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Endoscopic techniques for weight loss and treating metabolic syndrome

Brunaldi, Vitor O.a; Galvao Neto, Manoelb

Current Opinion in Gastroenterology: September 2019 - Volume 35 - Issue 5 - p 424–431
doi: 10.1097/MOG.0000000000000561
ENDOSCOPY: Edited by Anthony N. Kalloo

Purpose of review The endoscopic armamentarium against obesity and metabolic syndrome is rapidly growing and improving. Novel devices have been tested and recent data either support or reject their use. We aim to discuss current data on new endoscopic procedures addressing overweight, diabetes, and metabolic syndrome.

Recent findings Four-year follow-up of the aspiration therapy have shown efficacy and safety at long term. A recent consensus on intragastric balloon gathered experience from more than 40 000 procedures and standardized most steps of the treatment. The TransPyloric Shuttle has been proven effective at short term but carries high rates of adverse events. The endoscopic sleeve gastroplasty promotes similar weight loss to laparoscopic sleeve gastrectomy in mildly obese patien. The endoluminal magnetic partial jejunal diversion promoted good weight loss and a significant reduction in glycated hemoglobin (HbA1c) but most cases required laparoscopic assistance to couple the magnets. One-year follow-up demonstrated that the duodenal mucosal resurfacing carried a 1.0% reduction in HbA1c.

Summary Innovative endoscopic procedures focused on the treatment of overweight and related diseases are available and there is growing evidence supporting their use. Nonetheless, a multidisciplinary approach is mandatory.

Video abstract

aGastroenterology Department, Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil

bSurgery Department, Florida International University, Miami, Florida, USA

Correspondence to Vitor O. Brunaldi, MD, MSc, Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, Eneas de Carvalho Aguiar Av. 255, São Paulo City 05304-000, São Paulo State, Brazil. Tel: +55 1126616467; e-mail:,

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