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Nwaiwu et al. Mini-invasive Surg. 2025;9:20 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2024.112

Review Open Access

Primary endoscopic interventions in bariatric

surgery

Chibueze A. Nwaiwu, Errol M. Hunte, Marcoandrea Giorgi, Aurora Dawn Pryor
Department of Surgery, Brown University Health, Brown University, Providence, RI 02903, USA.

Correspondence to: Dr. Chibueze A. Nwaiwu, Department of Surgery, Brown University Health, Brown University, 593 Eddy
Street, APC 429, Providence, RI 02903, USA. E-mail: chibueze.nwaiwu@gmail.com

How to cite this article: Nwaiwu CA, Hunte EM, Giorgi M, Pryor AD. Primary endoscopic interventions in bariatric surgery. Mini-
invasive Surg. 2025;9:20. https://dx.doi.org/10.20517/2574-1225.2024.112

Received: 16 Dec 2024 First Decision: 13 May 2025 Revised: 26 May 2025 Accepted: 17 Jun 2025 Published: 27 Jun 2025

Academic Editor: Michel Gagner Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
2
The global prevalence of obesity [body mass index (BMI) ≥ 30 kg/m ] was estimated to affect nearly 890 million
adults in 2022, with increasing rates in both adults and children. While comprehensive lifestyle management (diet,
exercise, behavioral modification) and pharmacotherapy are central to obesity treatment, metabolic bariatric
surgery (MBS), such as sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), remains the most effective and
durable approach for obesity and obesity-related comorbidities, including hypertension, type 2 diabetes, and
cardiovascular disease. Despite its effectiveness, MBS is significantly underutilized due to multiple barriers such as
the risk of surgery, access limitations, prohibitive social factors, the perceived need for surgery, and fear and beliefs
about surgery. Endoscopic bariatric and metabolic therapies (EBMTs) have emerged as an alternative approach to
address this gap. While EBMTs are less invasive and have fewer complications than MBS, they are also less
effective, though more effective than lifestyle modifications and pharmacotherapy alone. EBMTs, including
procedures that involve gastric volume reduction through gastric remodeling or space-occupying devices,
malabsorption, or caloric intake reduction, are recommended by the American Society for Gastrointestinal
Endoscopy (ASGE) and American Society of Metabolic and Bariatric Surgery (ASMBS) for patients who have not
succeeded with lifestyle changes or medications, and as bridge therapies for patients who require weight loss for
additional medical treatments. Although EBMTs do not replace bariatric surgery, they complement the existing
treatment options, offering patients a less invasive pathway to weight loss and improved metabolic health.
Reimbursement models for physicians and the associated financial cost of EBMTs may present inherent
complexities. Nevertheless, the prospect of enhanced patient outcomes, substantial reductions in long-term
healthcare costs, and expansion of insurance coverage to include these procedures collectively foster optimism for
the wider integration of these innovative therapies into clinical practice.

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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