II. Endoscopic sleeve gastroplasty:

Endoscopic sleeve gastroplasty is a modern, minimally invasive weight-loss procedure that doesn’t involve any incisions. Instead of traditional surgery, a suturing device is introduced through the mouth and into the stomach. During the procedure, the stomach is sutured to reduce its size, which helps limit food intake.

This procedure may be an option for individuals with a body mass index (BMI) of 30 or higher who have not seen results with diet and exercise. Endoscopic sleeve gastroplasty supports significant weight loss by reducing the amount of food you can eat and is less invasive, lowering the risk of complications and allowing for a quicker recovery.

To achieve lasting results, it is important to commit to a healthy lifestyle, including long-term changes in diet and regular exercise, following the procedure.

Purpose

Endoscopic sleeve gastroplasty aids in weight loss and can reduce the risk of various serious weight-related health conditions, such as:

• Heart disease and stroke
• High blood pressure
• High cholesterol
• Osteoarthritis-related joint pain
• Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
• Sleep apnea
• Type 2 diabetes

This procedure, like other weight-loss methods, is typically recommended only after diet and exercise efforts have not been successful.

Eligibility

You may be eligible for endoscopic sleeve gastroplasty if you:

• Have a BMI of 30 or higher
• Have not been able to sustain weight loss with lifestyle changes alone
• Prefer not to undergo traditional bariatric surgery

This procedure isn’t suitable for everyone. A thorough screening process helps determine if it is the right option for you. Additionally, you must be committed to making healthy lifestyle changes, participating in behavioral therapy, and attending regular follow-up appointments.

People with certain medical conditions, such as a large hiatal hernia or gastrointestinal bleeding issues like gastritis or peptic ulcer disease, are not candidates for this procedure. It’s also important to note that endoscopic sleeve gastroplasty may not be covered by insurance.

Risks

Endoscopic sleeve gastroplasty has been shown to be a safe procedure with manageable side effects, such as pain and nausea, which typically resolve within a few days with medication. While the procedure is designed to be permanent, it can be converted to other forms of bariatric surgery if necessary.

When combined with lifestyle changes, endoscopic sleeve gastroplasty can lead to a total weight loss of 18% to 20% over 12 to 24 months.

Preparation

If you’re a candidate for endoscopic sleeve gastroplasty, your healthcare team will provide specific instructions on how to prepare. This may include lab tests, dietary restrictions, and medication adjustments, as well as starting an exercise program. Planning for post-procedure recovery, such as arranging for help at home, can also be beneficial, though recovery typically takes just a few days.

Procedure Details

Endoscopic sleeve gastroplasty is performed on an outpatient basis in the endoscopy unit. You’ll receive general anesthesia to keep you asleep during the procedure.

The procedure itself involves the use of a flexible tube called an endoscope, equipped with a camera and suturing device. The endoscope is inserted through the mouth and guided down into the stomach. Using this tool, the endoscopist places stitches to reduce the stomach’s size, shaping it into a tube-like structure. This reduction in stomach size limits food intake by making you feel full sooner.

The procedure generally lasts between 1 to 2.5 hours.

After the Procedure

After the procedure, you’ll be monitored in a recovery room for any complications. Once you recover from the anesthesia, you can typically go home the same day. In rare cases, an overnight hospital stay may be necessary.

For the first few hours post-procedure, you won’t be allowed to eat. You’ll begin with a liquid diet for at least two weeks, gradually transitioning to semisolid foods and, eventually, a regular healthy diet.

Results

Successful weight loss depends heavily on commitment to a healthy lifestyle, including proper nutrition, exercise, and emotional well-being. Most patients lose around 10% to 15% of their body weight in the first year after the procedure.

Endoscopic sleeve gastroplasty may also improve conditions often linked to obesity, such as:

• Heart disease or stroke
• High blood pressure
• Severe sleep apnea
• Type 2 diabetes
• Gastroesophageal reflux disease (GERD)
• Osteoarthritis-related joint pain

When Weight-Loss Surgery Doesn’t Work

Despite the procedure’s success, some individuals may not lose enough weight or may regain weight. This usually occurs when the necessary lifestyle changes are not followed. To maintain weight loss, it’s crucial to adopt permanent, healthy dietary habits and engage in regular physical activity.