Endoscopic Sleeve Gastroplasty - Procedure and Contraindications

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.