The global prevalence of obesity continues to rise, while traditional therapies face challenges due to limited efficacy, invasiveness, and economic burdens. Endoscopic bariatric and metabolic therapies (EBMTs) have emerged as novel approaches to obesity management, characterized by their minimally invasive nature, reversibility, and targeted therapeutic mechanisms. This review systematically expounds the technical classifications and mechanisms of EBMTs, focusing on the clinical value of gastric and small intestinal intervention techniques. Gastric intervention techniques primarily comprise space-occupying devices and anatomical reconstruction: the former achieves short-term weight reduction through physical volume restriction but exhibits device-dependent efficacy, while the latter sustains long-term outcomes via endoscopic suturing or folding that induces durable morphological changes. Small intestinal intervention techniques improve metabolic regulation via gut-pancreas axis modulation, encompassing digestive diversion-driven alterations in chyme transit patterns and mucosal ablation-activated regeneration of endocrine microenvironments. Future studies should prioritize large-scale longitudinal studies to validate the efficacy and safety of EBMTs, thereby establishing evidence-based support for the precision management of obesity and related metabolic disorders.
Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
| 1. | Xue Y, Song M, Chen X, et al. Consolidating international care models and clinical services for adult obesity. Curr Obes Rep, 2025, 14(1): 26. |
| 2. | Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol, 2019, 15(5): 288-298. |
| 3. | GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med, 2017, 377(1): 13-27. |
| 4. | GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet, 2025, 405(10481): 813-838. |
| 5. | Walradt T, Jirapinyo P. Endoscopic management of obesity and metabolic diseases. Trends Endocrinol Metab, 2025, 36(4): 373-385. |
| 6. | Sullivan S, Edmundowicz SA, Thompson CC. Endoscopic bariatric and metabolic therapies: new and emerging technologies. Gastroenterology, 2017, 152(7): 1791-1801. |
| 7. | Alqahtani AR, Elahmedi M, Aldarwish A, et al. Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study. Gastrointest Endosc, 2022, 96(1): 44-50. |
| 8. | Novikov AA, Afaneh C, Saumoy M, et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare? J Gastrointest Surg, 2018, 22(2): 267-273. |
| 9. | Negi A, Asokkumar R, Ravi R, et al. Nutritional management and role of multidisciplinary follow-up after endoscopic bariatric treatment for obesity. Nutrients, 2022, 14(16): 3450. |
| 10. | Vyas D, Deshpande K, Pandya Y. Advances in endoscopic balloon therapy for weight loss and its limitations. World J Gastroenterol, 2017, 23(44): 7813-7817. |
| 11. | Jamal MH, Al-Kanawati N, ElAbd R, et al. A study examining the orbera365 intragastric balloon safety and effects on weight loss. Obes Surg, 2021, 31(12): 5342-5347. |
| 12. | Vargas EJ, Pesta CM, Bali A, et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clin Gastroenterol Hepatol, 2018, 16(7): 1073-1080. e1. |
| 13. | ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee; Abu Dayyeh BK, Kumar N, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc, 2015, 82(3): 425-438. e5. |
| 14. | Salomone F, Currenti W, Magrì G, et al. Effects of intragastric balloon in patients with nonalcoholic fatty liver disease and advanced fibrosis. Liver Int, 2021, 41(9): 2112-2116. |
| 15. | Agnihotri A, Xie A, Bartalos C, et al. Real-world safety and efficacy of fluid-filled dual intragastric balloon for weight loss. Clin Gastroenterol Hepatol, 2018, 16(7): 1081-1088. e1. |
| 16. | Ponce J, Woodman G, Swain J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis, 2015, 11(4): 874-881. |
| 17. | Mion F, Ibrahim M, Marjoux S, et al. Swallowable Obalon® gastric balloons as an aid for weight loss: a pilot feasibility study. Obes Surg, 2013, 23(5): 730-733. |
| 18. | Sullivan S, Swain J, Woodman G, et al. Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss. Surg Obes Relat Dis, 2018, 14(12): 1876-1889. |
| 19. | Fittipaldi-Fernandez RJ, Zotarelli-Filho IJ, Diestel CF, et al. Randomized prospective clinical study of Spatz3® adjustable intragastric balloon treatment with a control group: a large-scale brazilian experiment. Obes Surg, 2021, 31(2): 787-796. |
| 20. | Abu Dayyeh BK, Maselli DB, Rapaka B, et al. Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial. Lancet, 2021, 398(10315): 1965-1973. |
| 21. | Daniel F, Abou Fadel C, Houmani Z, et al. Spatz 3 adjustable intragastric balloon: long-term safety concerns. Obes Surg, 2016, 26(1): 159-160. |
| 22. | Jense MTF, Palm-Meinders IH, Sanders B, et al. The Swallowable intragastric balloon combined with lifestyle coaching: short-term results of a safe and effective weight loss treatment for people living with overweight and obesity. Obes Surg, 2023, 33(6): 1668-1675. |
| 23. | Ienca R, Al Jarallah M, Caballero A, et al. The procedureless elipse gastric balloon program: multicenter experience in 1 770 consecutive patients. Obes Surg, 2020, 30(9): 3354-3362. |
| 24. | Alhashemi M, Alkhamis A, Jamal M, et al. Safety and effectiveness of two different fluid-filled intragastric balloons: a single center experience. Obes Surg, 2024, 34(12): 4482-4489. |
| 25. | Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc, 2013, 78(3): 530-535. |
| 26. | Vargas EJ, Rizk M, Gomez-Villa J, et al. Effect of endoscopic sleeve gastroplasty on gastric emptying, motility and hormones: a comparative prospective study. Gut, 2023, 72(6): 1073-1080. |
| 27. | Ng SK, Teoh AY. Endoscopic sleeve gastroplasty - current status and future perspectives. Dig Endosc, 2025. doi: 10.1111/den.14994. |
| 28. | Huberty V, Ibrahim M, Hiernaux M, et al. Safety and feasibility of an endoluminal-suturing device for endoscopic gastric reduction (with video). Gastrointest Endosc, 2017, 85(4): 833-837. |
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| 32. | Singh S, Bazarbashi AN, Khan A, et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis. Surg Endosc, 2022, 36(1): 252-266. |
| 33. | Jirapinyo P, Thompson CC. Endoscopic gastric body plication for the treatment of obesity: technical success and safety of a novel technique (with video). Gastrointest Endosc, 2020, 91(6): 1388-1394. |
| 34. | Espinós JC, Turró R, Moragas G, et al. Gastrointestinal physiological changes and their relationship to weight loss following the POSE procedure. Obes Surg, 2016, 26(5): 1081-1089. |
| 35. | Lopez Nava G, Arau RT, Asokkumar R, et al. Prospective multicenter study of the primary obesity surgery endoluminal (POSE 2.0) procedure for treatment of obesity. Clin Gastroenterol Hepatol, 2023, 21(1): 81-89. e4. |
| 36. | Jirapinyo P, Thompson CC. Endoscopic bariatric and metabolic therapies: surgical analogues and mechanisms of action. Clin Gastroenterol Hepatol, 2017, 15(5): 619-630. |
| 37. | Familiari P, Costamagna G, Bléro D, et al. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome. Gastrointest Endosc, 2011, 74(6): 1248-1258. |
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| 39. | Verlaan T, de Jong K, de la Mar-Ploem ED, et al. Trans-oral endoscopic restrictive implant system: endoscopic treatment of obesity? Surg Obes Relat Dis, 2016, 12(9): 1711-1718. |
| 40. | Mauro A, Lusetti F, Scalvini D, et al. A comprehensive review on bariatric endoscopy: where we are now and where we are going. Medicina (Kaunas), 2023, 59(3): 636. |
| 41. | Marinos G, Eliades C, Raman Muthusamy V, et al. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study. Surg Obes Relat Dis, 2014, 10(5): 929-934. |
| 42. | Thompson CC, Abu Dayyeh BK, Kushner R, et al. Percutaneous gastrostomy device for the treatment of class Ⅱ and class Ⅲ obesity: results of a randomized controlled trial. Am J Gastroenterol, 2017, 112(3): 447-457. |
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| 44. | Schiavo G, Rossetto O, Benfenati F, et al. Tetanus and botulinum neurotoxins are zinc proteases specific for components of the neuroexocytosis apparatus. Ann N Y Acad Sci, 1994, 710: 65-75. |
| 45. | Gui D, De Gaetano A, Spada PL, et al. Botulinum toxin injected in the gastric wall reduces body weight and food intake in rats. Aliment Pharmacol Ther, 2000, 14(6): 829-834. |
| 46. | Gui D, Mingrone G, Valenza V, et al. Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study. Aliment Pharmacol Ther, 2006, 23(5): 675-680. |
| 47. | Chen Q, Gao Y, Li F, et al. The role of gut-islet axis in pancreatic islet function and glucose homeostasis. Diabetes Obes Metab, 2025, 27(4): 1676-1692. |
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- 1. Xue Y, Song M, Chen X, et al. Consolidating international care models and clinical services for adult obesity. Curr Obes Rep, 2025, 14(1): 26.
- 2. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol, 2019, 15(5): 288-298.
- 3. GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med, 2017, 377(1): 13-27.
- 4. GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet, 2025, 405(10481): 813-838.
- 5. Walradt T, Jirapinyo P. Endoscopic management of obesity and metabolic diseases. Trends Endocrinol Metab, 2025, 36(4): 373-385.
- 6. Sullivan S, Edmundowicz SA, Thompson CC. Endoscopic bariatric and metabolic therapies: new and emerging technologies. Gastroenterology, 2017, 152(7): 1791-1801.
- 7. Alqahtani AR, Elahmedi M, Aldarwish A, et al. Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study. Gastrointest Endosc, 2022, 96(1): 44-50.
- 8. Novikov AA, Afaneh C, Saumoy M, et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic band for weight loss: how do they compare? J Gastrointest Surg, 2018, 22(2): 267-273.
- 9. Negi A, Asokkumar R, Ravi R, et al. Nutritional management and role of multidisciplinary follow-up after endoscopic bariatric treatment for obesity. Nutrients, 2022, 14(16): 3450.
- 10. Vyas D, Deshpande K, Pandya Y. Advances in endoscopic balloon therapy for weight loss and its limitations. World J Gastroenterol, 2017, 23(44): 7813-7817.
- 11. Jamal MH, Al-Kanawati N, ElAbd R, et al. A study examining the orbera365 intragastric balloon safety and effects on weight loss. Obes Surg, 2021, 31(12): 5342-5347.
- 12. Vargas EJ, Pesta CM, Bali A, et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clin Gastroenterol Hepatol, 2018, 16(7): 1073-1080. e1.
- 13. ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee; Abu Dayyeh BK, Kumar N, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc, 2015, 82(3): 425-438. e5.
- 14. Salomone F, Currenti W, Magrì G, et al. Effects of intragastric balloon in patients with nonalcoholic fatty liver disease and advanced fibrosis. Liver Int, 2021, 41(9): 2112-2116.
- 15. Agnihotri A, Xie A, Bartalos C, et al. Real-world safety and efficacy of fluid-filled dual intragastric balloon for weight loss. Clin Gastroenterol Hepatol, 2018, 16(7): 1081-1088. e1.
- 16. Ponce J, Woodman G, Swain J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis, 2015, 11(4): 874-881.
- 17. Mion F, Ibrahim M, Marjoux S, et al. Swallowable Obalon® gastric balloons as an aid for weight loss: a pilot feasibility study. Obes Surg, 2013, 23(5): 730-733.
- 18. Sullivan S, Swain J, Woodman G, et al. Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss. Surg Obes Relat Dis, 2018, 14(12): 1876-1889.
- 19. Fittipaldi-Fernandez RJ, Zotarelli-Filho IJ, Diestel CF, et al. Randomized prospective clinical study of Spatz3® adjustable intragastric balloon treatment with a control group: a large-scale brazilian experiment. Obes Surg, 2021, 31(2): 787-796.
- 20. Abu Dayyeh BK, Maselli DB, Rapaka B, et al. Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial. Lancet, 2021, 398(10315): 1965-1973.
- 21. Daniel F, Abou Fadel C, Houmani Z, et al. Spatz 3 adjustable intragastric balloon: long-term safety concerns. Obes Surg, 2016, 26(1): 159-160.
- 22. Jense MTF, Palm-Meinders IH, Sanders B, et al. The Swallowable intragastric balloon combined with lifestyle coaching: short-term results of a safe and effective weight loss treatment for people living with overweight and obesity. Obes Surg, 2023, 33(6): 1668-1675.
- 23. Ienca R, Al Jarallah M, Caballero A, et al. The procedureless elipse gastric balloon program: multicenter experience in 1 770 consecutive patients. Obes Surg, 2020, 30(9): 3354-3362.
- 24. Alhashemi M, Alkhamis A, Jamal M, et al. Safety and effectiveness of two different fluid-filled intragastric balloons: a single center experience. Obes Surg, 2024, 34(12): 4482-4489.
- 25. Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc, 2013, 78(3): 530-535.
- 26. Vargas EJ, Rizk M, Gomez-Villa J, et al. Effect of endoscopic sleeve gastroplasty on gastric emptying, motility and hormones: a comparative prospective study. Gut, 2023, 72(6): 1073-1080.
- 27. Ng SK, Teoh AY. Endoscopic sleeve gastroplasty - current status and future perspectives. Dig Endosc, 2025. doi: 10.1111/den.14994.
- 28. Huberty V, Ibrahim M, Hiernaux M, et al. Safety and feasibility of an endoluminal-suturing device for endoscopic gastric reduction (with video). Gastrointest Endosc, 2017, 85(4): 833-837.
- 29. Bove V, Matteo MV, Pontecorvi V, et al. Robotic endoscopic sleeve gastroplasty. Gut, 2023, 72(1): 27-29.
- 30. Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol, 2017, 15(1): 37-43. e1.
- 31. Lahooti A, Westerveld D, Johnson K, et al. Improvement in obesity-related comorbidities 5 years after endoscopic sleeve gastroplasty: a prospective cohort study. Gastrointest Endosc, 2024, S0016-5107(24): 03792-1. doi: 10.1016/j.gie.2024.12.017.
- 32. Singh S, Bazarbashi AN, Khan A, et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis. Surg Endosc, 2022, 36(1): 252-266.
- 33. Jirapinyo P, Thompson CC. Endoscopic gastric body plication for the treatment of obesity: technical success and safety of a novel technique (with video). Gastrointest Endosc, 2020, 91(6): 1388-1394.
- 34. Espinós JC, Turró R, Moragas G, et al. Gastrointestinal physiological changes and their relationship to weight loss following the POSE procedure. Obes Surg, 2016, 26(5): 1081-1089.
- 35. Lopez Nava G, Arau RT, Asokkumar R, et al. Prospective multicenter study of the primary obesity surgery endoluminal (POSE 2.0) procedure for treatment of obesity. Clin Gastroenterol Hepatol, 2023, 21(1): 81-89. e4.
- 36. Jirapinyo P, Thompson CC. Endoscopic bariatric and metabolic therapies: surgical analogues and mechanisms of action. Clin Gastroenterol Hepatol, 2017, 15(5): 619-630.
- 37. Familiari P, Costamagna G, Bléro D, et al. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome. Gastrointest Endosc, 2011, 74(6): 1248-1258.
- 38. Fogel R, De Fogel J, Bonilla Y, et al. Clinical experience of transoral suturing for an endoluminal vertical gastroplasty: 1-year follow-up in 64 patients. Gastrointest Endosc, 2008, 68(1): 51-58.
- 39. Verlaan T, de Jong K, de la Mar-Ploem ED, et al. Trans-oral endoscopic restrictive implant system: endoscopic treatment of obesity? Surg Obes Relat Dis, 2016, 12(9): 1711-1718.
- 40. Mauro A, Lusetti F, Scalvini D, et al. A comprehensive review on bariatric endoscopy: where we are now and where we are going. Medicina (Kaunas), 2023, 59(3): 636.
- 41. Marinos G, Eliades C, Raman Muthusamy V, et al. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study. Surg Obes Relat Dis, 2014, 10(5): 929-934.
- 42. Thompson CC, Abu Dayyeh BK, Kushner R, et al. Percutaneous gastrostomy device for the treatment of class Ⅱ and class Ⅲ obesity: results of a randomized controlled trial. Am J Gastroenterol, 2017, 112(3): 447-457.
- 43. Sullivan S, Stein R, Jonnalagadda S, et al. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology, 2013, 145(6): 1245-1252. e1-5.
- 44. Schiavo G, Rossetto O, Benfenati F, et al. Tetanus and botulinum neurotoxins are zinc proteases specific for components of the neuroexocytosis apparatus. Ann N Y Acad Sci, 1994, 710: 65-75.
- 45. Gui D, De Gaetano A, Spada PL, et al. Botulinum toxin injected in the gastric wall reduces body weight and food intake in rats. Aliment Pharmacol Ther, 2000, 14(6): 829-834.
- 46. Gui D, Mingrone G, Valenza V, et al. Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study. Aliment Pharmacol Ther, 2006, 23(5): 675-680.
- 47. Chen Q, Gao Y, Li F, et al. The role of gut-islet axis in pancreatic islet function and glucose homeostasis. Diabetes Obes Metab, 2025, 27(4): 1676-1692.
- 48. Essop T, Tran K, Purdy AC, et al. Comparative effects of GLP-1 agonists, sleeve gastrectomy and Roux-en-Y gastric bypass on diabetes mellitus outcomes. Curr Diab Rep, 2024, 24(12): 273-289.
- 49. Ryder REJ, Yadagiri M, Burbridge W, et al. Duodenal-jejunal bypass liner for the treatment of type 2 diabetes and obesity: 3-year outcomes in the First National Health Service (NHS) EndoBarrier Service. Diabet Med, 2022, 39(7): e14827. doi: 10.1111/dme.14827.
- 50. Jirapinyo P, Haas AV, Thompson CC. Effect of the duodenal-jejunal bypass liner on glycemic control in patients with type 2 diabetes with obesity: a meta-analysis with secondary analysis on weight loss and hormonal changes. Diabetes Care, 2018, 41(5): 1106-1115.
- 51. Ryder REJ, Laubner K, Benes M, et al. Endoscopic duodenal-jejunal bypass liner treatment for type 2 diabetes and obesity: glycemic and cardiovascular disease risk factor improvements in 1 022 patients treated worldwide. Diabetes Care, 2023, 46(4): e89-e91.
- 52. Vilarrasa N, de Gordejuela AG, Casajoana A, et al. Endobarrier® in grade Ⅰ obese patients with long-standing type 2 diabetes: role of gastrointestinal hormones in glucose metabolism. Obes Surg, 2017, 27(3): 569-577.
- 53. van Baar ACG, Holleman F, Crenier L, et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study. Gut, 2020, 69(2): 295-303.
- 54. Haidry RJ, van Baar AC, Galvao Neto MP, et al. Duodenal mucosal resurfacing: proof-of-concept, procedural development, and initial implementation in the clinical setting. Gastrointest Endosc, 2019, 90(4): 673-681. e2.
- 55. Rajagopalan H, Cherrington AD, Thompson CC, et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes: 6-month interim analysis from the first-in-human proof-of-concept study. Diabetes Care, 2016, 39(12): 2254-2261.
- 56. van Baar ACG, Devière J, Hopkins D, et al. Durable metabolic improvements 2 years after duodenal mucosal resurfacing (DMR) in patients with type 2 diabetes (REVITA-1 Study). Diabetes Res Clin Pract, 2022, 184: 109194.
- 57. Mingrone G, van Baar AC, Devière J, et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial. Gut, 2022, 71(2): 254-264.
- 58. Papaefthymiou A, Norton B, Hoebel PB, et al. First clinical application of a novel duodenal mucosal ablation device for type 2 diabetes using radiofrequency vapor ablation. Endoscopy, 2024, 56(S 01): E563-E564.
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