In both the United States and elsewhere around the world severe obesity has been on the rise for many years. During this time, standard approaches to long-term weight loss—primarily a restrictive diet and an exercise program—have not generally been effective at reducing the prevalence of obesity and various obesity-related health conditions. In light of this, a range of endobariatric and bariatric procedures have been developed that are designed with long-term success in mind. Two such procedures that have similar mechanisms for weight loss but use different techniques are gastric bypass surgery and endoscopic sleeve gastroplasty.
Until about 10 years ago, Roux-en-Y gastric bypass was the most commonly performed version of the most common type of weight loss surgery. Today, however, sleeve gastrectomy has become more common, but gastric bypass procedures are still used regularly. In both cases, the goal is to alter some of the organs of the digestive system in order to promote weight loss. The “Y” in the name refers to the Y-shaped configuration of the small intestine that is achieved through the surgery.
In the first phase of the surgical procedure, a bariatric surgeon separates the stomach into a small stomach pouch about the size of an egg and a larger lower section. The lower part of the stomach is closed with sutures, and the stomach pouch is surgically attached to a part of the small intestine called the jejunum. This represents one side of the Y, and it is done in order to dramatically reduce the size of the stomach and therefore limit the amount of food that can be eaten in one sitting.
The other side of the Y involves the lower part of the stomach. Even after being separated from the stomach pouch, it still produces valuable digestive juices. Additionally, this section is still connected to the duodenum, where other digestive enzymes from the liver and pancreas are introduced to the gastrointestinal tract. The stomach remnant and duodenum are then reconnected to the small intestine down the line from the stomach pouch, thereby bypassing a large section of the small intestine’s absorptive capacity.
Endoscopic sleeve gastroplasty (ESG) is designed to promote weight loss in a similar way as gastric bypass, though it is actually closer to gastric sleeve surgery in terms of the changes made to the digestive system. Instead of a small pouch, the stomach is reformed into a sleeve shape that is about 20-30% of its original size. Rather than separating the stomach into two sections, however, the sleeve gastroplasty procedure keeps the stomach whole but closes off the majority of the volume by suturing it from the inside in accordion-like folds.
Both the gastric bypass procedure and the endoscopic sleeve gastroplasty procedure have been able to help many people lose weight and keep it off over time. There is also substantial evidence that they both can have a positive impact on obesity-related conditions like type 2 diabetes, heart disease, metabolic syndrome, liver disease, sleep apnea, and high blood pressure. On a more practical level, they’re also both permanent procedures and not reversible. Yet for all their similarities, the two procedures have a number of important differences:
Though gastric bypass and endoscopic sleeve gastroplasty are different in several ways, they both generally follow the same guidelines for qualifying. To be a good candidate, a patient has to have a body mass index (BMI) of 35 or higher; patients with BMI between 30-35 can also qualify if they also have an obesity-related condition like heart disease or diabetes. Another standard criteria is that the patient has already attempted without success to drop excess weight with lifestyle changes or a traditional weight loss program.
Gastric bypass was once considered the “gold standard” of weight management interventions, but advances in medical technology have made alternatives like endoscopic sleeve gastroplasty much more appealing to many people. At True You Weight Loss, we are passionate about helping our patients find a new path to long-term weight loss. If you’d like to learn more about ESG or how our skilled and compassionate team can help you find freedom, please contact us today to request a consultation.