The future of bariatrics: endoscopy, endoluminal surgery, and natural orifice transluminal endoscopic surgery.

This review considers the evolving role of endoscopic techniques in the treatment of obesity, and developments in minimally invasive procedures in endoscopy, endoluminal surgery and natural orifice transluminal endoscopic surgery (NOTES). Endoscopic approaches that are similar to surgery but less invasive, relying on gastric restriction and/or malabsorption, show some promise. Intragastric injection of botulinum toxin is also considered, as is the role of minimally invasive bariatric endoscopic interventions. Gastrointestinal stimulation with implanted electrodes may have potential in the treatment of obesity and endoscopic applications have a role to play in post-surgical interventions. Evolving research into endosurgical approaches is described. Current work on the feasibility of a NOTES approach to bariatric procedures is described.