Obesity continues to be a major health problem in America, even as more and more people turn to various diet and exercise programs to help them lose weight. By and large, however, dieting and exercise simply don’t work over the long run. Bariatric surgery has been the go-to choice for those with severe obesity who can’t lose weight otherwise, but it comes with a series of risks. Fortunately, though, an alternative procedure has become available that can provide the results of bariatric surgery without the same risks: endoscopic sleeve gastroplasty.
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.
Overview of Bariatric Surgery
Bariatric surgery, also known simply as weight loss surgery, is a group of surgical procedures designed to help individuals with severe obesity achieve significant and sustainable weight loss. These procedures are designed to work through two main mechanisms: limiting calorie intake and reducing nutrient absorption. Bariatric surgery is mostly recommended for individuals who have not had success with other weight loss methods and are at risk of obesity-related health conditions. This is typically determined through body mass index (BMI), a figure that is derived by comparing a person’s height and weight.
Bariatric procedures like gastric bypass or sleeve gastrectomy have become relatively common in the past few decades, in large part because they have an impressive track record of success at helping people lose significant excess body weight. However, as effective as they may be, they are still highly involved inpatient surgeries that require incisions and a long recovery time. Moreover, simply participating in any kind of surgery opens a patient up to infection, bleeding, and the possibility of complications due to anesthesia.
Bariatric surgery was once done mostly as open surgery, which was considered invasive and came with significant risks. These days, though, the norm is to use laparoscopy, which involves the surgeon making small incisions in the abdominal wall; the laparoscope is then inserted through the incisions and tools on the end are used to actually make the alterations. While laparoscopy is considered minimally invasive, the need for incisions still brings a series of risks that need to be considered.
What Is Endoscopic Sleeve Gastroplasty?
Of course, even some of the people who might be willing to take on the risks of surgery simply can’t because of pre-existing conditions that make them unsuitable candidates. For example, lifelong smokers with lung problems are at a higher risk for complications with surgery; the same is true for people with serious heart conditions. In light of the inherent risks of laparoscopic surgery, endoscopic sleeve gastroplasty (ESG) offers an alternative approach that relies on a different type of technology: the endoscope.
ESG is truly a minimally invasive procedure because there are no incisions required to complete it. Instead, the endoscope (a flexible tube with a camera and other instruments attached to the end) is inserted through the mouth and down the esophagus. The whole procedure occurs with the patient sedated rather than under general anesthesia; this greatly reduces the chances of problems with the medication and also promotes a much faster recovery time. Also, the nature of the procedure means that it can be done quickly; for most patients the whole procedure will take only 30-45 minutes.
How Does Endoscopic Sleeve Gastroplasty Work?
ESG works using some of the same basic principles as a common type of bariatric surgery known as sleeve gastrectomy (or gastric sleeve). In a gastric sleeve procedure, the volume of the stomach is reduced by removing a large portion along the greater curvature. With a laparoscope, the surgeon will remove the excess stomach and then suture together the open edge until a smaller, sleeve-shaped stomach is left. With less stomach volume, the patient will become fuller faster and will be essentially forced to eat less in a single sitting.
ESG also involves reshaping the stomach into a sleeve, but the whole procedure is done with an endoscope from inside the stomach. Once the endoscope is in place, specialized tools on the end allow the endobariatric surgeon to close off 70-80% of the stomach by suturing it shut from the inside; the unused portion stays in place, but it becomes permanently closed off. The sutures don’t need to be removed and can also stay in the stomach permanently without causing any problems.
Once the procedure is complete, there is generally a 1-2 hour recovery time, though that is mostly related to any lingering effects of sedation. Most people will then be able to return to work and other regular activities after two or three days of rest at home. By comparison, a bariatric surgery like gastric bypass can take up to a month. When the procedure is first completed, a mostly liquid diet will be required; over the following days and weeks, other foods can be gradually introduced as the patient figures out their new experience of being “full.”
How Much Weight Can You Lose With Endoscopic Sleeve Gastroplasty?
As noted, the main mechanism of weight loss with ESG is the reduction in stomach volume. In addition to it limiting how much food can be eaten at one time, it will also help the patient develop a new relationship with food and the sensations of fullness and satiety. Also, guidance from the endobariatric physician will help the patient adjust their diet to best fit with the resulting changes to the digestive system. Moreover, access to this guidance will continue even after the initial adjustment period.
In fact, this guidance is one of the most valuable differences about True You; long after your procedure, you’ll still have access to our team of dietitians and nutritionists for ongoing support. At True You, we like to say that we’re connected for life. In addition to being able to call, text, or email our support team at any time, you’ll have lifelong access to monthly virtual support meetings. So no matter where in the country you live, you’ll always be able to get help or encouragement from our highly qualified staff.
As far as potential weight loss, the amount a person can lose with ESG will be highly dependent on their starting weight and their adherence to the recommended dietary changes. On average, our patients have lost 23.1% of their total body weight one year after the procedure, and a full 97% of our patients are able to lose at least 10% of body weight. This means that a person with a starting weight of 400 pounds could potentially lose nearly 100 pounds in the first year. After that, weight loss will continue for as long as the patient continues following the doctor’s and dietitian’s recommendations.
Current Endoscopic Sleeve Gastroplasty Research
As endoscopic sleeve gastroplasty has become more common and sought after, new research has explored its effectiveness as an obesity treatment. True You is proud to both collaborate with and lead research projects that can improve endobariatric procedures and lead to even better outcomes. Below are some examples of recent research efforts:
- ESG for Class III Obesity: People with class III obesity, also known as severe or morbid obesity, are usually encouraged to opt for laparoscopic sleeve gastrectomy. Yet because of the clear risks, this study looks at ESG as an alternative for people with a BMI of over 40 who are not interested or are ineligible for typical bariatric surgery.
- Ablate Weight Study: True You has worked on two different studies that look at a technique called gastric fundic ablation, a procedure that involves directing an electrical current to the fundus of the stomach (the top part). The purpose of the technique is to reduce the production of ghrelin, a hormone associated with hunger.
- HAPCET: Short for Hybrid Argon Plasma Coagulation and ESG Trial, HAPCET is a study that looks at ways to modify the ESG procedure in order to improve the durability of sutures and weight loss outcomes.
Contact True You Weight Loss Today
As obesity continues to plague so many Americans, new strategies are needed to make a long-term difference. Between the potential complications of surgery, extended recovery time, and overall higher costs, traditional bariatric surgery just isn’t feasible for many patients. That’s why at True You we are passionate about non-surgical endobariatric procedures like ESG. If you’d like to learn more about ESG or any of our other offerings, please contact us today to request a consultation.
