When your goal is healthy, sustainable weight loss but lifestyle habits alone haven’t proven successful, you might choose to have bariatric surgery. While these procedures can be highly effective, over 20% of patients eventually regain their weight. Disappointing, we know — but there is hope and another option: endoscopic bariatric revision.
DR. CHRISTOPHER MCGOWAN
Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.
While an invasive surgical revision used to be the only choice for patients experiencing weight regain after bariatric surgery, that’s no longer true. Endobariatrics utilizes advanced technology to provide safe, effective, minimally invasive, same-day revisions.
Curious about revision bariatric surgery at True You Weight Loss? Here’s what you need to know, including who makes a good candidate and what to expect before, during, and after the procedure.
What is Endoscopic Bariatric Revision?
An endoscopic bariatric revision is a minimally invasive procedure that can address complications like weight gain after an initial gastric bypass or sleeve gastrectomy.
Your surgeon will insert an endoscope (a flexible tube with a camera) through your mouth and into your stomach. Techniques like suturing or thermal energy may be used to help reduce the size of your stomach pouch or anastomosis (outlet) and restore the restriction from your original procedure.
Why Consider an Endoscopic Revision?
Weight regain following bariatric surgery isn’t uncommon. Many patients end up with a stretched-out stomach or pouch over time. This increased stomach capacity can result in more food intake and weight gain. When lifestyle isn’t enough, you might consider a revision procedure.
Types of Endoscopic Revisions
No matter which bariatric surgery you had, rest assured there’s a minimally invasive procedure that can be used.
The two main types are endoscopic gastric bypass revision and endoscopic gastric sleeve revision. As their names imply, each targets different original procedures and has unique goals.
Endoscopic Gastric Bypass Revision
Many people regain weight after gastric bypass, often because the surgically created pouch and outlet can stretch over time.
Also called a bariatric revision or transoral outlet reduction (TORe), an endoscopic revision of gastric bypass uses advanced techniques to reduce the size of your gastric pouch and outlet back to the size from your original procedure so you can continue on your weight loss journey.
Endoscopic Sleeve Gastrectomy Revision
Sleeve gastrectomy is the most common bariatric surgery. During this procedure, a surgeon staples your stomach to create a narrow, tube-like shape. Many people who have this done find that they can eat more over time, resulting in weight regain.
In an endoscopic sleeve gastrectomy revision, your surgeon will use an endoscope to tighten the sleeve gastrectomy. This helps decrease the capacity of your stomach so you feel fuller after eating less food.
The best part? It carries an extremely low risk of complications and has a very high success rate. Most side effects are minor — like nausea or mild abdominal discomfort during recovery — and there is less than a 1% risk of major complications.
Benefits of Endoscopic Bariatric Revision
Endoscopic bariatric revision is an excellent choice for people who need a tune-up following bariatric surgery. There are many benefits to pursuing this option over invasive surgery.
Minimally Invasive Approach
An endoscopic bariatric revision uses an endoscope, so it’s performed without any external incisions. The endoscope allows your surgeon to make the needed adjustments — like tightening or suturing the stomach pouch — internally with the help of a camera and tools.
Effective Weight Loss Solution
One of the best reasons to choose endoscopic bariatric revision is that it’s an effective solution for individuals who need an adjustment following their original surgery. It directly addresses the root causes of your weight regain, which your surgeon can do without changing your fundamental anatomy.
Safe and Reliable
The minimally invasive aspect of endoscopic bariatric revision helps reduce the risks associated with traditional laparoscopic or open surgeries, like having a longer recovery time or potential infections. It helps keep postoperative pain and discomfort to a minimum so you can return to regular activities ASAP (usually within 2-3 days).
Who is a Candidate for Endoscopic Bariatric Revision?
When considering any type of surgical procedure, it’s important to make sure it’s right for you. The first requirement for an endoscopic bariatric revision is that you’ve undergone bariatric surgery, such as gastric bypass or sleeve gastrectomy.
Additionally, for a revision procedure to be a good fit, you must be experiencing issues like unwanted weight gain from anatomical stretching and increased food intake.
Finally, a good candidate for these procedures is someone who is medically stable and has attempted (but has been unsuccessful) to continue weight loss through dietary and lifestyle changes.
Overall, an endoscopic bariatric revision is best for candidates who fit these requirements and are looking for a less invasive solution to restore the effectiveness of their original surgery.
What to Expect During the Procedure
It’s normal to be nervous when considering any procedure. To help soothe any apprehension, here’s what you can expect before, during, and after revision bariatric surgery.
Preparation
Preparation is key. Expect the following in the weeks and months leading up to your procedure.
- Initial consultation: At this appointment, you’ll discuss your medical history, current concerns, and goals with your bariatric physician to determine whether a revision procedure makes sense for you. You can also talk about pricing and review current medications (and supplements), as certain things may need to be temporarily paused.
- Testing: Before your procedure, your physician must have all of the necessary medical data to evaluate your health and digestive anatomy.
- Nutritional adjustments: In the days to weeks before your procedure, you will receive specific dietary instructions. These include a liquid diet the day before your appointment and/or a period of fasting to ensure your digestive tract is clear and minimize risks of complications while under anesthesia.
The Procedure
An endoscopic bariatric revision is fairly straightforward. Depending on the type of revisions needed, the entire procedure usually takes only 30-45 minutes.
First, you will be put under general anesthesia. Once you’re asleep, your physician will carefully place the endoscope through your mouth into your stomach so they can see inside and navigate the necessary revisions.
From there, your physician will use their planned techniques. This might include using sutures or thermal energy. In the context of an endoscopic bariatric revision, thermal energy refers to controlled tissue damage caused by heat to shrink your stomach or anastomosis. As this heals, your tissue contracts, resulting in a similar size and shape to your original surgery to help reduce food intake and promote weight loss.
Post-Procedure Care and Maintenance
After you’ve undergone your revision comes recovery, post-op care, and maintenance to ensure you’re healing properly and on track with your weight loss goals.
The recovery time from these procedures is generally short due to their minimally invasive nature. All patients return home the day of the procedure.
Critical elements of your post-procedure care include:
Diet and Lifestyle Changes
Nutrition is critical to support optimal recovery and maintenance after a revision. You’ll slowly graduate from a liquid diet back to a regular diet, which typically progresses as follows:
- Clear liquids, including plain water, broth, clear protein drinks, and sugar-free gelatin.
- Full liquids, like milk, creamy soups, yogurt, and protein shakes.
- Purees, including blended fruits and vegetables, mashed potatoes, and oatmeal provide more bulk but remain easy to swallow and digest.
- Soft foods, like tender-cooked fish, scrambled eggs, and softened vegetables.
- Your regular diet emphasizes smaller portions of nutrient-dense choices like fruits, vegetables, whole grains, and lean proteins.
Lifestyle habits will also help support post-procedure care and maintenance after your bariatric revision.
- Hydration: Take small sips of plain water throughout the day versus large gulps that may be too big for your reduced stomach capacity or displace nutritious foods.
- Sleep: Aim for 7-8 hours per night to promote rest and recovery.
- Avoid alcohol and tobacco: These can interfere with your healing process and should not be used, especially during the healing process.
- Exercise: Low-impact exercises, like walking, swimming, or biking, can help maintain lean muscle mass, burn calories, and support mental health without putting too much stress on your body.
Follow-Up Appointments
At True You, your care, recovery, and progress are our top priority, even in the months after your procedure. Stay in touch with your care team and attend your scheduled follow-up appointments where your recovery is monitored, questions and concerns can be addressed, and you receive the proper ongoing maintenance.
Endoscopic Bariatric Revisions: Quality Care at True You Weight Loss
True You Weight Loss offers revision bariatric surgery options tailored to your unique needs. Our highly experienced, triple-board-certified physicians will make informed recommendations and follow through with safe and effective procedures.
As one of the highest volume clinics in the country for non-surgical weight loss procedures, True You has performed thousands of endobariatric procedures to help people pursue weight loss without invasive surgeries.
To learn more about our endobariatric procedures, request a consultation. We look forward to helping you achieve your health and weight loss goals.
