A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and wei...A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside ...Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.展开更多
文摘A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.
文摘Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.
