Obesity is a significant problem worldwide. Several serious diseases that decrease patient quality of life and increase mortality (high blood pressure, dyslipidaemia, type 2 diabetes etc.) are associated with obesity. Obesity treatment is a multidisciplinary and complex process that requires maximum patient compliance. Change of lifestyle is fundamental in the treatment of obesity. While pharmacotherapeutic options are available, their efficacy is limited. Surgical treatment though highly effective, carries the risk of complications and is thus indicated mostly in advanced stages of obesity. Endoscopic treatments of obesity are less invasive than surgical options, and are associated with fewer complications and nutritional deficits. Currently, there is a large spectrum of endoscopic methods based on the principles of gastric volume reduction, size restriction and gastric or small bowel bypass being explored with only few available in routine practice. The aim of this publication is to present an up-to-date summary of available endoscopic methods for the treatment of obesity focusing on their efficacy, safety and nutritional aspects.

Department of Diabetology Institute for Clinical and Experimental Medicine Vídeňská 1958 9 14021 Prague Czech Republic

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine Vídeňská 1958 9 14021 Prague Czech Republic

Department of Internal Medicine Gastroenterology and Geriatrics University Hospital Olomouc 77900 Olomouc Czech Republic

Department of Physiology and Pathophysiology Faculty of Medicine University of Ostrava 70103 Ostrava Czech Republic

Department of Surgical Studies Faculty of Medicine University of Ostrava 70300 Ostrava Czech Republic

Faculty of Medicine and Dentistry Palacký University Olomouc 77147 Olomouc Czech Republic

Institute of Laboratory Medicine University Hospital Ostrava 70800 Ostrava Czech Republic

Research Obesity Centre Department of Human Movement Studies Faculty of Medicine University of Ostrava 70300 Ostrava Czech Republic

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Yumuk V., Tsigos C., Fried M., Schindler K., Busetto L., Micic D., Toplak H., Obesity Management Task Force of the European Association for the Study of Obesity European Guidelines for Obesity Management in Adults. Obes. Facts. 2015;8:402–424. doi: 10.1159/000442721. PubMed DOI PMC

WHO Organization Obesity and Overweight. [(accessed on 20 November 2021)]. Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

Overweight and Obesity—BMI Statistics. [(accessed on 20 November 2021)]. Available online: https://ec.europa.eu/eurostat/statistics-explained/index.php/Overweight_and_obesity_-_BMI_statistics.

Adult Obesity Facts. [(accessed on 11 October 2021)]; Available online: https://www.cdc.gov/obesity/data/adult.html.

Bluher M. Obesity: Global epidemiology and pathogenesis. Nat. Rev. Endocrinol. 2019;15:288–298. doi: 10.1038/s41574-019-0176-8. PubMed DOI

Heymsfield S.B., Wadden T.A. Mechanisms, pathophysiology, and management of obesity. N. Engl. J. Med. 2017;376:254–266. doi: 10.1056/NEJMra1514009. PubMed DOI

Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: Pathophysiology and clinical implications. Gastroenterology. 2012;142:711–725.e6. doi: 10.1053/j.gastro.2012.02.003. PubMed DOI

Yanovski S.Z., Yanovski J.A. Obesity. N. Engl. J. Med. 2002;346:591–602. doi: 10.1056/NEJMra012586. PubMed DOI

Sacks D., Baxter B., Campbell B.C.V., Carpenter J.S., Cognard C., Dippel D., Eesa M., Fischer U., Hausegger K., Hirsch J.A., et al. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int. J. Stroke. 2018;13:612–632. doi: 10.1016/j.jvir.2017.11.026. PubMed DOI

Pilitsi E., Farr O.M., Polyzos S.A., Perakakis N., Nolen-Doerr E., Papathanasiou A.E., Mantzoros C.S. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metab. Clin. Exp. 2019;92:170–192. doi: 10.1016/j.metabol.2018.10.010. PubMed DOI

Eren-Yazicioglu C.Y., Yigit A., Dogruoz R.E., Yapici-Eser H. Can GLP-1 be a target for reward system related disorders? A Qualitative synthesis and systematic review analysis of studies on palatable food, drugs of abuse, and alcohol. Front. Behav. Neurosci. 2020;14:614884. doi: 10.3389/fnbeh.2020.614884. PubMed DOI PMC

Eldar S., Heneghan H.M., Brethauer S.A., Schauer P.R. Bariatric surgery for treatment of obesity. Int. J. Obes. 2011;35:S16–S21. doi: 10.1038/ijo.2011.142. PubMed DOI

Smith B.R., Schauer P., Nguyen N.T. Surgical approaches to the treatment of obesity: Bariatric surgery. Med. Clin. North Am. 2011;95:1009–1030. doi: 10.1016/j.mcna.2011.06.010. PubMed DOI

Knowler W.C., Barrett-Connor E., Fowler S.E., Hamman R.F., Lachin J.M., Walker E.A., Nathan D.M. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 2002;346:393–403. PubMed PMC

Jung S.H., Yoon J.H., Choi H.S., Nam S.J., Kim K.O., Kim D.H., Kim J.W., Sohn W., Hyun Y.S., Park C.H., et al. Obesity, Comparative efficacy of bariatric endoscopic procedures in the treatment of morbid obesity: A systematic review and network meta-analysis. Endoscopy. 2020;52:940–954. doi: 10.1055/a-1149-1862. PubMed DOI

Mechanick J.I., Apovian C., Brethauer S., Garvey W.T., Joffe A.M., Kim J., Kushner R.F., Lindquist R., Pessah-Pollack R., Seger J., et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists—Executive summary. Endocr. Pract. 2019;25:1346–1359. PubMed

Di Lorenzo N., Antoniou S.A., Batterham R.L., Busetto L., Godoroja D., Iossa A., Carrano F.M., Agresta F., Alarçon I., Azran C., et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: Update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg. Endosc. 2020;34:2332–2358. doi: 10.1007/s00464-020-07555-y. PubMed DOI PMC

McCarty T.R., Thompson C.C. The current state of bariatric endoscopy. Dig. Endosc. 2021;33:321–334. doi: 10.1111/den.13698. PubMed DOI

Tawadros A., Makar M., Kahaleh M., Sarkar A. Overview of bariatric and metabolic endoscopy interventions. Ther. Adv. Gastrointest. Endosc. 2020;13:2631774520935239. doi: 10.1177/2631774520935239. PubMed DOI PMC

Sullivan S., Edmundowicz S.A., Thompson C.C. Endoscopic bariatric and metabolic therapies: New and emerging technologies. Gastroenterology. 2017;152:1791–1801. doi: 10.1053/j.gastro.2017.01.044. PubMed DOI

Rubino F., R′Bibo S.L., del Genio F., Mazumdar M., McGraw T.E. Metabolic surgery: The role of the gastrointestinal tract in diabetes mellitus. Nat. Rev. Endocrinol. 2010;6:102–109. doi: 10.1038/nrendo.2009.268. PubMed DOI PMC

Hadefi A., Huberty V., Lemmers A., Arvanitakis M., Maggs D., Costamagna G., Devière J. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes. Dig. Dis. 2018;36:322–324. doi: 10.1159/000487078. PubMed DOI

Nieben O.G., Harboe H. Intragastric balloon as an artificial bezoar for treatment of obesity. Lancet. 1982;1:198–199. doi: 10.1016/S0140-6736(82)90762-0. PubMed DOI

Velchik M.G., Kramer F.M., Stunkard A.J., Alavi A. Effect of the Garren-Edwards gastric bubble on gastric emptying. J. Nucl. Med. 1989;30:692–696. PubMed

Fittipaldi-Fernandez R.J., Zotarelli-Filho I.J., Diestel C.F., Klein M., de Santana M.F., de Lima J.H.F., Bastos F.S.S., Dos Santos N.T. Intragastric Balloon: A Retrospective Evaluation of 5874 Patients on Tolerance, Complications, and Efficacy in Different Degrees of Overweight. Obes. Surg. 2020;30:4892–4898. doi: 10.1007/s11695-020-04985-4. PubMed DOI

Lopez-Nava G., Asokkumar R., Rull A., Corbelle F., Beltran L., Bautista I. Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients? Endosc. Int. Open. 2019;7:E1691–W1698. doi: 10.1055/a-1007-1769. PubMed DOI PMC

Lopez-Nava G., Rubio M.A., Prados S., Pastor G., Cruz M.R., Companioni E., Lopez A. BioEnterics® intragastric balloon (BIB®). Single ambulatory center Spanish experience with 714 consecutive patients treated with one or two consecutive balloons. Obes. Surg. 2011;21:5–9. doi: 10.1007/s11695-010-0093-3. PubMed DOI

Kotzampassi K., Grosomanidis V., Papakostas P., Penna S., Eleftheriadis E. 500 intragastric balloons: What happens 5 years thereafter? Obes. Surg. 2012;22:896–903. doi: 10.1007/s11695-012-0607-2. PubMed DOI

Suchartlikitwong S., Laoveeravat P., Mingbunjerdsuk T., Vutthikraivit W., Ismail A., Islam S., Islam E. Usefulness of the ReShape intragastric balloon for obesity. Proceedings. 2019;32:192–195. doi: 10.1080/08998280.2018.1559397. PubMed DOI PMC

Neylan C.J., Dempsey D.T., Tewksbury C.M., Williams N.N., Dumon K.R. Endoscopic treatments of obesity: A comprehensive review. Surg. Obes. Relat. Dis. 2016;12:1108–1115. doi: 10.1016/j.soard.2016.02.006. PubMed DOI

Tate C.M., Geliebter A. Intragastric balloon treatment for obesity: Review of recent studies. Adv. Ther. 2017;34:1859–1875. doi: 10.1007/s12325-017-0562-3. PubMed DOI

Vargas E.J., Pesta C.M., Bali A., Ibegbu E., Bazerbachi F., Moore R.L., Kumbhari V., Sharaiha R.Z., Curry T.W., DosSantos G., et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clin. Gastroenterol. Hepatol. 2018;16:1073–1080.e1. doi: 10.1016/j.cgh.2018.01.046. PubMed DOI PMC

Fayad L., Cheskin L.J., Adam A., Badurdeen D.S., Hill C., Agnihotri A., Dunlap M., Simsek C., Khashab M.A., Kalloo A.N., et al. Endoscopic sleeve gastroplasty versus intragastric balloon insertion: Efficacy, durability, and safety. Endoscopy. 2019;51:532–539. doi: 10.1055/a-0852-3441. PubMed DOI

Abu Dayyeh B.K., Edmundowicz S.A., Jonnalagadda S., Kumar N., Larsen M., Sullivan S., Thompson C.C., Banerjee S., Forc A.B.E.T., Comm A.T. Endoscopic bariatric therapies. Gastrointest. Endosc. 2015;81:1073–1086. doi: 10.1016/j.gie.2015.02.023. PubMed DOI

Herve J., Wahlen C.H., Schaeken A., Dallemagne B., Dewandre J.M., Markiewicz S., Monami B., Weerts J., Jehaes C. What becomes of patients one year after the intragastric balloon has been removed? Obes. Surg. 2005;15:864–870. doi: 10.1381/0960892054222894. PubMed DOI

Marinos G., Eliades C., Muthusamy V.R., Greenway F. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: Clinical results from a 3-and 6-month study. Surg. Obes. Relat. Dis. 2014;10:929–934. doi: 10.1016/j.soard.2014.03.005. PubMed DOI

Sauer N., Rosch T., Pezold J., Reining F., Anders M., Groth S., Schachschal G., Mann O., Aberle J. A new endoscopically implantable device (SatiSphere) for treatment of obesity—efficacy, safety, and metabolic effects on glucose, insulin, and GLP-1 levels. Obes. Surg. 2013;23:1727–1733. doi: 10.1007/s11695-013-1005-0. PubMed DOI

Barrichello S., Hourneaux de Moura D.T., Hourneaux de Moura E.G., Jirapinyo P., Hoff A.C., Fittipaldi-Fernandez R.J., Baretta G., Felicio Lima J.H., Usuy E.N., de Almeida L.S., et al. Endoscopic sleeve gastroplasty in the management of overweight and obesity: An international multicenter study. Gastrointest. Endosc. 2019;90:770–780. doi: 10.1016/j.gie.2019.06.013. PubMed DOI

Lopez-Nava G., Galvao M.P., Bautista-Castano I., Fernandez-Corbelle J.P., Trell M., Lopez N. Endoscopic Sleeve Gastroplasty for Obesity Treatment: Two Years of Experience. Arq. Bras. Cir. Dig. 2017;30:18–20. doi: 10.1590/0102-6720201700010006. PubMed DOI PMC

Huberty V., Boskoski I., Bove V., Van Ouytsel P., Costamagna G., Barthet M.A., Deviere J. Endoscopic sutured gastroplasty in addition to lifestyle modification: Short-term efficacy in a controlled randomised trial. Gut. 2020;70:1479–1485. doi: 10.1136/gutjnl-2020-322026. PubMed DOI

Lopez-Nava G., Bautista-Castano I., Jimenez A., de Grado T., Fernandez-Corbelle J.P. The Primary Obesity Surgery Endolumenal (POSE) procedure: One-year patient weight loss and safety outcomes. Surg. Obes. Relat. Dis. 2015;11:861–865. doi: 10.1016/j.soard.2014.09.026. PubMed DOI

Sullivan S., Swain J.M., Woodman G., Antonetti M., De La Cruz-Muñoz N., Jonnalagadda S.S., Ujiki M., Ikramuddin S., Ponce J., Ryou M., et al. Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: The ESSENTIAL trial. J. Obes. 2017;25:294–301. doi: 10.1002/oby.21702. PubMed DOI

Lopez-Nava G., Asokkumar R., Turró Arau R., Neto M.G., Dayyeh B.A. Modified primary obesity surgery endoluminal (POSE-2) procedure for the treatment of obesity. VideoGIE. 2020;5:91–93. doi: 10.1016/j.vgie.2019.11.010. PubMed DOI PMC

Kumar N. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration. World J. Gastrointest. Endosc. 2015;7:847–859. doi: 10.4253/wjge.v7.i9.847. PubMed DOI PMC

Deviere J., Ojeda Valdes G., Cuevas Herrera L., Closset J., Le Moine O., Eisendrath P., Moreno C., Dugardeyn S., Barea M., de la Torre R., et al. Safety, feasibility and weight loss after transoral gastroplasty: First human multicenter study. Surg. Endosc. 2008;22:589–598. doi: 10.1007/s00464-007-9662-5. PubMed DOI

Moreno C., Closset J., Dugardeyn S., Barea M., Mehdi A., Collignon L., Zalcman M., Baurain M., Le Moine O., Deviere J. Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: Results of the second human pilot study. Endoscopy. 2008;40:406–413. doi: 10.1055/s-2007-995748. PubMed DOI

Koehestanie P., de Jonge C., Berends F.J., Janssen I.M., Bouvy N.D., Greve J.W. The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann. Surg. 2014;260:984–992. doi: 10.1097/SLA.0000000000000794. PubMed DOI

Forner P.M., Ramacciotti T., Farey J.E., Lord R.V. Safety and Effectiveness of an Endoscopically Placed Duodenal-Jejunal Bypass Device (EndoBarrierA (R)): Outcomes in 114 Patients. Obes. Surg. 2017;27:3306–3313. doi: 10.1007/s11695-017-2939-4. PubMed DOI

Kaválková P., Mráz M., Trachta P., Kloučková J., Cinkajzlová A., Lacinová Z., Haluzíková D., Beneš M., Vlasáková Z., Burda V., et al. Endocrine effects of duodenal-jejunal exclusion in obese patients with type 2 diabetes mellitus. J. Endocrinol. 2016;231:11–22. doi: 10.1530/JOE-16-0206. PubMed DOI

Sandler B.J., Rumbaut R., Swain C.P., Torres G., Morales L., Gonzales L., Schultz S., Talamini M.A., Jacobsen G.R., Horgan S. One-year human experience with a novel endoluminal, endoscopic gastric bypass sleeve for morbid obesity. Surg. Endosc. 2015;29:3298–3303. doi: 10.1007/s00464-015-4081-5. PubMed DOI

Norén E., Forssell H. Aspiration therapy for obesity; a safe and effective treatment. BMC Obes. 2016;3:56. doi: 10.1186/s40608-016-0134-0. PubMed DOI PMC

Thompson C.C., Abu Dayyeh B.K., Kushnir V., Kushner R.F., Jirapinyo P., Schorr A.B., Aronne L.J., Amaro A., Jaffe D.L., Schulman A.R., et al. Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial. Surg. Obes. Relat. Dis. 2019;15:1348–1354. doi: 10.1016/j.soard.2019.04.026. PubMed DOI

Zhang Y., Du S., Fang L., Yao S., Chen J.D. Retrograde gastric electrical stimulation suppresses calorie intake in obese subjects. J. Obes. 2014;22:1447–1451. doi: 10.1002/oby.20664. PubMed DOI

Bohdjalian A., Ludvik B., Guerci B., Bresler L., Renard E., Nocca D., Karnieli E., Assalia A., Prager R., Prager G. Improvement in glycemic control by gastric electrical stimulation (TANTALUS) in overweight subjects with type 2 diabetes. Surg. Endosc. 2009;23:1955–1960. doi: 10.1007/s00464-008-0222-4. PubMed DOI

Cha R., Marescaux J., Diana M. Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives. World J. Gastrointest. Endosc. 2014;6:419–431. doi: 10.4253/wjge.v6.i9.419. PubMed DOI PMC

Gniuli D., Calcagno A., Dalla Libera L., Calvani R., Leccesi L., Caristo M.E., Vettor R., Castagneto M., Ghirlanda G., Mingrone G. High-fat feeding stimulates endocrine, glucose-dependent insulinotropic polypeptide (GIP)-expressing cell hyperplasia in the duodenum of Wistar rats. Diabetologia. 2010;53:2233–2240. doi: 10.1007/s00125-010-1830-9. PubMed DOI

Rajagopalan H., Cherrington A.D., Thompson C.C., Kaplan L.M., Rubino F., Mingrone G., Becerra P., Rodriguez P., Vignolo P., Caplan J., et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes: 6-month interim analysis from the first-in-human proof-of-concept study. Diabetes Care. 2016;39:2254–2261. doi: 10.2337/dc16-0383. PubMed DOI

van Baar A.C.G., Holleman F., Crenier L., Haidry R., Magee C., Hopkins D., Rodriguez Grunert L., Galvao Neto M., Vignolo P., Hayee B., et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: One year results from the first international, open-label, prospective, multicentre study. Gut. 2020;69:295–303. doi: 10.1136/gutjnl-2019-318349. PubMed DOI PMC

Hu B., Ye L.S. Endoscopic applications of magnets for the treatment of gastrointestinal diseases. World J. Gastrointest. Endosc. 2019;11:548–560. doi: 10.4253/wjge.v11.i12.548. PubMed DOI PMC

Marrache M.K., Itani M.I., Farha J., Fayad L., Sharara S.L., Kalloo A.N., Khashab M.A., Kumbhari V. Endoscopic gastrointestinal anastomosis: A review of established techniques. Gastrointest. Endosc. 2020;93:34–46. doi: 10.1016/j.gie.2020.06.057. PubMed DOI

Machytka E., Bužga M., Zonca P., Lautz D.B., Ryou M., Simonson D.C., Thompson C.C. Partial jejunal diversion using an incisionless magnetic anastomosis system: 1-year interim results in patients with obesity and diabetes. Gastrointest. Endosc. 2017;86:904–912. doi: 10.1016/j.gie.2017.07.009. PubMed DOI

Bang C.S., Baik G.H., Shin I.S., Kim J.B., Suk K.T., Yoon J.H., Kim Y.S., Kim D.J. Effect of intragastric injection of botulinum toxin A for the treatment of obesity: A meta-analysis and meta-regression. Gastrointest. Endosc. 2015;81:1141–1149.e17. doi: 10.1016/j.gie.2014.12.025. PubMed DOI

Buchwald H., Avidor Y., Braunwald E., Jensen M.D., Pories W., Fahrbach K., Schoelles K. Bariatric surgery: A systematic review and meta-analysis. JAMA. 2004;292:1724–1737. doi: 10.1001/jama.292.14.1724. PubMed DOI

Maggard M.A., Shugarman L.R., Suttorp M., Maglione M., Sugerman H.J., Livingston E.H., Nguyen N.T., Li Z., Mojica W.A., Hilton L., et al. Meta-analysis: Surgical treatment of obesity. Ann. Intern. Med. 2005;142:547–559. doi: 10.7326/0003-4819-142-7-200504050-00013. PubMed DOI

Coupaye M., Puchaux K., Bogard C., Msika S., Jouet P., Clerici C., Larger E., Ledoux S. Nutritional consequences of adjustable gastric banding and gastric bypass: A 1-year prospective study. Obes. Surg. 2009;19:56–65. doi: 10.1007/s11695-008-9571-2. PubMed DOI

Kwon Y., Kim H.J., Lo Menzo E., Park S., Szomstein S., Rosenthal R.J. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: A meta-analysis. Surg. Obes. Relat. Dis. 2014;10:589–597. doi: 10.1016/j.soard.2013.12.005. PubMed DOI

Kaidar-Person O., Person B., Szomstein S., Rosenthal R.J. Nutritional deficiencies in morbidly obese patients: A new form of malnutrition? Part A: Vitamins. Obes. Surg. 2008;18:870–876. doi: 10.1007/s11695-007-9349-y. PubMed DOI

Kaidar-Person O., Person B., Szomstein S., Rosenthal R.J. Nutritional deficiencies in morbidly obese patients: A new form of malnutrition? Part B: Minerals. Obes. Surg. 2008;18:1028–1034. doi: 10.1007/s11695-007-9350-5. PubMed DOI

Shankar P., Boylan M., Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26:1031–1037. doi: 10.1016/j.nut.2009.12.003. PubMed DOI

Mechanick J.I., Youdim A., Jones D.B., Garvey W.T., Hurley D.L., McMahon M.M., Heinberg L.J., Kushner R., Adams T.D., Shikora S., et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg. Obes. Relat. Dis. 2013;9:159–191. PubMed

Behrns K.E., Smith C.D., Sarr M.G. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig. Dis. Sci. 1994;39:315–320. doi: 10.1007/BF02090203. PubMed DOI

Aarts E.O., Janssen I.M., Berends F.J. The gastric sleeve: Losing weight as fast as micronutrients? Obes. Surg. 2011;21:207–211. doi: 10.1007/s11695-010-0316-7. PubMed DOI PMC

Belfiore A., Cataldi M., Minichini L., Aiello M.L., Trio R., Rossetti G., Guida B. Short-term changes in body composition and response to micronutrient supplementation after laparoscopic sleeve gastrectomy. Obes. Surg. 2015;25:2344–2351. doi: 10.1007/s11695-015-1700-0. PubMed DOI

Punchai S., Hanipah Z.N., Meister K.M., Schauer P.R., Brethauer S.A., Aminian A. Neurologic manifestations of vitamin b deficiency after bariatric surgery. Obes. Surg. 2017;27:2079–2082. doi: 10.1007/s11695-017-2607-8. PubMed DOI

Lewis C.A., de Jersey S., Hopkins G., Hickman I., Osland E. Does bariatric surgery cause vitamin a, b1, c or e deficiency? A systematic review. Obes. Surg. 2018;28:3640–3657. doi: 10.1007/s11695-018-3392-8. PubMed DOI

Koffman B.M., Greenfield L.J., Ali I.I., Pirzada N.A. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33:166–176. doi: 10.1002/mus.20394. PubMed DOI

Damms-Machado A., Friedrich A., Kramer K.M., Stingel K., Meile T., Küper M.A., Königsrainer A., Bischoff S.C. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes. Surg. 2012;22:881–889. doi: 10.1007/s11695-012-0609-0. PubMed DOI

Cambi M.P.C., Baretta G.A.P., Spagnol M., Zilio R., Rossoni C. Systematization of nutritional care in endoscopic treatment for obesity. Obes. Surg. 2019;29:1074–1080. doi: 10.1007/s11695-018-3616-y. PubMed DOI

Compher C.W., Badellino K.O., Boullata J.I. Vitamin D and the bariatric surgical patient: A review. Obes. Surg. 2008;18:220–224. doi: 10.1007/s11695-007-9289-6. PubMed DOI

Wortsman J., Matsuoka L.Y., Chen T.C., Lu Z., Holick M.F. Decreased bioavailability of vitamin D in obesity. Am. J. Clin. Nutr. 2000;72:690–693. doi: 10.1093/ajcn/72.3.690. PubMed DOI

Parrott J., Frank L., Rabena R., Craggs-Dino L., Isom K.A., Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg. Obes. Relat. Dis. 2017;13:727–741. doi: 10.1016/j.soard.2016.12.018. PubMed DOI

Tremmel M., Gerdtham U.G., Nilsson P.M., Saha S. Economic burden of obesity: A systematic literature review. Int. J. Env. Res. Public Health. 2017;14:435. doi: 10.3390/ijerph14040435. PubMed DOI PMC

Long-term Results of Duodeno-jejunal Bypass in the Treatment of Obesity and Type 2 Diabetes