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Nwaiwu et al. Mini-invasive Surg. 2025;9:20 https://dx.doi.org/10.20517/2574-1225.2024.112 Page 15 of 20

[37] [71]
Figure 5. Other endoscopic interventions. (A) Duodenal mucosal resurfacing ; (B) AspireAssist (Aspiration Therapy) ; (C)
Intragastric BTA injection. BTA: Botulinum toxin A.

reported after BTA injection. However, the method of endoscopic ultrasound-guided injection or the
[75]
follow-up duration was not associated with a difference in weight loss outcomes , and this practice has
largely been abandoned.

SAFETY AND EFFICACY EBMT
Threshold for safety and efficacy
A joint task force formed by the ASGE and the ASMBS established safety and efficacy criteria for
endoscopic procedures in a Preservation and Incorporation of Valuable Endoscopic Innovations
[76]
document . The task force recommended that an EBMT intended to be used as a primary intervention for
obesity in individuals with Class II/III obesity should achieve a mean minimum threshold of 25% EWL
measured at 12 months. In addition, it should achieve a minimum mean difference of 15% EWL between a
primary EBMT group and a control group, and the difference should be statistically significant. However,
when used as a non-primary intervention (e.g., early intervention, bridging, or metabolic therapy), the
EBMT should achieve an average minimum threshold of 5% total weight loss. The risk of the incidence of
serious adverse events associated with EBMT should be at a rate of ≤ 5%. If an EBMT with a low/negligible
risk profile proves to have a significant impact on one or more obesity-related comorbidities, the threshold
for intervention may extend to individuals with Class I obesity (BMI 30-35 kg/m ) .
2 [76]
A meta-analysis of 22 studies (2,141 patients) evaluating the efficacy of bariatric EBMTs found that most
EBMTs demonstrated superior efficacy with TBWL mean difference of 4.9% (POSE), 4.5% (DJBL), 5.3%