Metabolic and bariatric endoscopy

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, incisionless procedure performed using full-thickness endoscopic suturing to reduce gastric volume. Weight loss following ESG is typically higher than medical or lifestyle therapy alone and lower than bariatric surgery, but individual results vary.

This procedure creates a sleeve in the stomach without any external incision. Sutures are placed in the stomach during an endoscopic procedure to reduce the size of the stomach and change the shape of the stomach into a sleeve. No external incisions are made, and most patients go home the same day as the procedure.

Am I a candidate?

Candidates for this procedure must meet these criteria:

• Are at least 22 years old.
• Are at least 30 pounds overweight.
• Are willing to participate in a medically supervised weight loss program.
• Have no previous weight loss surgery.
• Do not have an eating disorder.
• Do not have poorly-controlled diabetes type II.
• Do not have heart burn symptoms when taking heart burn medications.
• Have attempted weight-loss through diet and exercise without success.
• Have not been diagnosed with ulcers in the stomach or small intestines.
• Have not been diagnosed with inflammatory bowel disease.
• Have not had previous surgeries on the stomach.

The TORe procedure is for patients who have had a gastric bypass in the past and have had weight regain or for people with intractable dumping syndrome.

Benefits of TORe

• This a very low-risk, fast, non-surgical outpatient procedure, with no hospitalization required.
• Weight loss is comparable to that seen with new weight loss drugs.
• It can be used along with weight-loss drugs for improved weight loss.
• Patients have minimal pain in recovery and most go back to work in a week.

Intragastric balloon therapy involves placing into the digestive tract medical-grade silicone balloons that are filled with liquid or inert gas. After a set period of time the balloons are then drained and removed from the patient.

Balloons offered

Orbera Balloon System. Your physician places a single intragastric balloon. Patients return to the clinic after six months to have the balloon removed.

In Obalon Balloon System therapy, the patient swallows a capsule that contains a balloon. The balloons are inflated with a nitrogen-mix gas. Second and third balloons are swallowed 2 weeks and 8 weeks after the first balloon. All balloons are removed six months after placement of the first balloon.

Am I a candidate?

• Candidates for intragastric balloons must meet these criteria:
• Are not on blood thinners or nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, Aleve).
• Are at least 22 years old.
• Are at least 30 pounds overweight.
• Are willing to participate in a medically supervised weight loss program.
• Have no previous weight loss surgery.
• Do not have an eating disorder.
• Do not have poorly-controlled stabilized diabetes type II.
• Do not have heart burn symptoms when taking heart burn medications.
• Have attempted weight-loss through diet and exercise without success.
• Have not been diagnosed with ulcers in the stomach or small intestines.
• Have not been diagnosed with severe chronic obstructive pulmonary disease (COPD).
• Have not been diagnosed with inflammatory bowel disease.
• Have not had previous surgeries on the stomach.

Lifestyle therapy helps you make long-term changes to maximize the weight loss you see with intragastric balloons and helps you keep the weight off. All of the intragastric balloon packages include Lifestyle therapy.

The components of Lifestyle therapy include:

• Diet.
• Exercise advice.
• Behavior coaching.
• Lifestyle therapy will be administered by a team including your physician, registered dietitian and behavior coach throughout the 12-month program.
• 6 months with the balloons in place.
• 6 months after the balloons are removed.

Aspiration therapy involves the use of the AspireAssist device. This device is made of various components that create a pathway to allow aspiration of gastric contents out of the stomach for external disposal.

Am I a candidate?

Candidates for aspiration therapy must meet the following criteria:

• Are at least 50 pounds overweight.
• Have not been able to lose weight or maintain a weight loss with diet and exercise alone.
• Do not have a stricture in your esophagus, inflammatory bowel disease, severe gastroparesis or a blockage in your stomach.
• Do not have stomach ulcers that wouldn’t heal in the past or ulcerations in your stomach now.
• Do not have uncontrolled high blood pressure.
• Do not have severe heart failure.
• Have normal blood clotting.
• Do not have anemia.
• Are not pregnant or lactating.
• Have not been diagnosed with an eating disorder.
• Do not have chronic abdominal pain.
• Do not have cirrhosis in your liver or severe kidney disease.

Endoscopic gastric bypass revision is for patients who have regained weight lost after a Roux-en-Y Gastric Bypass procedure. This is an outpatient procedure that takes about an hour.

During the endoscopic procedure, we use a suturing device to tighten the connection between your gastric pouch and small intestine. This makes you feel full earlier in a meal to help you eat less.