Current status and future of metabolic endoscopy in nutritional regulation, tumor diagnosis and treatment

Obesity and its associated metabolic diseases have become a global health challenge. Lifestyle intervention, anti-obesity medications and bariatric metabolic surgery are the traditional modalities of obesity treatment. Previous research has proposed that metabolic endoscopy fills the gap between pharmacologic and surgical management with favorable efficacy and safety in the treatment of obesity and its metabolic-related diseases. In addition, the development of endoscopic imaging systems based on integrated photoacoustic/ultrasound dual-modality will greatly expand the application of metabolic endoscopy and update its concepts, including the detection of tumor metabolism and enhancement of precision in the infiltration depth of early gastrointestinal cancers, by semiquantitative measurement of blood oxygen saturation, and the enhancement of precise tumor treatment with the nano-modification of sono-photodynamic therapy (SPDT) in combination with photoacoustic/acoustic sensitizers. In this paper, we will make a systematic review and summary of the above, and propose for the first time to update the concept and specific content of metabolic endoscopy.