Abstract:

For a long time, obesity has been known as a risk factor for cardiovascular disease, which is one of the main causes of death in developed countries. This risk is due to the coexistence of other factors associated with obesity, such as hypertension, dyslipidemia, nonalcoholic fatty liver disease, and abnormalities in glycemic metabolism. Obesity is also a major risk factor for type 2 diabetes, and it is not surprising that the global prevalence of this disease continues to increase. Surgical intervention is now the most effective modality to treat severe obesity and its comorbidities. However, endoluminal interventions performed entirely through the gastrointestinal tract by using endoscopic devices offer the potential for an outpatient weight loss procedure that may be safer, less invasive, and more cost-effective, compared with current surgical approaches. Given the emerging role of endoscopic procedures in the treatment of obesity and rapid changes in endoscopic technologies and techniques, this review considers the current state of endoscopic management of obesity and type 2 diabetes. Endoscopic techniques attempt to mimic some of the anatomic features of bariatric surgery and rely on gastric restriction and duodenal exclusion. The endoscopic placement of the duodenal-jejunal bypass liner in morbidly obese patients induces significant weight loss. Additionally, early studies reported significant improvements in several parameters of glucose homeostasis in morbidly obese patients with type 2 diabetes. In this article we will review the available results obtained with the duodenal-jejunal bypass liner.

Authors:

Eduardo G. H. de Moura, MD, Director, Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, Ivan R. B. Orso, MD, Physician in the Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, Director, Gastrointestinal Endoscopy Unit, São Lucas Hospital, Assis Gurgacz School of Medicine, Gastroclínica, Cascavel, Brazil, Bruno C. Martins, MD, Physician in the Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, Guilherme S. Lopes, MD, Physician in the Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

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