title: Current endoscopic techniques in the treatment of obesity.
abstract: BACKGROUND
  in recent years new endoscopic strategies and techniques for the treatment of obesity have emerged and developed.
  
  
  OBJECTIVE
  in this article we will review and analyze the current state of the following techniques and the basic differential characteristics between each of them: balloons and prosthesis, injection of substances, systems of sutures, malabsorptives techniques and others currently in research.
  
  
  METHODS
  we will evaluate the endoscopic technique and their main indications, results, tolerances, complications and adverse effects observed, reporting our personal experience and in relation with an extensive literature review.
  
  
  RESULTS
  comparatively with the most widespread technique of the Bioenterics balloon, the Spatz balloon can provide greater weight loss but with worse tolerance and more complications and the Heliosphere Bag gets a similar weight loss but with greater technical difficulty. Other balloons and prosthesis (Ullorex, Semistationary, Silimed, Endogast) still require technical improvements and higher studies. The injection of botulinum toxin, although secure, seems to offer a smaller and more transient efficacy. Suture systems (TOGa, endoluminal vertical gastroplasty and POSE) appear to be effective but are technically more laborious. Malabsorptives procedures (Endobarrier, ValenTX) are somewhat laborious but effective, particularly indicated in obese patients with type 2 diabetes mellitus.
  
  
  CONCLUSIONS
  the development of new endoscopic techniques and improvement in existing designs, suggest an increasingly important role of the endoscopist in the treatment of obesity. We consider it important to individually select and use the endoscopic technique, depending on the desirable outcomes (efficacy, tolerance, safety, adverse effects and risks) and the experience of each hospital. We believe that these techniques should be applied by specifically trained endoscopists in specialized hospitals.
authors.affiliation: Unit of Endoscopy, Gastrodex, Hospital Universitario Dexeus, Barcelona, Spain. eespinet@idexeus.es
authors.forename: Eduardo
authors.initials: E
authors.lastname: Espinet-Coll
authors.forename: Javier
authors.initials: J
authors.lastname: Nebreda-Durán
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Gómez-Valero
authors.forename: Miguel
authors.initials: M
authors.lastname: Muñoz-Navas
authors.forename: Jordi
authors.initials: J
authors.lastname: Pujol-Gebelli
authors.forename: Carmen
authors.initials: C
authors.lastname: Vila-Lolo
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez-Gómez
authors.forename: Antonio
authors.initials: A
authors.lastname: Juan-Creix-Comamala
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D015905:Gastric Balloon; D015391:Gastroplasty / Q000295:instrumentation / Q000379:methods*; D020699:Gastroscopes; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009765:Obesity / Q000628:therapy*; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D013536:Suture Techniques
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A