Table 1: Overview of less invasive methods mimicking bariatric surgery.

SubjectsProcedureWeight loss over timeEffect on comorbidityComplication(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 > 1 0 0 , 0 0 0
(ii) 29–60 kg/m2
(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
Persistent emesis
Distal migration
Small bowel obstruction

Gastric plication
(e.g., TOGA, BaroSense, SurgASSIST, Endocinch, TERIS)
(i) 𝑛 = ± 8 0
(ii) 30–51 kg/m2
(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 yetVomiting
Stomach aches
Gastric perforation

Gastric botulinum toxin injections(i) 𝑛 = ± 1 0 0
(ii) 30–54 kg/m2
(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 yetNone reported

Gastric pacing (e.g., Transcend, Abiliti Intrapace, Tantalus II)(i) 𝑛 > 5 0 0
(ii) 30–57 kg/m2
(i) Laparoscopic
(ii) Under general anaesthesia
(iii) 2-3 hours
20–40% EWL after two yearsNot well evaluated yetLead dislodgement
Gastric perforation under view (directly corrected)

Vagal nerve stimulation(i) 𝑛 = ± 9 0
(ii) 18–49 kg/m2
(i) Laparoscopic
(ii) Under general anaesthesia
(iii) 60 to 90 minutes
14–23% EWL after 6 monthsNot well evaluated yetNone reported

Endoscopic duodenal-jejunal sleeve (Endobarrier, Valentx)(i) 𝑛 = 5 0 0
(ii) 40–60 kg/m2
(i) Endoscopic
(ii) Under general anaesthesia
(ii) Implantation and explantation in 15–45 minutes
12–40% EWL or 8–17 kg in three monthsT2DM remissionVomiting,
Abdominal pain
Mucosal tear
GI bleeding