Richard I. Rothstein, MD, Editor

A number of endoscopic devices and procedures have been developed to treat obesity and diabetes, and several already have regulatory approval and commercial availability. Others are in clinical or preclinical evaluation, and we await further study in order to determine their role in the growing armamentarium of obesity treatments. Several endoscopic treatments are currently in clinical evaluation for the management of diabetes. In this issue of Gastrointestinal Endoscopy Clinics of North America , experts on obesity, diabetes, and the treatments for these conditions provide an update and view to the future, including the status of bariatric and metabolic endoscopy. Initial topics address the current and future medical management of obesity and bariatric surgical interventions. This is followed by a state-of-the-art understanding of body weight and metabolic regulation and what is known about how surgical interventions influence these metabolic processes. Next, a series of articles written by individuals with direct experience highlight the various available and evolving endoscopic devices and techniques and suggest areas of utility and needed iteration. A contribution follows that reviews the important management of obesity in the pediatric population, including the potential role of endoscopic therapies for this growing cohort. Great ideas and carefully constructed clinical trials will not necessarily result in commercially viable endoscopic solutions that can improve the lives of our patients. The article on regulatory perspectives, written by authors with abundant experience, outlines the various considerations that should be addressed in order to facilitate the regulatory approval of safe and effective devices and therapies. The final contribution on reimbursement perspectives offers superb practical advice from an experienced colleague and outlines pathways of reimbursement strategies for the currently commercially available devices. Comprehensive clinical management by interdisciplinary teams delivering coordinated and longitudinal care is suggested, and billing codes to facilitate payment for standard and endoscopic treatments in evolution are presented.

I want to thank all of the authors in this issue of Gastrointestinal Endoscopy Clinics of North America who have generously given their time and expertise so evident in their contributions to this publication. A special thanks to Dr Charlie Lightdale, friend and colleague for so many years, who initiated this issue with the recognition of the importance and timeliness of an update on the current and emerging endoscopic technologies to address obesity and diabetes, and who extended an invitation to edit this collection of work. I appreciate the guidance and assistance of Kerry Holland, Senior Editor, and Donald Mumford, Senior Developmental Editor, at Elsevier, who kept this project moving forward. A thanks to Dartmouth-Hitchcock colleague, Dr Amber Spofford, for the review and editing of the contribution on pediatric treatments. Finally, a thank you to my wife, Lia, who has always provided support and encouragement for my academic career and its myriad responsibilities and activities. I hope you enjoy this issue of Gastrointestinal Endoscopy Clinics of North America dedicated to the topic of bariatric and metabolic endoscopy, and I hope that the information presented will be useful as you seek to improve the health of patients with obesity and diabetes in your clinical practice.