Endoscopic and Surgical Methods for Weight Loss

: Obesity management has evolved toward a multidisciplinary continuum that includes lifestyle interventions, pharmacotherapy, endoscopic bariatric and metabolic therapies, and Metabolic and Bariatric Surgery. This review summarizes the current role of endoscopic and surgical weight-loss interventions and compares their mechanisms, efficacy, safety, and clinical positioning. Endoscopic techniques include gastric volume reduction procedures such as endoscopic sleeve gastroplasty and POSE 2.0, intragastric balloons with different designs and dwell times, duodenal metabolic therapies including duodenal mucosal resurfacing and duodenal-jejunal bypass liners, and aspiration therapy. These approaches typically achieve total body weight loss ranging from approximately 6% to 20%, depending on the device and follow-up duration. In contrast, MBS, including Sleeve Gastrectomy, Roux-en-Y gastric bypass, and One Anastomosis Gastric Bypass, provides greater long-term weight reduction and metabolic improvement but with higher procedural complexity. Endoscopic therapies therefore occupy an intermediate position between pharmacologic treatment and surgery, expanding therapeutic options for patients who are not candidates for or decline surgical intervention.