Bariatric and Metabolic Endoscopy: New Approaches to Obesity and Diabetes

Charles J. Lightdale, MD, Consulting Editor

Each generation of gastrointestinal endoscopists has had unique challenges. For this generation, a major challenge (and opportunity) is to address the huge increase in the incidence of obesity and type 2 diabetes with attendant negative effects on mortality, quality of life, and cost of health care. The root causes of the obesity epidemic are controversial and debatable, but seem to have a relationship to a processed food supply high in sugars and fats, and to a less physically active lifestyle. Certain genetic subgroups may be particularly at risk. Children and adolescents are notably affected, and so dietary and behavioral changes must be applied early. Such interventions coupled with greater public awareness and concern may have blunted the accelerating obesity curve, but there will still be large numbers who require treatment.

There is an obvious need for new approaches. Diet and exercise programs have been effective for only a small minority of the morbidly obese, while pharmaceuticals have been largely ineffective, dangerous, or both. Surgical procedures producing food restriction or malabsorption have worked, but have not had wide acceptance because of risks, side effects, and difficult reversibility. These factors provide the opening for endoscopic innovation, where interventions may be carried out more safely, and offer treatments that can be applied serially in an incremental manner, and often with the possibility of easy reversal. In lessons learned from surgery, a team approach integrating physicians, nurses, dieticians, nutritionists, physical therapists, and psychologists would seem to be helpful.

The editor for this issue of the Gastrointestinal Endoscopy Clinics of North America on bariatric and metabolic endoscopy is Dr Richard Rothstein, a valued thought leader in gastrointestinal endoscopy with a futuristic eye, who has been naturally interested in revolutionary endoscopic treatments for obesity and diabetes. He has assembled an outstanding group of expert authors in the field, knowledgeable not only in endoscopy but also in the pathophysiology of the derangements associated with obesity and metabolic syndromes. Endoscopic interventions involving the stomach and the small bowel are presented in detail, including options for children and adolescents. Regulatory clearance of novel devices and reimbursement in this evolving area of gastrointestinal endoscopy are additional key topics covered in this issue, which will be of critical importance to researchers and clinicians alike.

This is a state-of-the-art issue and a look to the future for bariatric and metabolic endoscopy. It is also a clarion call for gastrointestinal endoscopists to get off the couch themselves and start thinking about how they may help alleviate the obesity and metabolic syndromes so highly pervasive in our modern society.

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