We read with great interest the review article on metabobariatric endoscopic therapies by Telese et al. (1) The authors have done a wonderful job of summarizing and reviewing up-to-date advances in metabobariatric endoscopic therapies. However, we would like to highlight a few additional points. Recently, the Food and Drug Administration came out with an update on intragastric balloons (IGBs) (2). Postapproval surveillance studies of IGBs reported unusual spontaneous hyperinflation of liquid-filled balloons with more air/liquid leading to increased nausea, vomiting, and pain in 6 of 258 (2.3%) patients who underwent Orbera (Apollo Endosurgery, Austin, TX) balloon implantation, requiring early balloon removal (2). There also have been reports of post-IGB implantation acute pancreatitis in 2 of 159 (1.3%) after the ReShape Duo (ReShape Medical, San Clemente, CA) balloon placement, possibly related to the compression of the pancreatic parenchyma/duct by the balloon (2). Although causality is yet to be proven, the risk of unexplained temporally-related deaths after IGB implantation has also been a cause of concern (2). Such risks need to be explained and discussed with the patients.
Notwithstanding their safety concerns, IGBs offer an excellent minimally invasive weight loss option not only for patients with grade I and II obesity, with a body mass index between 30 and 40 kg/m2 as suggested by the authors, but also for a select group of patients with grade III obesity as a bridge procedure to bariatric surgery and to facilitate nonbariatric surgeries, which are often difficult and risky in patients with grade III obesity (3).
Another metabobariatric endoscopic intervention worth mentioning for the completeness of the review is the Full Sense device (Baker, Foote, Kemmeter, Walburn, LLC, Grand Rapids, MI), which is a fully covered metallic stent placed in the lower esophagus with a connecting strut to a gastric disc, which compresses the cardia leading to satiety (4).
Although Roux-en-Y gastric bypass is an effective bariatric surgery, up to 15% of the patients regain weight requiring some form of revision procedure (5). The endoscopic bariatric armamentarium is not complete without a mention of transoral outlet reduction, which involves plication and reduction of the gastrojejunal anastomosis to have a mechanical effect on gastric emptying (5).
However, despite a few omissions and need for clarification mentioned above, the review is quite comprehensive, easy to read, and of benefit for the busy clinical gastroenterologists and endoscopists with particular interest in obesity and its associated comorbid conditions. We congratulate the authors for the review and thank the journal for publishing this article.
CONFLICTS OF INTEREST
Guarantor of the article: Uday C. Ghoshal, MD, DM.
Specific author contributions: A.E.: conceptualized and wrote the first draft. A.K. and U.C.G.: provided intellectual content and edited the article.
Financial support: None to report.
Potential competing interests: None to report.
1. Telese A, Sehgal V, Magee CG, et al. Bariatric and metabolic endoscopy: A new paradigm. Clin Transl Gastroenterol 2021;12(6):e00364.
2. US Food and Drug Administration. UPDATE: Potential risks with liquid-filled intragastric balloons - Letter to health care providers. FDA. 2020 (https://www.fda.gov/medical-devices/letters-health-care-providers/update-potential-risks-liquid-filled-intragastric-balloons-letter-health-care-providers-1
). Accessed June 28, 2021.
3. Bazerbachi F, Vargas EJ, Abu Dayyeh BK. Endoscopic bariatric therapy: A guide to the intragastric balloon. Am J Gastroenterol 2019;114(9):1421–31.
4. ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee, Abu Dayyeh BK, Kumar N, Edmundowicz SA, et al. Endoscopic bariatric therapies. GastrointestEndosc 2015;81(5):1073–86.
5. Efficacy of transoral outlet reduction in roux-en-Y gastric bypass patients to promote weight loss: A systematic review and meta-analysis. Endosc Int Open 2020;8(10):E1332–E1340. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511267/
. Accessed June 28, 2021.