Obésité : prise en charge, indications et méthodes du traitement endoscopique et chirurgical

Obesity is a serious disease that exposes the patient to numerous complications that result in an alteration of his or her quality and duration of life. Prevalence of obesity is increasing steadily, especially among teenagers: its importance represents a serious public health issue. In Europe, the prevalence of obesity varies from 10 to 25% of the population; in North America, it reaches figures as high as 25% of the inhabitants. Diet measures, medications and behavioural support are proposed to the patients but most of the time they are difficult to maintain in the long term, inconstantly efficacious and iteratively exposed to recurrences, making surgery a credible alternative. First operative procedures have consisted in intestinal by-pass, reducing the intestinal absorptive surface and causing malabsorption particularly for fat; related weight loss was important and rapid, but these procedures have been regularly associated to severe complications, and were thereafter abandoned. Presently, the current techniques are schematically: adjustable gastroplasty with a calibrated ring, vertical gastroplasty and gastric by-pass. This type of procedure is usually followed by a substantial weight loss, often sustained beyond 2 years, a reduction in complications prevalence. However mortality is not negligible, reaching 0.1-0.5 %; early and late complications are not infrequent leading to re-operation in 10% of cases. “Bariatric” surgery is only indicated in case of morbid obesity, and in absence of contraindications.