The role of endoscopic therapy in obesity management: intragastric balloons and aspiration therapy

Abstract

Weight management is increasingly incorporating endoscopic bariatric therapy (EBT). As the global burden of obesity and its comorbidities has increased, it is evident that novel therapeutic approaches will be necessary to address the obesity epidemic. EBTs offer greater efficacy than diet and lifestyle modification and lower invasiveness than bariatric surgery. The US Food and Drug Administration has approved two intragastric balloons and aspiration therapy for the treatment of obesity: Apollo Orbera is indicated for the treatment of Class I and Class II obesity, Re Shape Integrated Dual Balloon system is indicated for the same range with a comorbidity, and Aspire Bariatrics AspireAssist is approved for patients with a body mass index of 35–55 kg/m². These devices have proven safe and effective in clinical trials and are gaining commercial acceptance in the USA; the Orbera has been used extensively outside the USA for over 20 years. These devices will need to be delivered in the context of a multidisciplinary weight loss program, integrating comprehensive care of obesity. Patient selection is important, and ensuring appropriate patient expectations and understanding of alternatives such as pharmacologic therapy and surgery is essential. With several EBTs on the horizon, patients with obesity will have an even broader array of safe and effective options for weight management in the future.

Keywords:

• intragastric balloon
• Orbera
• ReShape
• AspireAssist
• aspiration therapy
• weight loss

Disclosure

Nitin Kumar, consultant in safety for Obalon. Shelby Sullivan, contracted research for ReShape Medical, GI Dynamics, Aspire Bariatrics, USGI Medical, Obalon Therapeutics, BAROnova. Paion, consultant for USGI Medical, Obalon, Elira Therapeutics, SynerZ, Spatz FGIA, and Aspire Bariatrics. Christopher C Thompson: Boston Scientific – consultant (consulting fees), Covidien – consultant (consulting fees)/endoluminal advisory board member, USGI Medical – consultant (consulting fees)/advisory board member (consulting fees)/research support (research grant), Valentx – consultant (consulting fees), Olympus – lab support (lab supplies/equipment), consultant, Apollo Endosurgery – consultant/research support (consulting fees/research grants), GI Windows – ownership interest, Aspire Bariatrics – research grant, Fractyl – consultant/advisory board member, GI Dynamics – expert reviewer, Spatz – research grant. The authors report no other conflicts of interest in this work.