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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EMetabolic surgery (gastric restriction [sleeve gastrectomy and gastric banding], a combination approach using Roux-en-Y gastric banding, and the malabsorption method using a duodenal switch) can effectively and safely reduce weight, achieve diabetes remission, reduce comorbidities, and improve quality of life in obese individuals.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emetabolic surgery\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eobesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egastric banding\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eduodenal switch\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esleeve gastrectomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etype 2 diabetes mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendoluminal devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendoscopic bariatric therapies\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendobarriers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eglycemic control\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egastroenterology procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe prevalence of obesity and diagnosed diabetes is a major problem in the United States. As of 2013, 26% of adults had a body mass index (BMI) \u0026gt;\u200530 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, and 9% (29.1 million) had diabetes mellitus (DM) [CDC\u2019s Division of Diabetes Translation. \u003Ca href=\u0022http:\/\/www.cdc.gov\/diabetes\/data\/\u0022\u003Ehttp:\/\/www.cdc.gov\/diabetes\/data\/\u003C\/a\u003E. Accessed May 28, 2015]. Both of these problems have increased over the last 50 years. Matthew M. Hutter, MD, Massachusetts General Hospital, Boston, Massachusetts, USA, discussed the options to correct these problems and outcomes for metabolic surgery.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe potential for metabolic surgery to be effective for treatment of type 2 DM (T2DM) was first proposed by Pories in 1995. His suggestion was confirmed by a 2005 meta-analysis that showed that many patients with obesity undergoing metabolic surgery experienced resolution or improvement not only in DM but also in hyperlipidemia, hypertension, and obstructive sleep apnea. Dr Hutter noted that the importance of this surgery for metabolic diseases led to a change in terminology from bariatric surgery to metabolic surgery.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EOptions for metabolic surgery include bypass and the use of gastric bands and sleeve gastrectomy. In the United States, there is a trend toward decreasing the use of bypass and band procedures and increasing the use of the sleeve. The 3-year, randomized STAMPEDE trial [Schauer PR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014] reported that intensive medical therapy plus metabolic surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) resulted in glycemic control in significantly more patients than did medical therapy alone (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001). Improved body weight, less use of glucose-lowering medications, and improved quality of life (QOL) were also more favorable for the metabolic surgery group (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mean Changes in Parameters of Diabetes ControlMean Changes in Measures of Diabetes Control from Baseline to 3 Years. Shown are the percentage change in glycated hemoglobin levels (Panel A), the percentage change in glycated hemoglobin levels according to body-mass index (BMI) (Panel B), the average number of diabetes medications during the study period (Panel C), and the changes in BMI (Panel D) over a 3-year period among patients receiving intensive medical therapy only, sleeve gastrectomy, or gastric bypass. I bars indicate standard errors. Mean values in each group are provided below the graphs; in Panels A and B, median values are also provided in parentheses. P values are for the comparison between each surgical group and the medical-therapy group in Panels A, C, and D. In Panel B, P=0.008 for the comparison between the surgical groups and the medical-therapy group for the subgroup of patients with a BMI of less than 35; P\u0026amp;lt;0.001 for the comparison for the subgroup with a BMI of 35 or more.From N Engl J Med, Schauer PR et al., Bariatric Surgery versus Intensive Medical Therapy for Diabetes\u0026#x2014;3-Year Outcomes, Volume No. 370, Page No. 2002-2013. Copyright \u0026#xA9; (2014) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1891907992\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Mean Changes in Parameters of Diabetes ControlMean Changes in Measures of Diabetes Control from Baseline to 3 Years. Shown are the percentage change in glycated hemoglobin levels (Panel A), the percentage change in glycated hemoglobin levels according to body-mass index (BMI) (Panel B), the average number of diabetes medications during the study period (Panel C), and the changes in BMI (Panel D) over a 3-year period among patients receiving intensive medical therapy only, sleeve gastrectomy, or gastric bypass. I bars indicate standard errors. Mean values in each group are provided below the graphs; in Panels A and B, median values are also provided in parentheses. P values are for the comparison between each surgical group and the medical-therapy group in Panels A, C, and D. In Panel B, P=0.008 for the comparison between the surgical groups and the medical-therapy group for the subgroup of patients with a BMI of less than 35; P\u0026amp;amp;lt;0.001 for the comparison for the subgroup with a BMI of 35 or more.From \u0026amp;lt;em\u0026amp;gt;N Engl J Med\u0026amp;lt;\/em\u0026amp;gt;, Schauer PR et al., Bariatric Surgery versus Intensive Medical Therapy for Diabetes\u0026#x2014;3-Year Outcomes, Volume No. 370, Page No. 2002-2013. Copyright \u0026#xA9; (2014) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16796\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EMean Changes in Parameters of Diabetes Control\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMean Changes in Measures of Diabetes Control from Baseline to 3 Years. Shown are the percentage change in glycated hemoglobin levels (Panel A), the percentage change in glycated hemoglobin levels according to body-mass index (BMI) (Panel B), the average number of diabetes medications during the study period (Panel C), and the changes in BMI (Panel D) over a 3-year period among patients receiving intensive medical therapy only, sleeve gastrectomy, or gastric bypass. I bars indicate standard errors. Mean values in each group are provided below the graphs; in Panels A and B, median values are also provided in parentheses. P values are for the comparison between each surgical group and the medical-therapy group in Panels A, C, and D. In Panel B, P=0.008 for the comparison between the surgical groups and the medical-therapy group for the subgroup of patients with a BMI of less than 35; P\u0026lt;0.001 for the comparison for the subgroup with a BMI of 35 or more.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EFrom \u003Cem\u003EN Engl J Med\u003C\/em\u003E, Schauer PR et al., Bariatric Surgery versus Intensive Medical Therapy for Diabetes\u20143-Year Outcomes, Volume No. 370, Page No. 2002-2013. Copyright \u00a9 (2014) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAlthough these are all effective procedures, studies have shown morbidity rates of 3% to 20% and mortality rates of 0.1% to 0.5% [ASGE\/ASMBS Task Force on Endoscopic Bariatric Therapy. \u003Cem\u003EGastrointest Endosc\u003C\/em\u003E. 2011]. In a head-to-head comparison, favorable outcomes for bypass, sleeve, and band procedures differ depending on the study. In a meta-analysis of 11 studies to quantify the overall effects of metabolic surgery compared with nonsurgical treatment for obesity, metabolic surgery led to greater body weight loss, higher remission rates of T2DM and metabolic syndrome, greater improvements in QOL, and reductions in medication use [Gloy VL et al. \u003Cem\u003EBMJ\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EOne study showed that, among patients with DM, neither the choice of procedure nor baseline BMI impacted DM resolution [Panunzi S et al. \u003Cem\u003EAnn Surg\u003C\/em\u003E. 2015]; however, a review reported that in patients with BMI \u0026lt;\u200535 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, metabolic surgery was associated with higher T2DM remission rates, a higher rate of glycemic control, and lower HbA\u003Csub\u003E1c\u003C\/sub\u003E levels compared with medical treatment [M\u00fcller-Stich BP et al. \u003Cem\u003EAnn Surg\u003C\/em\u003E. 2015]. Follow-up ranged from 12 to 36 months.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThese studies and others indicated that metabolic surgery is effective treatment not only for weight loss but also for achieving DM remission, improving metabolic syndromes, and achieving significant improvements in QOL.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EDespite the known consequences of obesity and the availability of surgical treatment options, only a small percentage of patients eligible for surgery are being treated. Many of these patients are concerned with what they feel may be an invasive, painful procedure requiring a long recovery. Other options are available, however. Aurora D. Pryor, MD, Stony Brook Medicine, Stony Brook, New York, USA, discussed the newer endoluminal bariatric therapies.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EEndoluminal bariatric treatment approaches are less painful and minimally invasive, reduce risk, and decrease recovery time and cost, but their risks and benefits need further study, as does the appropriateness of their disabilities, durabilities, and resource utilizations. The recommended weight loss thresholds are 5% of total body weight for treatment of early metabolic disease, 20% excess weight loss (EWL) for bridge therapy, and 25% EWL for primary therapy (less in the case of lower-risk procedures) [ASGE\/ASMBS Task Force on Endoscopic Bariatric Therapy. \u003Cem\u003EGastrointest Endosc\u003C\/em\u003E. 2011].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003ESpace-occupying devices such as intragastric bubbles were first proposed in 1982. Their use was discontinued in 1989 after several trials showed no benefit over sham procedures as well as significant complications. The BioEnterics Intragastric Balloon device that is expected to receive FDA approval in 2015 is showing more promise. In a 2005 study that assessed this device, EWL at 6 months was 34%, with a 45% improvement in comorbidities. In another 2005 study, significant weight loss was noted at 1 year (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). At the end of the second balloon-free year, 47% of patients sustained a \u0026gt;\u200510% weight loss. Glucose, insulin, low-density lipoprotein cholesterol, and triglycerides were also reduced relative to baseline after 1 year of balloon therapy (\u003Ca id=\u0022xref-fig-2-2\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). The reshape balloon is also expected to garner approval in 2015.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Weight and Comorbidity Reductions Following Intragastric Balloon TherapyPer protocol analysis. Percentage of patients achieving 10%, 15%, and 20% weight loss after 12 and 24 mo, and percentage of patients with elevated values for glucose (\u0026amp;gt;\u0026#x2005;6 mmol\/L), insulin (\u0026amp;gt;20 IU\/L), LDL-cholesterol (\u0026amp;gt;4.5 mmol\/L), triglycerides (TG) (\u0026amp;gt;2 mmol\/L), and elevated diastolic blood pressure (BP) (\u0026amp;gt;100 mm Hg) at baseline (start) and after 1 year.Reprinted from Gastrointest Endosc, Vol 61, Mathus-Vliegen EMH et al., Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up, Pages 19-27, Copyright (2005), with permission from American Society for Gastrointestinal Endoscopy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1891907992\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Weight and Comorbidity Reductions Following Intragastric Balloon TherapyPer protocol analysis. Percentage of patients achieving 10%, 15%, and 20% weight loss after 12 and 24 mo, and percentage of patients with elevated values for glucose (\u0026amp;amp;gt;\u0026#x2005;6 mmol\/L), insulin (\u0026amp;amp;gt;20 IU\/L), LDL-cholesterol (\u0026amp;amp;gt;4.5 mmol\/L), triglycerides (\u0026amp;lt;em\u0026amp;gt;TG\u0026amp;lt;\/em\u0026amp;gt;) (\u0026amp;amp;gt;2 mmol\/L), and elevated diastolic blood pressure (\u0026amp;lt;em\u0026amp;gt;BP\u0026amp;lt;\/em\u0026amp;gt;) (\u0026amp;amp;gt;100 mm Hg) at baseline (start) and after 1 year.Reprinted from \u0026amp;lt;em\u0026amp;gt;Gastrointest Endosc\u0026amp;lt;\/em\u0026amp;gt;, Vol 61, Mathus-Vliegen EMH et al., Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up, Pages 19-27, Copyright (2005), with permission from American Society for Gastrointestinal Endoscopy.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/14\/28\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16797\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EWeight and Comorbidity Reductions Following Intragastric Balloon Therapy\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EPer protocol analysis. Percentage of patients achieving 10%, 15%, and 20% weight loss after 12 and 24 mo, and percentage of patients with elevated values for glucose (\u0026gt;\u20056 mmol\/L), insulin (\u0026gt;20 IU\/L), LDL-cholesterol (\u0026gt;4.5 mmol\/L), triglycerides (\u003Cem\u003ETG\u003C\/em\u003E) (\u0026gt;2 mmol\/L), and elevated diastolic blood pressure (\u003Cem\u003EBP\u003C\/em\u003E) (\u0026gt;100 mm Hg) at baseline (start) and after 1 year.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EReprinted from \u003Cem\u003EGastrointest Endosc\u003C\/em\u003E, Vol 61, Mathus-Vliegen EMH et al., Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up, Pages 19-27, Copyright (2005), with permission from American Society for Gastrointestinal Endoscopy.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EBalloons may be endoscopically inserted or swallowed. Both require endoscopic retrieval. Another device is swallowed and dissolvable. A novel endoluminal device (TransPyloric Shuttle) is endoscopically positioned in the transpyloric area to delay gastric emptying, reduce caloric intake, and reduce weight [Marinos G et al. \u003Cem\u003ESurg Obes Relat Dis\u003C\/em\u003E. 2014]. After 3 months, patients receiving the device had a 25% and 41% EWL at 3 and 6 months, respectively. At 6 months, total weight loss was about 15%.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003ETansoral endoscopically placed tissue anchors to reduce stoma diameter and pouch volume, as well as the need for revisional gastric bypass surgery, have been shown to be feasible [Herron DM et al. \u003Cem\u003ESurg Endosc\u003C\/em\u003E. 2008]. Suture anchors can be applied either by application or by apposition. In one study, a novel endoscopic duodenal-jejunal bypass liner after 24 weeks reduced weight and significantly improved HbA\u003Csub\u003E1c\u003C\/sub\u003E levels (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.01) [de Jonge C et al. \u003Cem\u003EObes Surg\u003C\/em\u003E. 2013]. A European study has reported that the endoscopically placed duodenal-jejunal bypass liner (EndoBarrier Gastrointestinal Liner) is a feasible and safe noninvasive device with excellent short-term weight loss results, and has significant positive effects on T2DM [Schouten R et al. \u003Cem\u003EAnn Surg\u003C\/em\u003E. 2010].\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EHowever, endobarriers have been associated with bleeding, pain, vomiting, and obstruction. Weight gain may also occur once the endobarrier is removed.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EOne of the newest endoscopic procedures is duodenal mucosal resurfacing by thermal mucosal ablation. It is unique in that it does not involve an indwelling device. Initial results of one study showed a 2% drop in HbA\u003Csub\u003E1c\u003C\/sub\u003E levels at 3 months, which were maintained for 6 months [Rodriguez L et al. IFSO 2014 (abstr OS22.01)].\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EDr Pryor concluded that there are many devices and procedures in development that may help promote the resolution of metabolic disease independent of weight loss.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/14\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlhy1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlhy1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}