A new treatment method known as endoscopic sleeve gastroplasty is showing promise as a minimally invasive, safe and cost-effective weight loss intervention for patients with obesity.
Researchers at the Mayo Clinic in Rochester, Minnesota have been investigating this weight loss option and have recently published the results of a second study.
The first study demonstrated the technical feasibility and safety of the procedure; this second study investigated durability, weight loss, and gastrointestinal function.
What is Endoscopic Sleeve Gastroplasty?
Endoscopic sleeve gastroplasty is a procedure that restricts the stomach to the size of a sleeve similar to surgery (about an 80% reduction in size), but is performed completely from the inside of the stomach.
The procedure involves minimally invasive techniques of endoscopy, a non-surgical method gastroenterologists use to examine a person’s digestive tract. The endoscope, a flexible tube with a light and camera attached to it, is moved through the mouth and esophagus into the stomach.
An endoscopic suturing device is used to put in a set of sutures that get pulled and tightened to bring the section of stomach tissue together. The process is repeated several times from the bottom end of the stomach to the top until a sleeve is formed.
The procedure is done in an endoscopic outpatient facility. The patient is put under general anesthesia for the procedure, which takes about 2 hours, then moved into the recovery room. After a few hours, patients go home and can return to their normal lifestyle within one to three days.
The procedure mimics the anatomical changes of a surgical sleeve gastrectomy, but avoids the surgical risks and nutrient deficiencies associated with other types of bariatric surgery.
The stomach restriction helps the patient eat less, and combined with diet and exercise, gives them the ability to lose weight. Patients are encouraged to enroll in a weight loss program with an endocrinologist and nutritionist for evaluation and follow-up.
The procedure is meant to be permanent, but can be reversed, repeated, and done as many times as needed. It is done for people who want to lose an extra 40-60 pounds and may be an option for those who don’t qualify for other types of bariatric surgery.
More than 400 procedures have been done in the United States and Europe. It can be performed by gastroenterologists and by bariatric surgeons with endoscopic skills.
The cost of endoscopic sleeve gastroplasty is about one-third the cost of bariatric surgery. It is currently done in only a few centers in the United States; the major provider is the Mayo Clinic in Rochester, Minnesota, where researchers are investigating the procedure.
In 2013, Mayo Clinic researchers completed a small pilot study that demonstrated the safety and feasibility of endoscopic sleeve gastroplasty as a treatment for obesity. The results of this study were published in the September 2013 issue of Gastrointestinal Endoscopy.
A second study was designed to further study the metabolic effects of the procedure. The results of this study were recently published online in Clinical Gastroenterology and Hepatology.
This study involved 25 individuals with obesity (21 women and 4 men; mean age of 48; mean BMI of 35) who underwent endoscopic sleeve gastroplasty (using Overstitch suturing device from Apollo Endosurgery) from September 2012 to March 2015 at the Mayo Clinic in Rochester, Minnesota.
The study results showed that at 6, 9, 12, and 20 months after the procedure, the patients had lost 53%, 56%, 54%, and 45% of excess body weight, respectively.
It was also shown that the procedure delayed solid food emptying from the stomach, created an earlier feeling of fullness during a meal, and significantly reduced body weight.
Lead study author Barham K. Abu Dayyeh, MD, MPH, from the department of gastroenterology and hepatology, Mayo Clinic, Rochester, MN., said:
- “Given the low use of bariatric surgery and limited effectiveness of lifestyle changes and drug treatments, a significant gap exists in our current approach to obesity. Endoscopic sleeve gastroplasty offers an effective weight loss intervention at lower cost and higher patient satisfaction, potentially filling this gap in the management of obesity.”
Researchers at the Mayo Clinic believe endoscopic sleeve gastroplasty could be an alternative to bariatric surgery for selected patients with obesity. The next step is to confirm the findings of this study in a larger patient population in randomized controlled studies with longer follow-up.
Abu Dayyeh BK, Acosta Cardenas AJ, Camilleri M, Mundi MS, Rajan E, Topazian MD, Gostout CJ, Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals, Clinical Gastroenterology and Hepatology (2016), doi: 10.1016/j.cgh.2015.12.030, http://www.cghjournal.org/article/S1542-3565(15)01714-0/abstract