Christopher Thompson, MD, MSc, FACG, FASGE
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.
One of the devices we're focusing on currently, and we have available at Brigham Women's Hospital, is the intragastric balloon. And there's several different types of balloons available. And we have one balloon here that's been widely studied. And we're now offering it to patients.
The intragastric balloon is a silicon balloon. It's about the size of a grapefruit or a softball. And we place it endoscopically into the patient while they're under sedation. And so they'll go to sleep for the procedure. It takes us about 15 minutes. And we go in and put the balloon into the stomach and fill it with fluid. And the patient then wakes up and goes home that same day.
A candidate for this procedure would be anyone that has mild to moderate obesity. So, we classify obesity based on a scale. That is, the body mass index. So this is someone's weight in kilograms divided by their height in meters squared. So it's a complex formula. But anyone with a BMI of 30 to 40 would qualify for the procedure.
People do not qualify for surgery if their BMI is 30 to 35. And they even need other additional illnesses to receive surgery if their BMI is from 35 to 40, such as diabetes. So this really is designed to help people that don't yet qualify for surgery. There have been over 220,000 procedures performed globally. And the device has been available outside of the United States for the past decade. And we are the first hospital in New England to offer it. Weight loss is fairly well defined. We know that in the clinical trials in the United States, people can expect over a 30% excess weight loss.
The preparation before the procedure is actually quite limited. We like to see patients a couple weeks before to describe the procedures to them in detail. Let them know what they can expect afterwards. We like to start them on a medication called the proton pump inhibitor, as that decreases acid secretion in the stomach and prepares the stomach to receivable the balloon. Additionally, we do have them talk to nutritionists about proper dietary behavior and what the diet will look like after the procedure, as well.
The recovery period is really just a couple of hours in the endoscopy recovery room. And generally, getting some IV fluids and antiemetics, which are anti-nausea medicines. Then, the patient will then be discharged that same day. And the major thing that we worry about is nausea after the procedure. And we have very effective ways of dealing with that using different types of anti-nausea medicines.
There are some dietary restrictions for the first two days. Patients will be on a full liquid diet, focus on protein shakes and similar products. And then they'll transition to a soft, then back on to a regular diet. So they should be eating regularly within a week.
The balloon is approved for a six month dwell time. And then, that program itself consists of an additional six months of medically managed weight loss. So that's an entire 12 month period of time.
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.
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