Wednesday, March 23, 2016

Endoscopic Sleeve Gastroplasty

Bariatric surgery is an effective weight loss approach. Non-surgical weight loss approaches, such as pharmacotherapy, diet, exercise and lifestyle modification are often less effective than weight loss surgery. However, weight loss surgery has more associated complications than non-surgical methods. And less than 2% of the people who qualify for the surgery get the surgery. Fortunately, experts are exploring endoscopic surgical options that may reduce complications, and possibly make additional weight loss surgical options available to more candidates. One of these options is endoscopic sleeve gastroplasty (ESG).

Endoscopic procedures are done via the gastrointestinal tract using a flexible endoscope. Usually there are no surgical incisions associated with endoscopic procedures.
ESG is a form of bariatric surgery. Bariatric surgical approaches are restrictive, malabsorptive, or a combination of these approaches. For instance, the adjustable lap band is restrictive because it restricts the amount of food that pass through the band into the stomach. And gastric bypass surgery is both restrictive and malabsorptive. It is restrictive since it shrinks the size of the stomach, reducing the amount of food a person needs to eat to feel full. Gastric bypass surgery is also malabsorptive, because the surgery reroutes the small intestine in a way to cause food to bypass parts of the small intestine, allowing fewer calories (and nutrients) to be digested.

ESG is a restrictive form of bariatric surgery since the minimally invasive surgery reduces the amount of food the stomach can hold. The surgery can be an effective weight loss approach. Researchers at the Mayo Clinic in Rochester, Minnesota concluded that "ESG delays gastric emptying, induces early satiation, and significantly reduces body weight. ESG could be an alternative to bariatric surgery for selected patients with obesity." Another study indicated that "Endoscopic sleeve gastroplasty is a safe, effective, and reproducible primary weight loss technique."

Other examples of endoscopic weight loss procedures include the endobarrier and the gastric balloon. The endobarrier is a liner that is placed, endoscopically, in a portion of the small intestine. The device is designed to limit food digestion in a way that mimics gastric bypass surgery.

The gastric balloon is another endoscopic weight loss procedure. The device is first placed into the stomach endoscopically. The balloon is then filled with liquid or air. When the balloon is filled, a person's stomach feels full with less food. This can enable a person to eat less and lose weight. 
The recent FDA approval of two versions of the gastric balloon -- one manufactured by Apollo Endosurgery, Inc. and the other manufactured by  ReShape -- shows how far endoscopic procedures have come. As other endoscopic procedures, like ESG, are developed, tested, and proven effective, weight loss options will be enhanced. 


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