सारांश
- Obesity is a widespread health crisis with significant morbidity and mortality risks. Current treatment options include lifestyle changes, pharmacological therapies, endoscopic procedures, and bariatric surgery. However, surgery is expensive, has limitations, and poses risks, making endoscopic options attractive due to their lower cost, minimally invasive nature, and reversibility.
- Endoscopic bariatric therapies are categorized as primary (e.g., balloons, aspiration) and revisional (addressing weight regain post-surgery). Intragastric balloons induce satiety by gastric distension, decreasing food intake and aiding weight loss. Various balloon types exist, each with specific placement methods and durations of use, but contraindications include pre-existing gastric conditions.
- Endoscopic sleeve gastroplasty (ESG) and other restrictive procedures mimic surgical sleeve gastrectomy by reducing stomach volume. ESG involves placing sutures to decrease stomach size by roughly 70%, showing effectiveness comparable to other methods. Weight regain after bariatric surgery is common, often due to lifestyle factors or surgical limitations, leading to interest in endoscopic revision procedures.
- For Roux-en-Y gastric bypass patients experiencing weight regain, ablation techniques like Argon Plasma Coagulation (APC) or cryoablation can reduce outlet size. Thor, another option, involves suture placement to reduce pouch size, though strictures are a potential complication. Sleeve gastrectomy patients experiencing weight regain may benefit from redo procedures using overstitch devices.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) in patients with prior Roux-en-Y gastric bypass poses challenges. Device-assisted enteroscopy, particularly using the double-balloon enteroscope, facilitates ERCP in these cases. The double-balloon enteroscope allows deeper access into the small bowel for diagnostic and therapeutic interventions.
- The double-balloon enteroscope technique involves alternating advancement of the scope and overtube, using inflatable balloons for stabilization and traction. Common complications include abdominal discomfort and respiratory depression, though severe complications like perforation are rare. The double-balloon enteroscope offers better stability and control compared to single-balloon systems but requires more time and skill.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Majidah Bukhari
Adjunct Assistant Professor at University of Sharjah and Consultant in Gastroenterology and Advanced Therapeutic Endoscopy, Sulaiman Al Habib Hospital, Dubai, UAE
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