Endoscopic Bariatric and Metabolic Therapy. Where are We and Where are We Going?

Obese patients with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) require an endoscopy balloon or gastroplasty with/without duodenal mucosal resurfacing (DMR), while lean patients with NAFLD/NASH require endoscopic DMR. Duodenum is at the center of metabolic control; a sustained glycemic improvement is seen even after 12 months after a single DMR. Duodenal nutrient passage strongly influences insulin sensitivity, independent of weight change. DMR is safe and yields beneficial disease-modifying metabolic effects, especially in patients with high fasting plasma glucose levels. The newer DMR therapies include Laser, radiofrequency ablation (RFA) and electroporation.

RECETTM is the first nonthermal endoscopic ablative therapy and, thus, the only therapy to ablate cells selectively. It is feasible with the technical success achieved in 100% of subjects. It is safe and well-tolerated, with a few mild to moderate and transient adverse events. No serious adverse events have been reported with RECETTM. Duodenal RECETTM results in durable and clinically meaningful improvement in glycemic control. A dose response has been observed, with higher energy doses being more effective without any increased risk of adverse events.