Director of Therapeutic Endoscopy, Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
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Endoscopic Sleeve Gastroplasty – Minimally Invasive Weight Loss Procedure Video Transcript
Obesity is an epidemic. And actually, it's evolving into a global pandemic. It's affecting many people. There's over 200 million Americans that suffer from being overweight or obese. There has been several different options available for patients. And in particular, there's diet and exercise, and some medical therapy. And then at the other end of the spectrum, we have surgical therapies.
There are several different types of surgery that are available. Sleeve gastrectomy procedures or adjustable gastric bands. And then, we have the more invasive, more serious, and definitive procedure such as the Roux-en-Y gastric bypass procedure, and some of the longer limb bypass procedures.
Now, they're very effective in treating obesity. However, for patients that qualify for those procedures, they have to be very heavy, have what we call morbid obesity. And most of the people we talk about don't achieve that level of obesity, or that level of illness due to obesity. So most people do not actually have a surgical alternative. And that's why less than 2% of the obese population actually end up getting treated. So there are many obese people without an option.
We've learned that there's certain substances released from the stomach, the small bowel, and the distal small bowel that are involved in appetite regulation, in insulin secretion, and also in insulin resistance and how your body responds to insulin. So that has allowed us to develop targeted endoscopic therapies.
The Endoscopic Sleeve Gastroplasty Procedure
The endoscopic sleeve gastroplasty is a minimally invasive endoscopic procedure that involves going in through the mouth with an endoscope and a suturing device attached. And then, what we're able to do is fold the stomach in on itself by putting standard stitches in, like Prolene suture, the standard material you'd use for any suture. And we run those throughout the gastric tissue to bring it in and fold it in on itself to make the stomach smaller.
The sleeve gastrectomy patient is going to be someone with morbid obesity that would qualify for surgery. Whereas, the endoscopic sleeve gastroplasty is meant for people that don't quite have morbid obesity. And they likely would not qualify for surgery yet, either. The procedure is likely not fully reversible. If it's decided very soon after the procedure that they would like to reverse it, it would potentially be possible. However, once it's gone for six weeks, it would be unlikely that we could reverse it.
We recently finished a multicenter US trial that had very encouraging results. And we now have this available. This procedure has been around actually for many years in different forms. So we were the first to perform this procedure in the United States. And we published the results of that initial trial in 2010.
Preparation and Recovery
In preparation for this procedure, there are several steps involved. The patients need to meet with the anesthesiologist, because these procedures are performed under general anesthesia. The patients should not be on anticoagulation. Or, if they are on anticoagulation, then we have to find ways of dealing with that to get a window where we can actually go in and suture.
We do actually have a bit of dietary counseling that happens before the procedure. And we will generally meet with them a month before the procedure, at least to talk with them about what they can expect afterwards. The diet is also much more rigorous after this procedure. We typically have patients on a full liquid diet for six weeks after this procedure.
In that immediate post-operative period, we actually do curtail their activities, as well. We don't like patients to lift more than 20 pounds for the first couple of weeks. We ask them to take it easy, keeping in mind that on a liquid diet, they'll be somewhat fatigued, as well. So we also delay that ramp up to full physical exercise and activity over that first six weeks. Then after the first six weeks, they're back on soft foods again and they go back to a regular diet. And then they can, of course, resume their normal activities.
Future Treatment with Bariatric Endoscopy
There's a lot of very exciting activity in bariatric endoscopy right now. So there's many new devices on the horizon. And we are participating in several trials here at Brigham Women's Hospital, as well. As a matter of fact, some of the technologies that are now in companies have actually come from laboratories at Brigham Women's Hospital.