By Monica Saumoy, MD
For people who struggle with their weight, there are a number of treatment options available today.
Recent medical advancements have provided doctors with a range of weight loss interventions, from medication to surgery.
One of the more effective treatments available today is endoscopic sleeve gastroplasty (ESG), a minimally invasive weight-loss procedure that reduces the size of the stomach.
Repeated clinical studies have demonstrated the effectiveness of ESG in helping patients to lose weight, according to the National Institutes of Health.
For patients who have not had success with diet and lifestyle changes, ESG may be a good next step.
How It Works
During ESG, a flexible tube called an endoscope is inserted into a patient’s mouth, down the throat and into the stomach. The endoscope contains a tiny camera that allows the doctor to see inside the stomach, and a suturing device to be able to place sutures along the stomach’s interior that reduce the size and shape of the stomach.
Whereas a typical stomach is shaped similar to a kidney bean, a stomach that has undergone ESG is a tubular, sleeve-like shape. The purpose of the procedure is to make the stomach smaller so that the patient feels full sooner, and eats less.
Is ESG Right for You?
Weight loss options available today range from changes to diet and exercise to bariatric surgery to prescription medications that can suppress appetite, prevent absorption of dietary fat or stimulate the release of a hormone that promotes weight loss.
ESG is generally recommended for patients with a body mass index of 30 or above who have not had success with losing weight from diet and lifestyle changes. It is less invasive than sleeve gastrectomy, which is an inpatient procedure that involves removing part of the stomach and has a longer recovery time. Sleeve gastrectomy may be recommended for patients with a body mass index over 40.
People with metabolic syndrome, which is a group of conditions that together raise your risk of heart disease, diabetes and stroke, according to the National Heart, Lung, and Blood Institute, may also be good candidates for ESG.
Following Treatment
ESG is done in an outpatient setting and patients are sent home on the same day as their procedure. For the first few hours after ESG, a patient will not be allowed to eat or drink anything.
In the first few weeks after treatment, patients must follow a diet composed of liquids that may include broths or pureed soups, milk, yogurt and protein shakes. Following ESG, it is important to drink liquids slowly to avoid gulping air, which can cause discomfort.
By week four, patients can start incorporating soft foods such as oatmeal and scrambled eggs into their diet. It is important to eat smaller portions and to avoid overeating which can distend the stomach.
Beyond this, patients must gradually return to a normal diet as eating solid foods too quickly can break sutures prematurely.
Exercise should also be carefully undertaken, with no heavy exercise in the first several days. Due to the low-calorie intake, too much exertion can cause a person to feel lightheaded or even faint. Walking or light cycling is recommended. More strenuous exercise such as running or aerobics may begin after the patient has introduced more protein and solid foods into their diet.
In some cases, ESG patients will be prescribed weight-loss medication following the procedure.
Most patients will experience significant weight loss in the first year after treatment. According to the National Institutes of Health, studies have shown that ESG patients lose 16% of their total body weight loss within 12 months of treatment, and for many the rate is even higher.
For all patients, the long-term success of ESG is dependent on making lifestyle modifications, including a healthy diet and regular exercise.
A Multidisciplinary Approach
Successful weight management must extend beyond the ESG procedure. Increasingly, doctors are taking a multidisciplinary approach to obesity that involves coordination between surgeons and gastroenterologists, dietitians, psychologists and other healthcare professionals. This integrated strategy is meant to address the core issues that lead a patient to develop obesity.
If you struggle with your weight and feel like you’ve tried every diet and exercise plan available, it may be time to talk with your doctor about the options available to you.
At the Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center, a team of weight loss specialists offer a comprehensive and multidisciplinary approach to treating obesity, including endoscopic sleeve gastroplasty.
To find a gastroenterologist with Penn Medicine Princeton Health or for more information about the Center for Bariatric Surgery & Metabolic Medicine at Princeton Medical Center, call 1 (888) 742-7496 or visit www.princetonhcs.org.
Monica Saumoy, MD, is board certified and fellowship trained in gastroenterology and board certified in internal medicine and obesity medicine. She is a member of the medical staff at Penn Medicine Princeton Health and specializes in minimally invasive and therapeutic gastrointestinal procedures.
