Current endoscopic techniques in the treatment of obesity Técnicas endoscópicas actuales en el tratamiento de la obesidad

Background: in recent years new endoscopic strategies and techniques for the treatment of obesity have emerged and developed. Aim of the study: 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. Antecedentes: en los últimos a os han surgido y se han ido desarrollando nuevas estrategias y técnicas endoscópicas para el tratamiento de la obesidad. Propósito del estudio: en este artículo revisamos y analizamos el estado actual de estas técnicas y las características básicas diferenciales entre cada una de ellas: balones y prótesis, inyección de sustancias, sistemas de suturas, técnicas malabsortivas y otras actualmente en investigación. Métodos: se evalúa tanto la técnica endoscópica como sus principales indicaciones, resultados, tolerancias, complicaciones y efectos adversos observados, aportando nuestra experiencia personal