and -0.15% (p o 0.05), respectively. Improvements were also seen in triglycerides, HDL, LDL, ALT, and AST. At trial exit, IWQOL-Lite mean scores improved across all domains: þ10.5, þ14.4, þ1.9, þ9.6, þ6.9, and þ9.1 for PF, SE, SL, PD, W, and O, respectively. An improvement of greater than 7.7 in any domain is considered statistically significant. Conclusions: This study demonstrates clinically significant weight loss with ElipseTM, the first procedureless gastric balloon. The weight loss was similar to that seen in prior studies of endoscopically placed balloons. There were no serious adverse events. In addition, ElipseTM therapy led to a significant improvement in waist circumference, HgbA1c, and overall quality of life.

INTRODUCTION: The global increase in obesity incidence results in an increase of type 2 diabetes mellitus (T2DM) incidence. Surgical treatment has proven to be effective, however it carries a high risk of complications. The duodenal-jejunal bypass liner (EndoBarrier®, GI Dynamics, DJBL) is an endoscopic implant that mimics the intestinal bypass portion of the Roux-en-Y Bystric bypass. It results in weight loss and improvements in glucose control in obese patients with T2DM. AIMS & METHODS: This is an interim report of an ongoing three years study. The aim of this prospective, controlled, multicentre study is to determine the effectiveness of DJBL and to identify clinical factors associated with a sub-optimal outcome of DJBL. RESULTS: Forty four subjects (24 with an implant, 20 controls) were included in the study. The groups were comparable with respect to age, gender, BMI (mean 37.7 vs. 38.1 kg/m2), T2DM duration (7.2 vs. 8.3 years), HbA1c level (8.8 % vs 8.1 %) and T2DM treatment. In the DJBL group, all devices were successfully implanted. Only three devices had to be explanted prior to the end of the 6 months study period (bleeding, dislocation and need for ERCP because of choledocholithiasis). The mean procedure time was 21.2 minutes for an implantation and 35.5 minutes for an explantation. At six months there was significantly greater weight loss (27% vs. 9%) and significantly improved HbA1c % (2.3 vs. 1.1) in the DJBL group. T2DMmedicinal treatment could be reduced in more device subjects than controls. There was no serious adverse event. Mild abdominal pain and nausea after implantation were experienced by 75% of patients during first 14 days after implantation, 40% of patients during the first month and 11% of patiens after one month. Lower initial BMI, distal position of the anchor and lower body height were identified as negative prognostic factors for pain. CONCLUSION: The DJBL is safe when implanted for 6 months, and results in significant weight loss and HbA1c reduction. This suggests that this novel device is a candidate for the primary therapy of morbid obesity and type 2 diabetes. Lower initial BMI, distal position of the anchor and lower body height could be negative prognostic factor for pain

INTRODUCTION: The global increase in obesity incidence results in an increase of type 2 diabetes mellitus (T2DM) incidence. Surgical treatment has proven to be effective, however it carries a high risk of complications. The duodenal-jejunal bypass liner (EndoBarrier®, GI Dynamics, DJBL) is an endoscopic implant that mimics the intestinal bypass portion of the Roux-en-Y Bystric bypass. It results in weight loss and improvements in glucose control in obese patients with T2DM. AIMS & METHODS: This is an interim report of an ongoing three years study. The aim of this prospective, controlled, multicentre study is to determine the effectiveness of DJBL and to identify clinical factors associated with a sub-optimal outcome of DJBL. RESULTS: Forty four subjects (24 with an implant, 20 controls) were included in the study. The groups were comparable with respect to age, gender, BMI (mean 37.7 vs. 38.1 kg/m2), T2DM duration (7.2 vs. 8.3 years), HbA1c level (8.8 % vs 8.1 %) and T2DM treatment. In the DJBL group, all devices were successfully implanted. Only three devices had to be explanted prior to the end of the 6 months study period (bleeding, dislocation and need for ERCP because of choledocholithiasis). The mean procedure time was 21.2 minutes for an implantation and 35.5 minutes for an explantation. At six months there was significantly greater weight loss (27% vs. 9%) and significantly improved HbA1c % (2.3 vs. 1.1) in the DJBL group. T2DMmedicinal treatment could be reduced in more device subjects than controls. There was no serious adverse event. Mild abdominal pain and nausea after implantation were experienced by 75% of patients during first 14 days after implantation, 40% of patients during the first month and 11% of patiens after one month. Lower initial BMI, distal position of the anchor and lower body height were identified as negative prognostic factors for pain. CONCLUSION: The DJBL is safe when implanted for 6 months, and results in significant weight loss and HbA1c reduction. This suggests that this novel device is a candidate for the primary therapy of morbid obesity and type 2 diabetes. Lower initial BMI, distal position of the anchor and lower body height could be negative prognostic factor for pain