Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Obesity and Endoscopic Treatment

비만과 내시경 치료

  • Kim, Sung-Soo (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 김성수 (가톨릭대학교 의과대학 내과학교실)
  • Published : 2011.05.30
⟨ Previous Next ⟩

Abstract

Obese patients have been increasing with the development of a social economy. Obesity is a disease with high mortality rates due to associated cardiovascular disease and diabetes. Diet or exercise therapy, medications, bariatric surgery are used for treating obesity. However, although bariatric surgery is safe and effective, it is expensive, and reoperation is a burden if patients fail to lose weight. Operative complications are also a problem. The recent development of endoluminal techniques may permit obesity treatment and many endoscopic procedures have been attempted. The role of endoscopy for treating obesity is treating the postoperative complications of bariatric surgery, for example, a stricture or widening of the anastomosis, fistula, or leaks. Second, endoscopic applications could be used for weight reduction to temporarily bridge surgery for high-risk patients with obesity, and for reducing weight in patients unable to undergo surgery. This article provides a brief overview of bariatric surgery and its complications and introduces several endoscopic applications to treat obesity.

사회 경제의 발달과 함께 비만 환자가 증가하고 있으며, 고도 비만은 동반된 심혈관계 질환이나 당뇨 등으로 인해 사망률이 높은 질환이다. 비만의 치료로는 식이 혹은 운동 요법, 약물치료, 비만 수술이 있다. 그러나 비만 수술은 안전한 수술이지만 고가이고 만족스러운 체중 감량에 실패하는 경우 재수술을 해야 하는 부담도 있으며, 또한 빈도는 작지만 수술로 인한 합병증도 문제이다. 최근 미세 내시경 기술이 발달하면서 비만치료에 내시경을 이용한 시술이 많이 시도되고 있다. 비만 치료에서 내시경 시술의 역할은 비만 수술의 합병증, 예를 들면 문합구 협착, 문합구 이완, 누공 혹은 누출 등에 대한 치료, 동반 질환이 심해 수술 후 합병증이 예상되는 경우 수술 전에 일시적으로 체중 감량을 하는 내시경 시술, 그리고 초기 비만이나 동반 질환이 심해 수술을 받을 수 없는 환자에서 체중 감량을 목적으로 하는 시술 등 내시경적 비만 치료의 영역은 넓다. 본문에서는 비만 수술의 개요와 합병증, 각종 내시경적 비만치료 시술에 대해 소개하였다. 아직 임상 연구 단계이거나 임상 성적이 풍부하지 않은 시술이 많기 때문에 앞으로 발전할 수 있는 영역이라 생각한다.

Keywords

References

  1. Ibrahim M, Blero D, Deviere J. Endoscopic options for the treatment of obesity. Gastroenterology 2010;138:2228-2232. https://doi.org/10.1053/j.gastro.2010.04.030
  2. Kim KK. Pharmacotherapy for obesity. J Korean Med Assoc 2011;54:409-418. https://doi.org/10.5124/jkma.2011.54.4.409
  3. Zhao Y, Encinosa W. Statistical Brief #23; Bariatric surgery utilization and outcomes in 1998 and 2004. Healthcare Cost and Utilization Project (HCUP) statistical briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US). http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp.
  4. Feldman. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Saunders: Elsevier, 2010:115.
  5. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg 2009;19:1605-1611. https://doi.org/10.1007/s11695-009-0014-5
  6. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724-1737. https://doi.org/10.1001/jama.292.14.1724
  7. O'Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg 2006;16:1032-1040. https://doi.org/10.1381/096089206778026316
  8. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753-761. https://doi.org/10.1056/NEJMoa066603
  9. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741-752. https://doi.org/10.1056/NEJMoa066254
  10. Khaitan L, Van Sickle K, Gonzalez R, Lin E, Ramshaw B, Smith CD. Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 2005;71:6-10.
  11. Gagner M, Gentileschi P, de Csepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 2002;12:54-60.
  12. Catalano MF, Rudic G, Anderson AJ, Chua TY. Weight gain after bariatric surgery as a result of a large gastric stoma: endotherapy with sodium morrhuate may prevent the need for surgical revision. Gastrointest Endosc 2007;66:240-245. https://doi.org/10.1016/j.gie.2006.06.061
  13. Spaulding L. Treatment of dilated gastrojejunostomy with sclerotherapy. Obes Surg 2003;13:254-257. https://doi.org/10.1381/096089203764467162
  14. Mullady DK, Lautz DB, Thompson CC. Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc 2009;70:440-444. https://doi.org/10.1016/j.gie.2009.01.042
  15. Peifer KJ, Shiels AJ, Azar R, Rivera RE, Eagon JC, Jonnalagadda S. Successful endoscopic management of gastrojejunal anastomotic strictures after Roux-en-Y gastric bypass. Gastrointest Endosc 2007;66:248-252. https://doi.org/10.1016/j.gie.2006.10.012
  16. Tucker ON, Szomstein S, Rosenthal RJ. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg 2007;11:1673-1679. https://doi.org/10.1007/s11605-007-0341-6
  17. Spaun GO, Martinec DV, Kennedy TJ, Swanstrom LL. Endoscopic closure of gastrogastric fistulas by using a tissue apposition system (with videos). Gastrointest Endosc 2010;71:606-611. https://doi.org/10.1016/j.gie.2009.09.044
  18. Dray X, Krishnamurty DM, Donatelli G, et al. Gastric wall healing after NOTES procedures: closure with endoscopic clips provides superior histological outcome compared with threaded tags closure. Gastrointest Endosc 2010;72:343-350. https://doi.org/10.1016/j.gie.2010.02.023
  19. Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg 2007;204:47-55. https://doi.org/10.1016/j.jamcollsurg.2006.09.023
  20. Salinas A, Baptista A, Santiago E, Antor M, Salinas H. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2006;2:570-572. https://doi.org/10.1016/j.soard.2006.08.007
  21. Lopes TL, Wilcox CM. Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy. Gastroenterol Clin North Am 2010;39:99-107. https://doi.org/10.1016/j.gtc.2009.12.008
  22. Nieben OG, Harboe H. Intragastric balloon as an artificial bezoar for treatment of obesity. Lancet 1982;1:198-199.
  23. Evans JD, Scott MH. Intragastric balloon in the treatment of patients with morbid obesity. Br J Surg 2001;88:1245-1248. https://doi.org/10.1046/j.0007-1323.2001.01840.x
  24. Genco A, Bruni T, Doldi SB, et al. Bioenterics intragastric balloon: the Italian experience with 2,515 patients. Obes Surg 2005;15:1161-1164. https://doi.org/10.1381/0960892055002202
  25. Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment- resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc 2005;61:19-27. https://doi.org/10.1016/S0016-5107(04)02406-X
  26. Dastis NS, François E, Deviere J, et al. Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years. Endoscopy 2009;41:575-580. https://doi.org/10.1055/s-0029-1214826
  27. Genco A, Balducci S, Bacci V, et al. Intragastric balloon or diet alone? A retrospective evaluation. Obes Surg 2008;18:989-992. https://doi.org/10.1007/s11695-007-9383-9
  28. Schwartz MP, Wellink H, Gooszen HG, Conchillo JM, Samsom M, Smout AJ. Endoscopic gastroplication for the treatment of gastro-oesophageal reflux disease: a randomised, sham-controlled trial. Gut 2007;56:20-28. https://doi.org/10.1136/gut.2006.096842
  29. Fogel R, De Fogel J, Bonilla Y, De La Fuente R. Clinical experience of transoral suturing for an endoluminal vertical gastroplasty: 1-year follow-up in 64 patients. Gastrointest Endosc 2008;68:51-58. https://doi.org/10.1016/j.gie.2007.10.061
  30. Cohen RV, Schiavon CA, Pinheiro JS, Correa JL, Rubino F. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/$m^{2}$: a report of 2 cases. Surg Obes Relat Dis 2007;3:195-197. https://doi.org/10.1016/j.soard.2007.01.009
  31. Rodriguez-Grunert L, Galvao Neto MP, Alamo M, Ramos AC, Baez PB, Tarnoff M. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve. Surg Obes Relat Dis 2008;4:55-59. https://doi.org/10.1016/j.soard.2007.07.012
  32. Tarnoff M, Rodriguez L, Escalona A, et al. Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc 2009;23:650-656. https://doi.org/10.1007/s00464-008-0125-4
  33. Moreno C, Closset J, Dugardeyn S, et al. Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study. Endoscopy 2008;40:406-413. https://doi.org/10.1055/s-2007-995748
  34. Chiellini C, Iaconelli A, Familiari P, et al. Study of the effects of transoral gastroplasty on insulin sensitivity and secretion in obese subjects. Nutr Metab Cardiovasc Dis 2010;20:202-207. https://doi.org/10.1016/j.numecd.2009.03.012
  35. Closset J, Germanova D, Loi P, Mehdi A, Moreno C, Deviere J. Laparoscopic gastric bypass as a revision procedure after transoral gastroplasty. Obes Surg 2011;21:1-4. https://doi.org/10.1007/s11695-009-0036-z
  36. de Jong K, Mathus-Vliegen EM, Veldhuyzen EA, Eshuis JH, Fockens P. Short-term safety and efficacy of the trans-oral endoscopic restrictive implant system for the treatment of obesity. Gastrointest Endosc 2010;72:497-504. https://doi.org/10.1016/j.gie.2010.02.053