New endoscopic procedures for diabetes mellitus type 2 and obesity treatment

Obesity, defined as body mass index (BMI) equal to or greater than 30 kg/m2, is a rising, epidemic disease worldwide. Dietary and lifestyle modifications and pharmacologic therapy revealed ineffective results as mid- and long-term weight loss. Presently bariatric surgery is the gold standard in severe obesity treatment (1). Since 1980, the prevalence of obesity has doubled, and almost two billion of adults are overweight and more than a quarter of these are obese (2). More and more obese patients have severe metabolic, cardiovascular or respiratory comorbidities, that make risky and technically demanding the execution of bariatric surgery from both surgical and anesthetic point of view. Increasing severity of obesity is associated with higher surgical morbidity and mortality, longer hospitalization, increasing rate of readmission (3) and costs for the treatment of a single patient. In addition, the last long term follow-up studies demonstrated the concerning issue of weight regain after primary bariatric surgery. More than 20% of patients, in fact, experience a significant post-operative weight regain after sleeve gastrectomy or gastric bypass. This weight regain after a primary surgical treatment is a condition associated with a strong risk recurrence of comorbid conditions such as diabetes, hypertension, and obstructive sleep apnea (4). Revisional surgery is associated with higher morbidity compared to the primary treatment, and results in term of weight loss have been inconsistent (5)