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Bariatric Endoscopic Interventions
Barham K. Abu Dayyeh, M.D. MPH Consultant in Gastroenterology and Hepatology Director of Bariatric and Metabolic Endoscopy
Mayo Clinic, Rochester, MN
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Disclosures § Consultant: Apollo Endosurgery
§ Consultant: Metamodix
§ Research Support: Aspire Bariatrics
§ Research Support: GI Dynamics
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Treatments for obesity
Risk
E F F I C A C Y
1-2% patients receive
surgery
SOARD 2013, 9: 159-91
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Treatments for obesity
Risk
E F F I C A C Y
1-2 % patients receive
surgery
SOARD 2013, 9: 159-91
Treatment Gap
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Obesity Disease Burden
Moderate Severe
Body Mass Index
Obesity Burden
Obesity Distribution
Moderate Obesity Burden
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Obesity Continuum
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Endoscopic Bariatric Therapies
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Gastric EBTs Balloons
Others
POSE ESG
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Small Bowel EBTs
Duodenal Sleeves
Gastroduodenojejunal Sleeves
Duodenal Mucosal Resurfacing
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Other EBTs
Aspiration Therapy
Full Sense Device
Self-assembling Magnets for Endoscopy
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EBTs: Efficacy of FDA approved devices
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Intragastric Balloons
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Intragastric Balloons FDA approved in the US
Orbera Reshape Duo Obalon
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Abu Dayyeh, Kumar, Edmundowicz, et al. Gastrointest Endosc. 2015 Sep;82(3):425-38
%TBWL with the Orbera IGB: Published International Experience N=6845
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%TBWL with the Orbera IGB: US Pivotal Trial (ITT)
N=255
Abu Dayyeh, Courcoulas, Eaton, et al. DDW 2015
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%TBWL with the Orbera IGB: Mayo Clinic experience post FDA approval N=30
Months Pre-IBG BMI (Kg/m2)
%TBWL
3
36.8 + 1.4
12.8 + 1.0
6 14.1 + 1.6
Kadouh, Acosta, Abu Dayyeh, et al. Obesity Week 2016
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ReShape Duo IGB Pivotal US RCT: REDUCE Trial (N=326)
%EWL at 24 weeks (balloon removal)
Ponce et al. Surg Obes Relat Dis. 2015;11(4):874-81
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Endoscopic Sleeve Gastroplasty
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Endoscopic Sleeve Gastroplasty
Abu Dayyeh and Gostout GIE 2013 Sep;78(3):530-5 Abu Dayyeh et al. CGH 2016 .
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ESG Multi-Center Study: 242 Patients
Lopez-Nava, Sharaiha, Acosta, Topazian, Gostout, Abu Dayyeh. DDW 2016
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ESG Multi-Center Study: 242 Patients
Lopez-Nava, Sharaiha, Acosta, Topazian, Gostout, Abu Dayyeh. DDW 2016
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Aspiration Therapy
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Aspiration Therapy
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Aspiration Therapy: US Pivotal Trial Results N=207
Thompson, Abu Dayyeh, Kushner, et al. DDW 2016
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Summary
1- Endoscopic bariatric therapies can potentially offer effective weight loss at lower cost and risk in a select group of patients with mild to moderate obesity 2- EBTs should be utilized as part of a structured program that includes dietary intervention, exercise therapy, and behavioral modification 3- EBTs should be offered as part of the continuum of obesity care. Patients should be prospectively followed to identify poor responders and offer them alternative therapy including bariatric surgery
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“I look through a half opened door into the future, full of interest, intriguing beyond my power to describe.”
William J. Mayo, M.D. 1931
Questions?