STOMACH AND DUODENUM: Edited by Tilak U. ShahEndobariatrics: well past infancy and maturing rapidlyShrestha, Shreesha,b; Shrestha, Eshac; Shah, Tilakd Author Information aDivision of Gastroenterology and Hepatology, Virginia Commonwealth University Health Center bDivision of Gastroenterology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA cDepartment of Clinical Physiology, Kantipur Dental College and Teaching Hospital, Nepal dDepartment of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331 Correspondence to Shreesh Shrestha, MD, Division of Gastroenterology, Virginia Commonwealth University, 1200 East Broad Street, 14th floor, Box 980341, Richmond, VA 23298, USA. Tel: +1 804 828 4060; e-mail: [email protected] Current Opinion in Gastroenterology: November 2022 - Volume 38 - Issue 6 - p 592-599 doi: 10.1097/MOG.0000000000000884 Buy Metrics Abstract Purpose of review This review summarizes the key developments with regard to FDA-approved endoscopic bariatric metabolic therapies (EBMTs) in the last 2 years. Recent findings The prevalence of obesity has increased during the coronavirus disease 2019 (COVID-19) pandemic, and obesity worsens COVID-19 related outcomes. Several studies have confirmed the safety and short-term efficacy of intragastric balloons (IGBs). In the short-term IGBs may improve steatosis and fibrosis in nonalcoholic fatty liver disease and improve quality of life and mental health. Unfortunately weight loss from these temporarily placed devices is not sustained long-term. Endoscopic sleeve gastroplasty (ESG) may be more effective and durable than IGBs, and result in fewer adverse events compared to bariatric surgery. The recently completed MERIT trial may catapult ESG as a first-line EBMT. Aspiration therapy meets safety and effectiveness thresholds for incorporation into routine practice, but overall acceptance has been lower than other FDA-approved EBMTs. Summary The field of endobariatrics is rapidly maturing. Significant knowledge gaps remain with regards to combining EBMTs with pharmacologic therapy to improve durability of weight loss. The rapid expansion in the literature supporting safety and long-term efficacy ESG may prompt revision of existing guidelines. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.