Endoscopic Weight Loss Procedures

There are two forms of endoscopic procedures currently available today. Each has pros and cons, and speaking with Dr. Tsuda is the next step toward understanding whether either is appropriate for your particular circumstances.

Endoscopic weight loss procedures are a relatively new addition to the continuum of care for patients with obesity. Unlike surgical interventions, no incisions are made in the abdomen. Instead, specially-made tools, including a high-definition camera, are introduced into the stomach through the mouth. They are made to pass through the esophagus without causing damage, allowing the surgeon to perform the procedure from within. Endoscopy may be appropriate for patients who are not good candidates for surgical intervention or who fear surgery. Generally speaking, while they may be very effective for long-term weight loss, they do not have the same weight loss potential as stapled surgical procedures.

Gastric Balloon

The gastric balloon is a temporary, non-surgical option for patients looking to lose 10-15% of their body weight. There are different forms of gastric balloons, but they each work similarly. The uninflated gastric balloon is introduced into the stomach through endoscopy or simply by swallowing a pill. Once appropriately placed in the stomach, the weight-loss surgeon or gastroenterologist inflates the balloon with sterile saline (salt water) or air. The balloon occupies space in the abdomen, reducing the amount of food a patient can eat. For patients interested in the swallowable balloon, which is currently not approved in the United States, Dr. Tsuda assists with travel arrangements to South America, where a trusted medical provider can place it.

Gastric balloons have generally shown mixed long-term success because they are removed after six months. While a second balloon can be placed, these procedures are inherently temporary. As such, patients must improve their diet and exercise choices to maintain their weight loss. Health insurance plans do not cover gastric balloons, so patients should expect to pay out of pocket for the procedure.

>Gastric Balloon

Endoscopic Sleeve Gastroplasty (ESG)

The endoscopic sleeve gastroplasty is similar in principle to the traditional surgical gastric sleeve. During the procedure, an endoscope is placed into the stomach through the mouth and esophagus. The stomach is reduced in volume by strategically placing sutures. When tightened, the stomach folds on itself, reducing its volume by about 30%. Most patients can lose up to 20% of their body weight with relatively few side effects and a shorter recovery time than a sleeve performed surgically. An endoscopic gastroplasty may also be performed as an initial procedure in patients for whom a gastric sleeve has not provided sufficient weight loss, or in those who have gained weight due to pouch dilation.

The FDA recently approved the ESG procedure, and although it still lacks widespread insurance coverage, it can be performed on a cash-pay basis. Patients should speak with their weight-loss surgeon to better understand the viability of an ESG for their situation.

>Endoscopic Sleeve Gastroplasty (ESG)