Development of minimally invasive techniques for management of medically-complicated obesity

Table 1 Proposed physiological roles of gastrointestinal peptide hormones

Hormone	Localization	Proposed physiological roles
Peptide YY	Ileum and colon	Inhibits gastric emptying/intestinal transit; possible blockade of hunger
Glucagon-like	Ileum and colon	Delays gastric emptying;
Peptide 1		Incretin: Augments insulin secretion
Glucose-dependent insulinotropic peptide	Duodenum and proximal jejunum	Incretin: Augments insulin secretion
Oxyntomodulin	Ileum and colon	Blockade of hunger; inhibits gastric secretion and emptying
Ghrelin	Gastric fundus	Appetite stimulant; increases gastric motility
Pancreatic polypeptide	Pancreas	Suppresses food intake; inhibits gastric emptying
Cholecystokinin	Duodenum and proximal jejunum	Suppresses food intake; initiates satiety; inhibits gastric emptying

Table 2 Gastrointestinal peptides hormones after bariatric surgery

Hormone	Bariatric surgery	Blood hormone levels
Peptide YY	RYGB	Increased postprandially
Glucagon-like peptide 1	RYGB	Increased postprandially
Glucose-dependent insulinotropic peptide	RYGB and AGB	Increased postprandially
Oxyntomodulin	RYGB	Increased postprandially
Ghrelin	RYGB and SG	Low Fasting and Postprandially
Pancreatic polypeptide	RYGB	Decreased
Cholecystokinin	VBG	Increased

RYGB: Roux Y gastric bypass surgery; AGB: Adjustable gastric band; SG: Vertical sleeve gastrectomy; VBG: Vertical banded gastroplasty.

Table 3 Endoscopic techniques for treatment of obesity

Technique	Proposed mechanisms of action
Intragastric balloon	Increases gastric distension and satiety and delays gastric emptying
Endolumenal vertical gastroplasty	Restriction of food intake and Induce early satiety
Transoral gastroplasty	Restriction of food intake
Trans-oral endoscopic restrictive Implant system	Restriction of food intake
Duodeno-jejunal bypass sleeve	Reduced intestinal digestion and absorption And delayed gastric emptying
Gastroduodenojejunal bypass sleeve	Prevent absorption of nutrients
Aspiration therapy	Reduced presence of available nutrients

Table 4 Miscellaneous techniques for treatment of obesity

Technique	Proposed mechanisms of action
Electrical stimulation	Reduced gastric accommodation and
	Delayed gastric emptying
Intragastric botulinum toxin injections	Prolonged gastric emptying time and
	Reduced maximal gastric capacity
Natural orifice translumenal	Transluminal access to intra-abdominal
Endoscopic surgery	Structures