Current evidence and emerging role of endoscopic bariatric and metabolic therapies in gastrointestinal endoscopy

Obesity and related metabolic disorders, such as type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease(NAFLD) and dyslipidemia, are rising global health concerns. Traditional management approaches including lifestyle modification, pharmacotherapy and bariatric surgery are effective but often limited by issues of adherence, invasiveness and accessibility. Endoscopic bariatric and metabolic therapies (EBMTs) have emerged as minimally invasive alternatives that fill the gap between medical and surgical interventions. These therapies, including intragastric balloons(IGB), endoscopic sleeve gastroplasty(ESG), duodenal-jejunal bypass liners(DJBL), duodenal mucosal resurfacing(DMR) and aspiration therapy, employ diverse mechanisms to achieve weight loss and metabolic improvement. This review summarizes the current evidence on the efficacy, safety and long-term outcomes of EBMTs, with a focus on weight reduction, glycemic control and cardiovascular risk management. We also discuss technical innovations, procedural considerations, patient selection and the role of multidisciplinary care. Emerging trends, such as combination approaches, novel device development, AI-assisted endoscopy and modulation of gut hormone pathways, are explored to highlight the evolving landscape of minimally invasive metabolic interventions. Overall, EBMTs represent a rapidly advancing field with significant potential to reshape the management of obesity and metabolic diseases, underscoring the need for continued research and standardized clinical protocols to maximize patient outcomes.