Obesity Treatment: Endoscopic Bariatric Procedures

Dr. Christopher McGowan
July 16, 2021

The United States has an obesity problem, and the impulse to throw money at the problem clearly hasn’t been working. In fact, when you include everything from diet soft drinks to health clubs to appetite suppressants, the weight management industry in America is valued at a whopping $78 billion per year. Yet even with all of those resources devoted to weight loss, the obesity epidemic keeps getting worse; indeed, the prevalence of obesity has continued to rise over the last few decades to the point where over 42% of Americans are now considered obese. 

What is perhaps most surprising is that the vast majority of these resources are spent on fad diets or unsustainable exercise regimens that continually fail to bring promised results. Study after study has shown that people who try dieting end up regaining more than half of any weight they managed to lose initially. This phenomenon is at least partly explained by a new understanding of metabolic processes and the tendency for the human body to regain weight that was lost. 

It is in light of these fundamental difficulties in losing weight that many people turn to more elaborate weight loss solutions. While gastric bypass and other bariatric surgeries have become well known for their potential effectiveness, the inherent risks of surgery (infection, bleeding, etc.) and long recovery times make them less than ideal and in some cases simply not an option. For this reason, endoscopic bariatric procedures have become a new and exciting alternative for people who haven’t had success with other weight loss methods. 

What is Bariatric Endoscopy?   

The main difference between traditional bariatric surgery and bariatric endoscopy is the use of an endoscope. These days, most bariatric surgery is performed laparoscopically; this involves making small incisions around the abdomen that will accommodate the use of a laparoscope, a special surgical tool with a camera mounted on the end. The surgeon inserts the laparoscope through the various abdominal incisions in order to visualize the surgery taking place deep inside the abdomen. Laparoscopic surgery is considered minimally invasive surgery and is therefore much safer than open surgery. 

Yet even though laparoscopy is safer than exploratory surgery, it still requires multiple incisions that can potentially cause bleeding, infection, and a variety of other complications. Moreover, the recovery time is still quite considerable; depending on the type of surgery, it may take two months or longer to fully recover. These challenges associated with bariatric surgery can even make it an inaccessible option to some of the people who need it most. For many morbidly obese people, any kind of surgery is deemed too great a risk because of the various comorbidities associated with extreme obesity such as heart disease, type 2 diabetes, sleep apnea, and high blood pressure. 

In recent years, however, a new type of bariatric procedure has emerged that can lead to similar results as surgery but without the need for incisions, stitches, and a long recovery time. This type of procedure is called bariatric endoscopy, and it involves the use of an endoscope instead of a laparoscope. Rather than being inserted through abdominal incisions, an endoscope is extended down the esophagus. Originally used primarily for visualization, endoscopic bariatric therapies now utilize an endoscope with specialized tools on the end that allow the doctor to make changes to the gastrointestinal tract from the inside, thus avoiding the need for any incisions. 

Beyond skipping the need for abdominal incisions, bariatric endoscopy also allows the complete procedure to be done in a short, outpatient timeframe. This of course means no scars and considerably less chance of bleeding or infection, but it also means a short recovery time. Because endoscopic procedures are so minimally invasive and quick, they also don’t typically require general anesthesia; patients respond well to twilight sedation which, in turn, reduces the time spent in either the doctor’s office or hospital.  

Examples of Endobariatric Procedures 

Because of the nature of and risks associated with standard bariatric surgery, only people who meet a certain set of criteria are eligible. With most endobariatric procedures, however, patients are generally eligible if they have a body mass index (BMI) of at least 30 and haven’t had success with other weight loss methods. Overall, though, one important factor in all of these options that will lead to the greatest success is commitment to the program. Below are some of the most common and successful examples of bariatric endoscopy: 

Endoscopic Sleeve Gastroplasty (ESG): One of the most popular and effective endobariatric procedures available is endoscopic sleeve gastroplasty. ESG is similar to standard surgical procedure called sleeve gastrectomy, but it primarily differs in the use of endoscopy rather than laparoscopy. In ESG, the endoscopist will use a special suturing tool mounted on the end of the flexible tube to reshape the stomach from the inside; when the procedure is complete, the sutures will have reformed the stomach into a banana-shaped sleeve that is about 80% smaller in size. The reduced stomach volume helps the patient feel full faster at the same time as promoting a caloric deficit. Over time, the reduced food intake will lead to weight loss as the body begins burning fat for energy. This procedure is not reversible. 

ORBERA®: The ORBERA® Managed Weight Loss System is a non-surgical weight loss procedure that operates on a similar principle of reducing stomach volume in order to promote satiety and fat burning. In this case, though, the reduction is done by endoscopic placement of a special intragastric balloon. The deflated silicone balloon is placed in the stomach and then filled with a safe saline solution until it is around the size of a grapefruit. With the ORBERA® gastric balloon in the stomach taking up space, less food is able to be consumed in a sitting. During the roughly six months the balloon is in the stomach, it reduces calorie intake while also reinforcing long term healthy eating habits.  

Revisions: Even if a patient has already had another weight loss surgery, bariatric endoscopy can still be useful. In surgeries like Roux-en-Y gastric bypass surgery or sleeve gastrectomy, the effectiveness can wane over time; this is usually because some element of the procedure has become stretched out and is no longer capable of significantly reducing calorie intake. In a revision procedure, an endoscope can be used to tighten up or otherwise return the original surgical work to a state of effectiveness again. And because the revision is done using endoscopy, the patient will also benefit from the safety and efficiency of the method. For patients who had a prior gastric bypass and have regained weight, the endoscopic revision (referred to as Transoral Outlet Reduction, or TORe) has been shown to provide the same results as a surgical revision, but with significantly lower risk. 

Request a Consultation Today! 

At True You Weight Loss, we understand how challenging it can be to lose weight and keep it off over the long term. A traditional weight loss program is rarely effective for most people, and bariatric surgery has risks as well as long recovery times; instead, we offer a series of incisionless endoscopic weight loss procedures that can help you lose excess weight and keep it off long after the procedure is complete. 

If you have tried the old methods without much success at meeting your weight loss goals (including losing weight and regaining it later on), it might be time for a new approach. True You Weight Loss is the nation’s first and only dedicated endobariatric weight loss center, and our highly trained staff is uniquely qualified and experienced to perform a variety of endobariatric procedures. If you would like to learn more about our offerings, please contact us today to request a consultation.

Dr. Christopher McGowan
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.

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