ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (On-demand) | May 2023-Mechanisms of Action for Endoscopic Therapies: How Do They Work? Does it Matter?

Mechanisms of Action for Endoscopic Therapies: How Do They Work? Does it Matter?

Video Transcription

Video Summary

In this video, Dr. Pichamon-Quiropinho from Brigham Women's Hospital and Harvard Medical School discusses the mechanisms of action for endoscopic therapies for obesity. She starts by providing an overview of the various endoscopic therapies available, including gastric interventions such as balloons, transpyloric shuttle, endoscopic sleeve, and aspiration therapy, as well as small bowel interventions like the duodenal jejunal bypass liner and duodenal mucosal resurfacing. Dr. Pichamon-Quiropinho explains that gastric interventions primarily work by affecting gastric emptying and gut hormones, while small bowel interventions have a direct impact on metabolic improvement with or without weight loss. She presents data on the effectiveness of these therapies, including the percentage of weight loss and improvement in metabolic outcomes. Dr. Pichamon-Quiropinho also discusses the mechanisms of action for each device, including how gastric balloons delay gastric emptying and suppress ghrelin levels, how the transpyloric shuttle works by delaying gastric emptying, and how endoscopic sleeves and aspiration therapy affect gut hormones. For small bowel interventions, she explores the increase in effect, the foregut-hindgut hypothesis, and the role of bile acids and gut microbiome. She concludes by emphasizing the need for more mechanistic studies to guide personalized therapy.

Asset Subtitle

Pichamol Jirapinyo, MD, MPH

Keywords

endoscopic therapies

gastric interventions

small bowel interventions

mechanisms of action

gut hormones

weight loss