[Focus on bariatric endoscopy in Belgium].

Bariatric endoscopy is an increasingly recognized alternative to surgery for obesity treatment. Recent guidelines from leading medical societies (IFSO, ASMBS, ASGE, ESGE) have included endoscopic sleeve gastroplasty (ESG) and the intragastric balloon (IGB) in their recommendations. These procedures are indicated for patients with a body mass index (BMI) between 27 and 40 kg/m² who cannot or do not wish to undergo surgery. ESG reduces stomach volume through endoscopic suturing of the gastric wall, leading to early satiety and an average total weight loss of 16 % within 12 months. While less effective than surgical sleeve gastrectomy, it carries significantly fewer severe complications. The IGB, temporarily placed in the stomach, allows for moderate weight loss (10-15 % of total weight), but weight regain is almost inevitable after removal. However, it can be useful preoperatively or as an adjunct to other treatments. Other emerging endoscopic devices (EndoBarrier, duodenal resurfacing, etc.) show promise, but their safety and efficacy remain to be confirmed. The future of these techniques will depend on their long-term efficacy/risk recognition and reimbursement, particularly in Belgium, where they are not yet covered by health insurance.