Editing Evolving bariatric options


== '''Endoscopic Sleeve Gastroplasty''' ==
Replicates sleeve gastrectomy anatomy through endoluminal full-thickness suturing. Anterior and posterior walls suctioned together, then a sleeve is sutured.

* Slows gastric emptying for     solids but not liquids
* Earlier satiety
* Decreased total caloric     intake
* No changes to gut hormones

Thought to be a good option for less comorbid patients

Weight loss in 1000 consecutive patients at 6, 12 and 19 months was 14, 15 and 15%

== '''Duodenal Mucosal Resurfacing''' ==
Essentially ablates the duodenal mucosa to aid in diabetes management

* Duodenal mucosa thought to     play an important role in glucose homeostasis/insulin sensitivity
* Expect an HbA1c reduction of     ~1% at six months

== '''Duodenal-jejunal bypass liner''' ==
Plastic sleeve that is anchored between duodenal bulb and proximal jejunum

* Fully reversible, placed     endoscopically
* Prevents food and chyme     contacting duodenum
* Somewhat analogous to RYGB in     functional effect
* Meta-analysis - total weight     loss of 19% at explant (1 year - should not be left in longer due to risks     of side effect), and EWL of 37%
* Also appears to help with     diabetes

Adverse effects - pain, nausea, vomiting

* Sometimes severe, leading to     early removal
* Migration/obstruction, liver     abscesses, pancreatitis have been reported

== '''Intra-gastric balloon''' ==

* Typically leave it in for six     months to prove a point, then remove
* Aim to lose 15-20kg

[[Category:Bariatrics]]