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Endoscopic Sleeve Gastroplasty - Procedure and Contraindications

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Endoscopic sleeve gastroplasty is a procedure used for losing weight. It is safer and less risky. Read below to know more about it.

Written by

Dr. Gayathri. N

Medically reviewed by

Dr. Ghulam Fareed

Published At December 16, 2022
Reviewed AtDecember 16, 2022

Introduction:

Obesity has been a primary cause of concern nowadays. It invariably affects everyone because of the sedentary lifestyle changes people have adopted nowadays. It has turned itself into a public health menace affecting over 650 million adults worldwide. It will still keep on increasing because of the increasing consumption of unhealthy food and sophisticated lifestyle. Less physical activity is also a primary cause since work-from-home culture has gradually increased and has made people lazier.

Only 1 % of the population who are obese were ready to prefer surgical treatment over other weight loss methods due to the risks it poses. Since there are a lot of complications involved in traditional bariatric (treatments related to obesity) surgeries, introducing new surgical techniques which would involve fewer complications would be a boon to obese patients. Endoscopic surgeries contain fewer risks, are more cost-effective and less invasive (use of instrumentation in surgery), and will help many patients reach good results by providing effective weight loss in a short time.

This procedure was first introduced by Abu Dayyeh et al. in 2013. In this procedure, the doctor will insert a full-thickness endoscopic suturing device down the throat and into the stomach.

Permanent sutures are added endoscopically to reduce the size of the stomach. This procedure is done if the individual has tried reducing his/her weight but could not succeed. It applies to an individual who is overweight with a body mass index of 30 or more. Since it is a cosmetic procedure, insurance is not covered by most insurance companies.

Why Is This Procedure Needed?

The procedure is needed because:

  • This procedure helps in reducing a lot of ill effects caused due to being overweight by reducing weight.

  • Like heart disease, stroke, type 2 diabetes, osteoarthritis and nonalcoholic fatty liver disease.

  • This procedure is also very useful for individuals who have tried other weight loss methods like diet, exercise, and medicines.

  • It works by limiting the amount of food consumed and also delays the process of gastric emptying.

What Are the Types of Equipment Needed for This Procedure?

Things needed include:

  • Endoscope.

  • A flexible tube with a camera attached to it.

  • Endoscopic suturing device.

How Is This Procedure Performed?

  • Before the start of the procedure, some instructions on eating habits will be given.

  • The patient will be advised to take lab tests to check the general parameters of blood pressure, blood sugar level, etc.

  • A screening test will help doctors to see if the procedure is beneficial for the patients.

  • It is performed in a hospital using general anesthesia.

  • The patient will be placed in a supine position (lying flat facing upwards).

  • The doctor uses a tiny camera to visualize the inside of the abdomen without making an incision on the outside.

  • In a flexible endoscopic suturing system with a needle driver, a suturing anchor is inserted down your throat inside the stomach.

  • The doctor would place 12 sutures using a full-thickness endoscopic suturing device like overstitch, approximately in the stomach, stitching the anterior and posterior wall of the stomach, making it in the shape of a tube, without making an incision on the stomach.

  • This will reduce the size of the stomach, and it would automatically have an impact on the amount of food the patient consumes. A Z-shaped suturing pattern is used for suturing.

  • The procedure would take approximately 90 minutes to complete, and the patients mostly get discharged on the same day.

  • Some patients might be kept at the hospital for a day or two after the completion of the procedure for observation.

  • All the patients will be scheduled for follow-ups in one, three, six, and twelve months of follow-up visits.

  • The main advantage of this procedure is that there will be no scars or incisions since there will be no removal of any part of the stomach.

  • Following the completion of the procedure, the individual must follow a healthy diet, and regular maintenance of the body must also be followed by regular exercise.

How Will the Recovery Be?

Since it is minimally invasive, the recovery will be faster compared to normal surgery.

After the completion of the procedure, the healthcare team will shift the patient to a room for recovery from the operation theater to monitor the vital signs. The doctor will not allow the patient to eat or drink anything a few hours after the surgery. Then a normal liquid diet can be followed. This will continue for at least two weeks. Then gradually, the diet plan has a mix of semisolid and liquid food. After a month, the patient will be allowed to consume solid food.

With the help of lifestyle modification changes, this procedure results in about 15 - 20 % weight loss within one to two years.

What Are the Contraindications for This Procedure?

  • People not ready to make the necessary lifestyle changes are not eligible for this procedure.

  • People more prone to gastrointestinal bleeding are also not eligible for this procedure.

  • People who suffer from ulcers or gastritis are also not a good fit for this procedure.

  • People who have hiatal hernia (it occurs when the upper part of the stomach bulges into the chest cavity through the diaphragm) cannot do this procedure.

  • Patients suffering from psychiatric disorders and other eating disorders are also contraindicated.

Conclusion:

Although traditional methods are available to reduce the size of the stomach, this method uses fewer instruments, is cost-effective, involves less risk, and, at the same time, provides good healing, making it a more patient-friendly procedure. This procedure helps to improve the confidence level of the individual by giving them the results they need, provided they follow a healthy balanced diet and a proper exercise schedule after the surgery. This procedure is a sort-out one since the benefits outweigh the traditional surgery benefits.

Frequently Asked Questions

1.

How Much Time Does Endoscopic Sleeve Gastroplasty Take?

In the weight loss procedure, the surgeon uses an endoscope to reduce the size of the stomach. The doctor uses general anesthesia, which lasts for around 60 to 90 minutes. The effects of weight loss management can last for several years. The results depend on individual diet and lifestyle choices.

2.

How Productive Is Endoscopic Sleeve Gastroplasty?

Some studies have shown that ESG is effective in weight loss. Some people lose 20 percent of their body weight within six to nine months of the surgical procedure. The effectiveness can vary and depend on several factors, such as diet, weight, overall health, and exercise habits.

3.

Is Endoscopic Sleeve Gastroplasty Everlasting?

ESG provides long-term results. The procedure is permanent and reversible. It depends on an individual ability to maintain a diet over a long period. An individual can again regain weight if not following proper treatment. Some people may require different treatment procedures to maintain weight loss.

4.

How Much Weight Loss Is With ESG?

The amount of weight loss depends on several factors, such as age, gender, dietary habits, lifestyle changes, and exercise recommendations. People can lose 15 to 20 percent of their body weight within six to twelve months after the procedure.

5.

Does ESG Lead To Hair Loss?

Hair loss is not a common issue of ESG. Some people may experience hair loss after ESG or other weight loss procedures. Hair loss can be due to other factors, such as hormonal changes. Rapid weight loss can cause hair loss. If there is weight loss after an ESG, it is a temporary procedure and can be managed with stress management and proper diet intake.

6.

Is ESG Surgery Safe and Effective?

ESG is safe and effective in obese and overweight people. ESG can lose weight within a short period, which can improve overall health and obesity-related conditions such as heart disease and diabetes. Regular exercise, lifestyle changes, and dietary habits can maintain weight loss.

7.

What Is the Achievement Rate of ESG?

The success rate of ESG depends on the surgical technique, post-operative care instructions, and follow-up. It is an effective weight loss tool. Some people lose weight within the first year of the procedure. The success rate of ESG depends on the patient's age, weight, gender, and overall health status. People with high body mass index may require more treatment options, such as bariatric surgery.

8.

What Are the Chances of Getting Pregnant With ESG?

ESG is a non-surgical procedure that does not involve any incisions. The procedure does not affect the reproductive organs of an individual. The person can get pregnant even after ESG and the procedure does not affect the person's fertility. Weight loss can affect a person's menstrual cycle and fertility. Rapid weight loss can lead to hormonal level changes that can affect menstruation and ovulation.

9.

What Should an Individual Consume After ESG?

Some guidelines for what to eat are as follows:
- Clear liquids such as water and sugar-free gelatin.
- Pureed foods such as soups and mashed vegetables.
- Low-fat food such as soft fruits and cooked vegetables.
- Take small, frequent meals.
- Take fiber-rich foods such as eggs, legumes, fish, meat, whole grains, and vegetables.
- Avoid high-fat, high-calorie, and sugary food.

10.

Which Is the Best Surgical Procedure for Weight Loss?

The best surgical procedure will depend on age, gender, medical history, health needs, and weight loss goals. The common weight loss surgeries are as follows:
- Gastric sleeve surgery (a portion of the stomach surgically removed) to create a banana-shaped pouch. 
- Gastric bypass surgery.
- Adjustable gastric banding (silicone band around the stomach).
- Biliopancreatic diversion with a duodenal switch.

11.

How Does an Individual Sleep After an ESG?

The tips for sleeping after ESG are as follows:
- Sleep on the back can prevent discomfort and allow stomach healing.
- Elevate the upper body at a 45-degree angle. 
- Avoid sleeping toward the stomach side.
- Eat at least two hours before bedtime.

12.

What Are the Requirements of ESG?

ESG is a weight loss procedure designed for obese and overweight people. People who are not eligible for other weight loss surgeries can adopt ESG. The procedure is not appropriate for everyone. The appropriateness depends on the individual age, medical history, and health status.

13.

Why Does an Individual Not Lose Weight After ESG?

The possible reasons are as follows:
- If an individual is not following the proper diet.
- Consuming a high-calorie diet.
- If an individual is not exercising enough to maintain weight loss.
- Certain medical conditions can lead to weight gain.
- Inadequate sleep can disrupt hormones.

14.

How Many Calories Should an Individual Eat After ESG?

An individual must make a diet plan from the healthcare provider. The number of calories depends on the patient's needs and weight loss goals. Generally, the doctor may recommend 800 to 1200 calories per day to consume in the initial stages after the procedure.
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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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