Endoscopic sleeve gastroplasty

Overview

Endoscopic sleeve gastroplasty is a newer type of minimally invasive weight-loss procedure. There are no cuts with endoscopic sleeve gastroplasty. Instead, a suturing device is inserted into the throat and down to the stomach. The endoscopist then sutures the stomach to make it smaller.

Endoscopic sleeve gastroplasty may be an option if you're significantly overweight — a body mass index of 30 or more — and diet and exercise haven't worked for you. This method leads to significant weight loss by limiting how much you can eat. And because the procedure is minimally invasive, it reduces the risk of complications and allows a quick return to daily activities.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

Why it's done

Endoscopic sleeve gastroplasty is done to help you lose weight and lower the risk of serious weight-related health problems, including:

• Heart disease and stroke.
• High blood pressure.
• High cholesterol levels.
• Joint pain caused by osteoarthritis.
• Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH).
• Sleep apnea.
• Type 2 diabetes.

Endoscopic sleeve gastroplasty and other weight-loss procedures or surgeries are typically done only after you've tried to lose weight by improving your diet and exercise habits.

Who it's for

Endoscopic sleeve gastroplasty is available to people who:

• Have a body mass index (BMI) above 30.
• Haven't been able to maintain weight loss with lifestyle changes alone.
• Don't qualify for or want traditional bariatric surgery.

But endoscopic sleeve gastroplasty isn't for everyone who is overweight. A screening process helps your health care team see if the procedure might be beneficial for you. And you must be willing to commit to healthy lifestyle changes, behavioral therapy and regular medical follow-up.

Endoscopic sleeve gastroplasty isn't right for anyone who has a large hiatal hernia or a condition associated with gastrointestinal bleeding, such as gastritis or peptic ulcer disease.

Endoscopic sleeve gastroplasty may not be covered by health insurance.

Risks

So far, endoscopic sleeve gastroplasty has been shown to be a safe procedure. Pain and nausea may happen for several days after the procedure. These symptoms are usually managed with medicine. Most people feel better after a few days.

In addition, although it's not designed to be a temporary procedure, endoscopic sleeve gastroplasty can be converted to another bariatric surgery.

When combined with lifestyle changes, endoscopic sleeve gastroplasty results in about 18% to 20% total body weight loss at 12 to 24 months.

How you prepare

If you qualify for endoscopic sleeve gastroplasty, your health care team will give you instructions on how to prepare for your procedure. You may need to have lab tests and exams before surgery. You may have restrictions on eating, drinking and taking medicines. You also may be required to start a physical activity program.

It's helpful to plan for your recovery after the procedure. For instance, arrange for a companion or someone else to help at home. Recovery from endoscopic sleeve gastroplasty generally takes only a few days.

What you can expect

During the procedure

Endoscopic sleeve gastroplasty is done in the endoscopy unit as an outpatient procedure. General anesthesia is used, so you'll be in a sleep-like state during the procedure.

The procedure is done using a flexible tube called an endoscope. It has a camera and an endoscopic suturing device attached. The endoscope is inserted down the throat into the stomach. The tiny camera and suturing device allow the endoscopist to see and operate inside the stomach without making cuts in the belly.

Using the endoscope, the endoscopist places sutures in the stomach. The sutures change the structure of the stomach, leaving it shaped like a tube. This limits the amount of food you can eat because you feel fuller sooner.

Endoscopic sleeve gastroplasty takes about 1 to 2.5 hours.

After the procedure

After the endoscopic sleeve gastroplasty, you wake up in a recovery room, where medical staff watches you for complications.

After recovering from sedation, most people go home the same day. Some people might need to stay overnight in the hospital, but this is rare.

After the procedure, you generally won't be allowed to eat for a few hours. Then you'll start a liquid diet, which you need to continue for at least two weeks.

Eventually, you move on to semisolid foods, and then to a regular healthy diet.

Results

As with any weight-loss program, commitment to nutrition, physical activity, emotional health and resiliency play a large role in how much weight you lose. Typically, people who complete their entire programs and follow all the guidelines can expect to lose about 10% to 15% of their body weight in the first year.

Endoscopic sleeve gastroplasty may improve conditions often related to being overweight, including:

• Heart disease or stroke.
• High blood pressure.
• Severe sleep apnea.
• Type 2 diabetes.
• Gastroesophageal reflux disease (GERD).
• Joint pain caused by osteoarthritis.

When weight-loss surgery doesn't work

It's possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don't follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.