Endoscopic Bariatric Therapies in Inflammatory Bowel Disease: Patient Selection, Nutritional Risk, and Periprocedural Management.

Background/

Objectives

Obesity is increasingly recognised as a clinically relevant comorbidity in patients with inflammatory bowel disease (IBD), with potential effects on inflammatory burden, treatment response, surgical risk, nutritional status, and quality of life. Endoscopic bariatric therapies (EBTs), including intragastric balloons and endoscopic sleeve gastroplasty, offer minimally invasive weight-loss options between pharmacotherapy and bariatric surgery. However, their role in IBD remains poorly defined. This narrative review examines patient selection, nutritional risk, periprocedural management, and future research priorities for EBTs in IBD.

Methods

A narrative review was performed, focusing on obesity in IBD, bariatric endoscopy, bariatric surgery, nutritional deficiencies, sarcopenic obesity, biologic therapy, and periprocedural risk. Evidence from general bariatric endoscopy studies, IBD-specific obesity literature, clinical guidelines, and expert consensus documents was synthesised.

Results

Direct evidence evaluating EBTs in patients with IBD is very limited. Most practical considerations must therefore be extrapolated from general bariatric endoscopy studies and bariatric surgery data in IBD. Patients with sustained clinical and preferably endoscopic remission, stable nutritional status, and uncomplicated disease phenotypes may represent the most suitable candidates. Active upper gastrointestinal Crohn's disease, stricturing or penetrating disease, recent surgery, severe malnutrition, sarcopenia, and high-dose corticosteroid exposure should prompt caution or avoidance. Structured follow-up is needed to monitor nutritional deficiencies, body composition, procedural symptoms, and possible IBD activity.

Conclusions

EBTs may represent a promising option for selected patients with IBD and obesity, but current evidence remains insufficient for firm recommendations. Prospective registries, phenotype-stratified cohort studies, and comparative trials are needed.