Endoscopic Sleeve Gastroplasty: A Newer Option for Weight Loss

At a Glance

  • Though 98 million people in the United States could benefit from weight loss surgery, only 2 percent pursue the procedure.
  • On average, gastroplasty patients lose between 17 and 20 percent of their body weight within six months to a year of the surgery.
  • To perform endoscopic sleeve gastroplasty, the physician inserts an endoscope with a suturing device down the patient’s throat into the stomach.

“The reason why endoscopic sleeve gastroplasty has become so successful is that it’s very acceptable to a lot of patients, and I think that’s the key. With obesity, you want something that patients are willing to do and take that leap of faith to start making a change.”

— Reem Z. Sharaiha, MD, MSc

Of the 98 million individuals in the United States who are obese and who would benefit from weight loss surgery, a scant 2 percent ultimately pursue it. “There are a number of reasons for this, including a fear of surgery and the potential side effects or perceived complications,” says Reem Z. Sharaiha, MD, MSc, Director of Bariatric Endoscopy in the Division of Gastroenterology and Hepatology at NewYork-Presbyterian/Weill Cornell Medical Center. “Furthermore, there are an additional 86 million with a BMI of 30 to 40 for whom diet and exercise have not worked, and medication would only help achieve a 5 percent weight drop. People want something more sustainable without surgery, and that is where endoscopic weight loss procedures are coming more into play.”

More than three years ago, Dr. Sharaiha and her colleagues began offering endoscopic sleeve gastroplasty, a minimally invasive, safe, and cost-effective alternative to surgery. “Patients can expect to lose between 17 and 20 percent of their body weight on average by six months to a year. This is an ideal option for select patients,” says Dr. Sharaiha. “And it’s a repeatable procedure.”

Endoscopic sleeve gastroplasty mimics the traditional surgical sleeve. In a procedure performed under general anesthesia in an outpatient endoscopy unit, the physician inserts an endoscope with a suturing device down the patient’s throat into the stomach, making about six to eight sutures to transform the stomach into a tube-shaped structure one-third of its original size. “The way I bring the stomach together is similar to a corset or an accordion, where you just pleat the stomach on itself,” says Dr. Sharaiha. “Patients generally spend two to three hours in recovery before going home the same day.”

Dr. Sharaiha believes that research results coming in five to 10 years will more clearly validate the procedure’s efficacy. “However, what we do know from our two-year and three-year data is that the people who follow up with their dietician and nutritionist continue to have good weight loss,” says Dr. Sharaiha, who also notes that the effects of the procedure extends to improvements in blood sugar levels, cholesterol, and blood pressure based on data they recently submitted for publication.

Dr. Sharaiha continues to explore the full potential of the procedure. “We know the patient can achieve weight loss, but we want to know if it’s sustainable, if it improves a patient’s health, and down the line if it improves mortality. Those are harder endpoints,” she says. “If we can determine these points, we can begin to change the paradigm of this disease.

“The reason why endoscopic sleeve gastroplasty has become so successful is that it’s very acceptable to a lot of patients, and I think that’s the key,” adds Dr. Sharaiha. “With obesity, you want something that patients are willing to do and take that leap of faith to start making a change.”

According to Dr. Sharaiha, the increasing prevalence of obesity further necessitates close collaborations between surgeons, gastroenterologists, and endocrinologists. “We’re starting to treat obesity more as a chronic condition,” she says. “The patient may need more treatments throughout their lifetime, more surgery perhaps, endoscopy, medication, or all three.”

Dr. Sharaiha emphasizes that no single approach will help a patient achieve all of their weight loss goals. “Over time, patients need a program that includes behavioral changes, diet, exercise, and nutrition counseling,” says Dr. Sharaiha, who together with Louis J. Aronne, MD, Director of the Center for Weight Manage-ment and Metabolic Clinical Research, and Alfons Pomp, MD, Chief of Laparoscopy and Bariatric Surgery at NewYork-Presbyterian/ Weill Cornell, has established the Weight Management Center to offer comprehensive, individualized treatment plans for each of their patients.

Case Study: Endoscopic Sleeve Gastroplasty

A 60-year-old woman, weighing 214 pounds with a body mass index of 33.5 kg/m2, underwent successful endoscopic sleeve gastroplasty (ESG). One year post-ESG, she weighed 169 pounds (45 pounds weight loss, 21 percent total body weight loss, with BMI 26.5). However, her weight reached a plateau and she reported a diminishing change in satiety. A preliminary study showed ESG-induced decrease in caloric consumption and slowing of gastric emptying. Endoscopy revealed prior gastroplasty with loosened sutures. An endoscopic suturing system was used to place running stitches. The stitches were cinched to approximate opposing gastric walls. Two layers of sutures were placed to narrow the gastric lumen. Three months after this procedure, patient weighed 156 pounds (an additional 13-pound weight loss and 8 percent total body weight loss). From her initial ESG, the patient lost 58 pounds and 27 percent total body weight loss, with an improved BMI of 24.4. This case highlights the efficacy and repeatability of endoscopic sleeve gastroplasty for further weight loss.

Case Study A

Endoscopic sleeve gastroplasty after one year with loosening of prior sutures

Case Study B

Gastric body after tightening of gastric sleeve

Case Study C

Upper GI series after tightening demonstrating narrow gastric body with fundal reservoir (blue arrow)

  • Source: Kumta NA, Doshi R, Aronne LJ, Sharaiha RZ. Trimming the fat: endoscopic suturing for tightening of prior endoscopic sleeve gastroplasty. Gastrointestinal Endoscopy. 2016 Sep 10.

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