Aspiration Therapy for Obesity

Obesity is currently the most important global public health issue due to its high prevalence in the population, disease-related adverse effects on health, quality of life, and healthcare costs. Lifestyle modification and pharmacotherapy are only partially successful in reducing the body weight and are in general unable to maintain weight loss over the long term. Bariatric surgery provides effective and durable weight loss but is associated to an elevated risk of complications, both in the short- and long term. For these reasons, many efforts have been made in the recent years to develop endoscopic bariatric therapies for patients with class II and III obesity, who do not have significant and persistent benefits from conservative treatments and are not qualified for invasive surgical procedures. Aspiration therapy by AspireAssist (Aspire Bariatrics, King of Prussia, PA) has been approved in 2016 for use in patients 22 years and older, with a BMI of 35-65 kg/m2, who have failed to lose or maintain weight loss with nonsurgical weight loss therapies. The device consists of a modified percutaneous gastrostomy tube (A-Tube™) and an external detachable device to facilitate drainage. The device allows patients to remove a portion of ingested meals through the gastrostomy tube; about 30% of the calories consumed in a meal could be aspirated with this system. Several studies have demonstrated the effectiveness and safety of aspiration therapy, with low rates of adverse events and no deaths related to the procedure, as well as no evidence of eating disorders developed during therapy.