Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory.
Endoscopy ; Gastric Balloon ; Humans ; Investments ; Obesity*

Balloon Occlusion ; Esophageal and Gastric Varices ; Humans ; Polyethylene Glycols ; Sclerotherapy

Balloon tamponade using Sengstaken–Blakemore (SB) tube is employed as a bridging therapy in cases in which endoscopic therapy fails to control esophageal variceal bleeding. Although SB tube insertion can lead to successful hemostasis, it is accompanied by numerous complications, with SB tube transection being one of the rarest complications. A 53-year-old man with liver cirrhosis and hepatocellular carcinoma presented with massive esophageal variceal bleeding. Therapeutic endoscopic variceal ligation failed, and SB tube was inserted. The SB tube was unexpectedly disconnected because of the patient's irritability due to hepatic encephalopathy. The esophageal and gastric balloon of the SB tube remained inflated in the stomach. Whereas the use of other endoscopic instruments was ineffective, endoscopic removal was successfully accomplished using endoscopic scissors. In conclusion, we detected SB tube transection in a patient with hepatic encephalopathy and removed remnants of the inflated tube using endoscopic scissors.
Balloon Occlusion ; Carcinoma, Hepatocellular ; Esophageal and Gastric Varices ; Gastric Balloon ; Hemostasis ; Hepatic Encephalopathy ; Humans ; Ligation ; Liver Cirrhosis ; Middle Aged ; Stomach

A Sengstaken-Blakemore (S-B) tube has been widely used to treatment of bleeding esophageal varices. It controls bleeding in 50~92% of cases and provide more time to plan future management. However, there are a number of complications with its use, some of which are lethal. We recently observed a very unusual complication of a S-B tube, namely an impaction of the gastric balloon at the gastroesophageal junction, which could not be deflated by removing the clamps and suctioning the air with a syringe. The gastric balloon was punctured endoscopically with needle knife and deflated. The S-B tube was then be easily removed.
Esophageal and Gastric Varices ; Esophagogastric Junction ; Gastric Balloon ; Hemorrhage ; Needles ; Suction ; Syringes

Bariatric-metabolic surgery (BMS) has the potential of decreasing body weight and improving obesity-related metabolic syndrome by restricting food intake and malabsorption. Laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch are four major BMS procedures. Sleeve plus surgery, one-anastomosis gastric bypass, intragastric balloon and endoscopic surgery are also arising and gaining popularity due to their specific efficacy. Currently, BMS is now experiencing an era with deeply integrated interdisciplinarity, optimizing and innovating of surgeries and well-illustrated clinical efficacy, as a result, more obese patients would benefit from BMS.
Bariatric Surgery ; Gastrectomy ; Gastric Balloon ; Gastric Bypass ; Humans ; Laparoscopy ; Morbidity ; Obesity/surgery* ; Obesity, Morbid/surgery*

Obesity is a serious disorder that increases morbidity and mortality. Primary intervention with life style modification and medication is not always effective for obese patients. Endoscopic management of obesity may be a less invasive, more cost-effective, and relatively safer option than bariatric surgery. Moreover, therapeutic endoscopy is considered to be the primary modality for managing complications that occur after bariatric surgery. In the near future, role of gastroenterologists will be more important in the management of obesity and its related problems.
Bariatric Surgery/adverse effects ; Biliary Tract Diseases/etiology ; Endoscopy, Gastrointestinal ; Gastric Balloon ; Gastric Bypass ; Humans ; Obesity/*therapy ; *Physician's Role

A newly developed short double-balloon enteroscope with a working channel enlarged to a diameter of 3.2 mm is a novel innovation in stent placement for patients with surgically altered anatomies. Herein, we report three patients in whom this new scope contributed to an efficient technique and ideal treatment. In the first case, the double guidewire technique was efficient and effective for multiple stent placements. In the second case, covered self-expandable metal stent (SEMS) placement, which is the standard treatment for malignant biliary obstruction, could be performed in a technologically sound and safe manner. In the third case, SEMS placement was performed as palliative treatment for malignant afferent-loop obstruction; this procedure could be performed soundly and safely using the through-the-scope technique. The wider working channel of this new scope also facilitates a smoother accessory insertion and high suction performance, which reduces procedure time and stress on endoscopists. Furthermore, this new scope, which has advanced force transmission, adaptive bending, and a smaller turning radius, is expected to be highly successful in both diagnosis and therapy for various digestive diseases in patients with surgically altered anatomies.
Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Double-Balloon Enteroscopy ; Gastric Outlet Obstruction ; Humans ; Palliative Care ; Radius ; Stents* ; Suction

No abstract availble.
*Balloon Occlusion ; Esophageal and Gastric Varices/*diagnosis/therapy ; Female ; Gastroscopy ; Humans ; Middle Aged ; Tomography, X-Ray Computed

A Sengstaken-Blakemore (S-B) tube, when used approximately, still has a place in the management of acute variceal bleeding, and controls bleeding in 40~90% of the cases. However its use is accompanied by number of complications such as esophageal ulcer, pulmonary aspiration, and malfunction of the tube, which requires replacement. We recently observed a very unusual complication: the remaining gastric balloon of a S-B tube was broken off in the fundus of stomach by the patient's traction. The gastric balloon was easily and safely removed using an endoscopic snare after deflating the gastric balloon with a needle puncture.
Gastric Balloon ; Hemorrhage ; Hypogonadism ; Mitochondrial Diseases ; Needles ; Ophthalmoplegia ; Punctures ; SNARE Proteins ; Stomach ; Traction ; Ulcer

Intervention treatment such as balloon retrograde or anterograde transvenous obliteration has been used for management of refractory hepatic encephalopathy as well as gastric variceal bleeding. Recently, plug-assisted retrograde transvenous obliteration without a help of balloon was newly developed to treat these patients. Here, we report three cases suffering refractory hepatic encephalopathy who were treated with this new technique.
Balloon Occlusion ; Esophageal and Gastric Varices ; Hepatic Encephalopathy* ; Humans ; Portasystemic Shunt, Surgical ; Splenorenal Shunt, Surgical*