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Endoscopic bariatric therapies (EBTs) are minimally invasive tools to facilitate weight loss in adults with obesity and may appeal to those wishing to avoid traditional bariatric surgery (TBS). There are considerable knowledge gaps about patient beliefs, expectations, and concerns about these novel therapies, particularly in comparison with TBS.

Background: In selected cases of post-bariatric leaks and fistulas, endoscopy is an initial treatment modality. Management can be complex and require multiple endoscopic sessions with varying degrees of success. Our aim was to describe our tertiary care experience on endoscopy management of refractory post-bariatric leaks and fistulas. Methods: Patients with post-bariatric leaks and/or fistulas who failed an initial endoscopic intervention were included. Endoscopic treatments were classified into four strategies: (1) closure management, (2) active drainage, (3) passive drainage, and (4) plugging. Clinical success and adverse events were assessed. Results: A total of 25 patients (mean age = 45.3 ± 11.8 years and 56% female) were included. Clinical success was achieved in 20 patients (80%) with a mean of 3.0 ± 1.5 procedures and a median time to healing of 114.5 (53–210.3) days. Closure and plugging were the main successful strategies used for early and acute leaks/fistulas, while drainage was for late and chronic leaks/fistulas. Adverse events were observed in 13 patients (52%) with one serious adverse event. Patients with fistulas had a lower success rate (72.2% vs. 100%, P= 0.052). Of those with clinical failure (n= 5), four underwent reconstructive surgery, eventually led to success in 3 patients. The other one died of septic shock related to a complicated fistula. Conclusions: Complex multi-modality endoscopic management ultimately achieved clinical success in most cases of refractory leaks/fistulas post-bariatric with an acceptable safety profile. However, a close follow-up to detect the development of long-term failure is warranted. These patients should be referred to a specialized bariatric center with expertise in bariatric endoscopy and surgery.

Endoluminal stenting serves as an essential tool in the gastroenterologist's arsenal to manage perforations, leaks, fistulas, and both benign and malignant strictures; however, the heterogeneity of stent design, indication, and location renders comprehensive and systemic comparison of their efficacy a perennial challenge, despite their widespread use. Appraisal of their associated risks faces similar obstacles. Given the lack of robust, randomized, prospective data, understanding the complications of stents, as well as prevention and management of these complications, becomes all the more critical for those who use stents and/or manage patients with these important therapeutic devices. Here, we present a review of the literature—primarily through the lens of esophageal stents—to describe strategies for mitigating and resolving 3 major stent-related adverse events: stent migration, stent in-growth, and respiratory-esophageal fistula formation.

With the growing epidemic of obesity, endoscopic bariatric therapies have evolved to help bridge the treatment divide between behavioral/pharmacologic therapies—which have limited efficacy—and bariatric surgical interventions—which are invasive and contraindicated in those with extensive medical comorbidities. Among endoscopic bariatric therapies, endoscopic suturing procedures focused on gastric remodeling have a promising foothold in the multidisciplinary management of obesity and its comorbidities given their safety, efficacy, and anticipated durability. Predicated on the twin goals of restricting gastric accommodation and delaying gastric emptying—thereby improving satiation and satiety, respectively—endoscopic suturing can facilitate clinically substantive weight loss with minimized risk to patients.

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Intragastric balloons are anatomy-preserving, minimally invasive obesity therapies. Enhanced tolerance and durability could help broaden clinical adoption. We investigated the safety and efficacy of an adjustable intragastric balloon (aIGB) in adults with obesity.