Download PDF
Endoscopy 2010; 42(2): 155-162
DOI: 10.1055/s-0029-1243876
Review

© Georg Thieme Verlag KG Stuttgart · New York

The future of bariatrics: endoscopy, endoluminal surgery, and natural orifice transluminal endoscopic surgery

N.  Tsesmeli1 , D.  Coumaros1
  • 1Service d’Hépatogastroentérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
Further Information

Publication History

submitted 10 October 2008

accepted after revision 16 July 2009

Publication Date:
05 February 2010 (online)

Also available at
    Permissions and Reprints

This review considers the evolving role of endoscopic techniques in the treatment of obesity, and developments in minimally invasive procedures in endoscopy, endoluminal surgery and natural orifice transluminal endoscopic surgery (NOTES). Endoscopic approaches that are similar to surgery but less invasive, relying on gastric restriction and/or malabsorption, show some promise. Intragastric injection of botulinum toxin is also considered, as is the role of minimally invasive bariatric endoscopic interventions. Gastrointestinal stimulation with implanted electrodes may have potential in the treatment of obesity and endoscopic applications have a role to play in post-surgical interventions. Evolving research into endosurgical approaches is described. Current work on the feasibility of a NOTES approach to bariatric procedures is described.

References

  • 1 Gui D, De Gaetano A, Spada P L. et al . Botulinum toxin injected in the gastric wall reduces body weight and food intake in rats.  Aliment Pharmacol Ther. 2000;  14 829-834
    CrossrefPubMedGoogle Scholar
  • 2 Albani G, Petroni M L, Mauro A. et al . Safety and efficacy of therapy with botulinum toxin in obesity: a pilot study.  J Gastroenterol. 2005;  40 833-835
    CrossrefPubMedGoogle Scholar
  • 3 Garcia-Compean D, Mendoza-Fuerte E, Martinez J A. et al . Endoscopic injection of botulinum toxin in the gastric antrum for the treatment of obesity. Results of a pilot study.  Gastroenterol Clin Biol. 2005;  29 789-791
    CrossrefPubMedGoogle Scholar
  • 4 Junior A C, Savassi-Rocha P R, Coelho L G. et al . Botulinum A toxin injected into the gastric wall for the treatment of class III obesity: a pilot study.  Obes Surg. 2006;  16 335-343
    CrossrefPubMedGoogle Scholar
  • 5 Gui D, Mingrone G, Valenza V. et al . Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study.  Aliment Pharmacol Ther. 2006;  23 675-680
    CrossrefPubMedGoogle Scholar
  • 6 Mittermair R, Keller C, Geibel J. Intragastric injection of botulinum toxin A for the treatment of obesity.  Obes Surg. 2007;  17 732-736
    CrossrefPubMedGoogle Scholar
  • 7 Foschi D, Corsi F, Lazzaroni M. et al . Treatment of morbid obesity by intraparietogastric administration of botulinum toxin: a randomized, double-blind controlled study.  Int J Obes (Lond). 2007;  31 707-712
    PubMedGoogle Scholar
  • 8 Awan A N, Swain C P. Endoscopic vertical band gastroplasty with an endoscopic sewing machine.  Gastrointest Endosc. 2002;  55 254-256
    CrossrefPubMedGoogle Scholar
  • 9 Schiefke I, Zabel-Langhennig A, Neumann S. et al . Long term failure of endoscopic gastroplication (EndoCinch).  Gut. 2005;  54 752-758
    CrossrefPubMedGoogle Scholar
  • 10 Hu B, Chung C S, Sun L C. et al . Transoral obesity surgery: endoluminal gastroplasty with an endoscopic suture device.  Endoscopy. 2005;  37 411-414
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Kantsevoy S, Hu B, Jagannath S. et al . Technical feasibility of endoscopic gastric reduction: a pilot study in a porcine model.  Gastrointest Endosc. 2007;  65 510-513
    CrossrefPubMedGoogle Scholar
  • 12 Fogel R, De Fogel J, Bonilla Y. et al . Clinical experience of transoral suturing for an endoluminal vertical gastroplasty: 1-year follow-up in 64 patients.  Gastrointest Endosc. 2008;  68 51-58
    CrossrefPubMedGoogle Scholar
  • 13 Devière J, Ojeda Valdes G. et al . Safety, feasibility and weight loss after transoral gastroplasty: First human multicenter study.  Surg Endosc. 2008;  22 589-598
    CrossrefPubMedGoogle Scholar
  • 14 Moreno C, Closset J, Dugardeyn S. et al . Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study.  Endoscopy. 2008;  40 406-413
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Elder K, Wolfe B. Bariatric surgery: a review of procedures and outcomes.  Gastroenterology. 2007;  132 2253-2271
    CrossrefPubMedGoogle Scholar
  • 16 Tarnoff M, Shikora S, Lembo A. Acute technical feasibility of an endoscopic duodenal-jejunal bypass sleeve in a porcine model: a potentially novel treatment for obesity and type 2 diabetes.  Surg Endosc. 2008;  22 772-776
    CrossrefPubMedGoogle Scholar
  • 17 Tarnoff M, Shikora S, Lembo A. et al . Chronic in-vivo experience with an endoscopically delivered and retrieved duodenal-jejunal bypass sleeve in a porcine model.  Surg Endosc. 2008;  22 1023-1028
    CrossrefPubMedGoogle Scholar
  • 18 Rodriguez-Grunert L, Galvao N eto, Alamo M. et al . First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve.  Surg Obes Relat Dis. 2008;  4 55-59
    CrossrefPubMedGoogle Scholar
  • 19 Chopita N, Vaillaverde A, Cope C. et al . Endoscopic gastroenteric anastomosis using magnets.  Endoscopy. 2005;  37 313-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Jamil L H, Krause K R, Chengelis D L. et al . Endoscopic management of early upper gastrointestinal hemorrhage following laparoscopic Roux-en-Y gastric bypass.  Am J Gastroenterol. 2008;  103 86-91
    PubMedGoogle Scholar
  • 21 Adam L, Silva R G, Rizk M. et al . Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty.  Gastrointest Endosc. 2007;  65 337-339
    CrossrefPubMedGoogle Scholar
  • 22 Ukleja A, Afonso B, Pimentel R. et al . Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass.  Surg Endosc. 2008;  22 1746-1750
    CrossrefPubMedGoogle Scholar
  • 23 Fernández-Esparrach G, Bordas J M, Llach J. et al . Endoscopic dilation with Savary-Gilliard bougies of stomal strictures after laparoscopic gastric bypass in morbidly obese patients.  Obes Surg. 2008;  18 155-161
    CrossrefPubMedGoogle Scholar
  • 24 Merrifield B F, Lautz D, Thompson C C. Endoscopic repair of gastric leaks after Roux-en-Y gastric bypass: a less invasive approach.  Gastrointest Endosc. 2006;  63 710-714
    CrossrefPubMedGoogle Scholar
  • 25 Eisendrath P, Cremer M, Himpens J. et al . Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery.  Endoscopy. 2007;  39 625-630
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Silecchia G, Boru C E, Mouiel J. et al . Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial.  Obes Surg. 2006;  16 125-131
    CrossrefPubMedGoogle Scholar
  • 27 Catalano M F, Rudic G, Anderson A J. et al . Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision.  Gastrointest Endosc. 2007;  66 240-245
    CrossrefPubMedGoogle Scholar
  • 28 Thompson C C, Slattery J, Bundga M E. et al . Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain.  Surg Endosc. 2006;  20 1744-1748
    CrossrefPubMedGoogle Scholar
  • 29 Yu S, Jastrow K, Clapp B. et al . Foreign material erosion after laparoscopic Roux-en-Y gastric bypass: findings and treatment.  Surg Endosc. 2007;  21 1216-1220
    CrossrefPubMedGoogle Scholar
  • 30 Evans J A, Williams N N, Chan E P. et al . Endoscopic removal of eroded bands in vertical banded gastroplasty: a novel use of endoscopic scissors (with video).  Gastrointest Endosc. 2006;  64 801-804
    CrossrefPubMedGoogle Scholar
  • 31 Mattar S G, Qureshi F, Taylor D. et al . Treatment of refractory gastroesophageal reflux disease with radiofrequency energy (Stretta) in patients after Roux-en-Y gastric bypass.  Surg Endosc. 2006;  20 850-854
    CrossrefPubMedGoogle Scholar
  • 32 Bergstrom M, Swain P, Park P O. Early clinical experience with a new flexible endoscopic suturing method for natural orifice transluminal endoscopic surgery and intraluminal endosurgery (with videos).  Gastrointest Endosc. 2008;  67 528-533
    CrossrefPubMedGoogle Scholar
  • 33 Overcash W. Natural orifice surgery (NOS) using StomaphyX™ for repair of gastric leaks after bariatric revisions.  Obes Surg. 2008;  18 882-885
    CrossrefPubMedGoogle Scholar
  • 34 Higa K D, Boone K, Nimeri A. et al . Gastric bypass: increased restriction for poor weight loss.  Surg Endosc. 2007;  21 1922-1923
    CrossrefPubMedGoogle Scholar
  • 35 Herron D M, Birkett D H, Thompson C C. et al . Gastric bypass pouch and stoma reduction using a transoral endoscopic anchor placement system: a feasibility study.  Surg Endosc. 2008;  22 1093-1099
    CrossrefPubMedGoogle Scholar
  • 36 Tang S, Olukoga C, Provost D. et al . Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos).  Gastrointest Endosc. 2008;  68 132-138
    CrossrefPubMedGoogle Scholar
  • 37 Felsher J, Rosen M, Farres H. et al . A novel endolaparoscopic intragastric partitioning for treatment of morbid obesity.  Surg Laparosc Endosc Percutan Tech. 2004;  14 243-246
    PubMedGoogle Scholar
  • 38 Del Genio G, Gagner M, Nocca D. et al . Endoscopic cervical bariatric surgery: follow-up study in a porcine model.  Obes Surg. 2008;  18 1188-1191
    CrossrefPubMedGoogle Scholar
  • 39 Milone L, Gagner M, Ueda K. et al . Effect of a polyethylene endoluminal duodeno-jejunal tube (EDJT) on weight gain: a feasibility study in a porcine model.  Obes Surg. 2006;  16 620-626
    CrossrefPubMedGoogle Scholar
  • 40 Shang E, Hasenberg T, Magdeburg R. et al . First experiences with a circular stapled gastro-jejunostomy by a new transorally introducible stapler system in laparoscopic Roux-en-Y gastric bypass.  Obes Surg. 2009;  19 230-236
    CrossrefPubMedGoogle Scholar
  • 41 Xu X, Zhu H B, Chen J D. Pyloric electrical stimulation reduces food intake by inhibiting gastric motility in dogs.  Gastroenterology. 2005;  128 43-50
    CrossrefPubMedGoogle Scholar
  • 42 Yin J, Zhang J, Chen J. Inhibitory effects of intestinal electrical stimulation on food intake, weight loss and gastric emptying in rats.  Am J Physiol Regulatory Integrative Comp Physiol. 2007;  293 78-82
    PubMedGoogle Scholar
  • 43 Xu J, McNearney T A, Chen J D. Gastric/intestinal electrical stimulation modulates appetite regulatory peptide hormones in the stomach and duodenum in rats.  Obes Surg. 2007;  17 406-413
    CrossrefPubMedGoogle Scholar
  • 44 Liu S, Tang M, Tao S. et al . Central expressions of ghrelin and cholecystokinin in rats with gastric electrical stimulation.  Obes Surg. 2008;  18 109-114
    CrossrefPubMedGoogle Scholar
  • 45 Xu X, Pasricha P J, Chen J D. Feasibility of gastric electrical stimulation by use of endoscopically placed electrodes.  Gastrointest Endosc. 2007;  66 981-986
    CrossrefPubMedGoogle Scholar
  • 46 Sallam H S, Chen J D, Pasricha P J. Feasibility of gastric electrical stimulation by percutaneous endoscopic transgastric electrodes.  Gastrointest Endosc. 2008;  68 754-759
    CrossrefPubMedGoogle Scholar
  • 47 Yao S K, Ke M Y, Wang Z F. et al . Visceral sensitivity to gastric stimulation and its correlation with alterations in gastric emptying and accommodation in humans.  Obes Surg. 2005;  15 247-253
    CrossrefPubMedGoogle Scholar
  • 48 Yao S, Ke M, Wang Z. et al . Retrograde gastric pacing reduces food intake and delays gastric emptying in humans: a potential therapy for obesity?.  Dig Dis Sci. 2005;  50 1569-1575
    CrossrefPubMedGoogle Scholar
  • 49 Liu J, Hou X, Song G. et al . Gastric electrical stimulation using endoscopically placed mucosal electrodes reduces food intake in humans.  Am J Gastroenterol. 2006;  101 798-803
    CrossrefPubMedGoogle Scholar
  • 50 Ayinala S, Batista O, Goyal A. et al . Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis.  Gastrointest Endosc. 2005;  61 455-461
    CrossrefPubMedGoogle Scholar
  • 51 Elfvin A, Andersson S, Abrahamsson H. et al . Percutaneous implantation of gastric electrodes – a novel technique applied in animals and in patients.  Neurogastroenterol Motil. 2007;  19 103-109
    CrossrefPubMedGoogle Scholar
  • 52 Lin X M, Hayes J, Peters L J. et al . Entrainment of intestinal slow waves with electrical stimulation using intraluminal electrodes.  Ann Biomed Eng. 2000;  28 582-587
    CrossrefPubMedGoogle Scholar
  • 53 Liu S, Hou X, Chen J D. Therapeutic potential of duodenal electrical stimulation for obesity: acute effects on gastric emptying and water intake.  Am J Gastroenterol. 2005;  100 792-796
    CrossrefPubMedGoogle Scholar
  • 54 Liu J, Qiao X, Hou X. et al . Effect of intestinal pacing on small bowel transit and nutrient absorption in healthy volunteers.  Obes Surg. 2009;  19 196-201
    CrossrefPubMedGoogle Scholar
  • 55 Fritscher–Ravens A, Mosse C A, Mukerjee D. et al . Transluminal endosurgery: single lumen access anastomotic device for flexible endoscopy.  Gastrointest Endosc. 2003;  58 585-591
    CrossrefPubMedGoogle Scholar
  • 56 Swanstrom L L, Kozarek R, Pasricha P J. et al . Development of a new access device for transgastric surgery.  J Gastrointest Surg. 2005;  9 1129-1136
    CrossrefPubMedGoogle Scholar
  • 57 Park A E, Adrales G L, McKinlay R. et al . A novel intestinal anastomotic device in a porcine model.  Am Surg. 2004;  70 767-773
    PubMedGoogle Scholar
  • 58 Kantsevoy S V, Niiyama H, Jagannath S. et al . The endoscopic transilluminator: an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy.  Gastrointest Endosc. 2006;  63 1055-1058
    CrossrefPubMedGoogle Scholar
  • 59 Kantsevoy S V, Jagannath S B, Niiyama H. et al . Endoscopic gastrojejunostomy with long-term survival in a porcine model.  Gastrointest Endosc. 2005;  62 287-292
    CrossrefPubMedGoogle Scholar
  • 60 Bergstrom M, Ikeda K, Swain P. et al . Transgastric anastomosis by using flexible endoscopy in a porcine model (with video).  Gastrointest Endosc. 2006;  63 307-312
    CrossrefPubMedGoogle Scholar
  • 61 Mintz Y, Horgan S, Savu M. et al . Hybrid natural orifice translumenal surgery (NOTES) sleeve gastrectomy: a feasibility study using an animal model.  Surg Endosc. 2008;  22 1798-1802
    CrossrefPubMedGoogle Scholar
  • 62 Madan A, Tichansky D, Khan K. Natural orifice transluminal endoscopic gastric bypass performed in a cadaver.  Obes Surg. 2008;  18 1192-1199
    CrossrefPubMedGoogle Scholar
  • 63 Hagen M, Wagner O, Swain P. et al . Hybrid natural orifice transluminal endoscopic surgery (NOTES) for Roux-en-Y gastric bypass: an experimental surgical study in human cadavers.  Endoscopy. 2008;  40 918-924
    Article in Thieme ConnectPubMedGoogle Scholar
  • 64 Ramos A C, Zundel N, Neto M G. et al . Human hybrid NOTES transvaginal sleeve gastrectomy: initial experience.  Surg Obes Relat Dis. 2008;  4 660-663
    CrossrefPubMedGoogle Scholar

N. TsesmeliMD 

Service d’Hépatogastroentérologie
Hôpitaux Universitaires de Strasbourg

1, place de l’Hôpital
Strasbourg
France

Fax: +33-3-88116337

Email: tsesniki@gmail.com