An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery

Table 1

Overview of less invasive methods mimicking bariatric surgery.

	Subjects	Procedure	Weight loss over time	Effect on comorbidity	Complication(s)
	(i) Number treated; (ii) BMI	(i) Endoscopic/laparoscopic; (ii) Sedation; (iii) Time
Intragastric balloons; (e.g., BIB, Heliosphere BAG, Spatz Adjustable Balloon System)	(i) 𝑛>100,000; (ii) 29–60 kg/m^2	(i) Endoscopic; (ii) Under midazolam; (iii) Implantation in ≤20 minutes	15 kg (range 9–21 kg) or 2–10 BMI-points in 6 months; An average 24 kg after one year	T2DM and hypertension ameliorate/resolve in a minority; dyslipidemia improves in 50%; 11% remains unchanged	Dyspepsia; Persistent emesis; Esofagitis; Distal migration; Small bowel obstruction
Gastric plication; (e.g., TOGA, BaroSense, SurgASSIST, Endocinch, TERIS)	(i) 𝑛=±80; (ii) 30–51 kg/m^2	(i) Endoscopic; (ii) Under general anaesthesia; (iii) Average 125 min (range 60–140 minutes)	24–46% EWL in 6 months; 23–53% EWL in 1 year; NB location of the plication affects result	Not well evaluated yet	Vomiting; Nausea; Stomach aches; Gastric perforation; Obstruction
Gastric botulinum toxin injections	(i) 𝑛=±100; (ii) 30–54 kg/m^2	(i) Endoscopic; (ii) Under midazolam; (iii) 8–24 injections in antrum/fundus	Conflicting results; Average weight loss 12 kg/4 BMI points in 2 months (versus 6 kg/2 BMI points in the sham group)	Not well evaluated yet	None reported
Gastric pacing (e.g., Transcend, Abiliti Intrapace, Tantalus II)	(i) 𝑛>500; (ii) 30–57 kg/m^2	(i) Laparoscopic; (ii) Under general anaesthesia; (iii) 2-3 hours	20–40% EWL after two years	Not well evaluated yet	Lead dislodgement; Gastric perforation under view (directly corrected)
Vagal nerve stimulation	(i) 𝑛=±90; (ii) 18–49 kg/m^2	(i) Laparoscopic; (ii) Under general anaesthesia; (iii) 60 to 90 minutes	14–23% EWL after 6 months	Not well evaluated yet	None reported
Endoscopic duodenal-jejunal sleeve (Endobarrier, Valentx)	(i) 𝑛=500; (ii) 40–60 kg/m^2	(i) Endoscopic; (ii) Under general anaesthesia; (ii) Implantation and explantation in 15–45 minutes	12–40% EWL or 8–17 kg in three months	T2DM remission	Vomiting,; Nausea; Abdominal pain; Mucosal tear; GI bleeding; Migration/obstruction