Non-Surgical weight loss
For those who don't fit into surgical guidelines, and those who don't want bariatric surgery - endoscopic bariatrics is recommended. With the technique most suited for specific obese condition, will give desirable results with regard to weight loss and resolution of disease condition when combined along with a good diet and activity plan. This technique is also advisable for the people with regain issues and certain complications.
Primary Endoscopic Bariatric Procedures
Primary endoscopic bariatric therapy is recommended for patients with moderate to severe obesity ( 10 to 25 kg overweight). It is also useful for morbidly obese patients who defer or is not fit for surgery. Though various newer modalities are under experimentation, two procedures made it to regular clinical use. Though gastric balloon is available for the past 30 years, recent addition of refillable one year ballon has made endoscopic therapy famous. With the introduction of Sleeve Gastroplasty,, this non-surgical therapy is gaining immense popularity. Team BAROS of Apollo Hospitals, Chennai is the first center in Asia to introduce ESG in 2012.
Endoscopic Intragastric Balloon (EGB)
Endoscopic placement of the balloon is temporary and reversible without surgical incisions. It is an inflatable medical device that is placed into the stomach to reduce weight. It provides weight loss when diet and exercise have failed and surgery is not wanted or not recommended. The balloon limits the amount of food the stomach can hold and thereby creates an early feeling of fullness and satiety. After six months (or up to twelve months with some newer devices), the device is removed using Endoscopy again. The use of the balloon is complemented with counseling and nutritional support or advice.
Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic Sleeve Gastroplasty is a newer type of weight-loss procedure where the size of your stomach is reduced using an endoscopic suturing device without the need for surgery, this reduces the risk of complications. This procedure may be an option if you have a body mass index of 27 or more — and diet and exercise haven’t worked for you. The end result mimics a Laparoscopic Sleeve Gastrectomy, however, the volume of the stomach will be more. Like other weight-loss procedures, Endoscopic Sleeve Gastroplasty requires a commitment to a healthier lifestyle.
Revisional Endoscopic Surgery
With more than 4 decades of bariatric surgery in practice and increasing volume of surgery across the globe, there are growing incidence of weight regain and inadequate weight loss. Eventually obesity related diseases reappear as well. Studies have reported incidence as high as 30% of weight recidivism after bariatric surgery. With increased risk of intra-operative and post-operative complications following revision bariatric surgery and just moderate outcome with regards to excess weight loss and resolution of co-morbidities, endoscopic therapy has come as a great option as first step in revision for weight regain.
Endoscopic Re-sleeve Gastroplasty
Endoscopic Re-Sleeve Gastroplasty is a revisional bariatric procedure. ERS is an ideal alternative to surgery for patients who regain weight after sleeve gastrectomy. A dilated sleeve is a major predictor of weight regain. An endoscopic suturing system is used to plicate the dilated vertical sleeve and reduce its size to 100 cc, thus restoring the restrictive component. This can be added with or without a second layer of reinforcing stay sutures. The entire procedure avoids the need for surgery, thus reducing the risk of revision surgical complications.
Endoscopic Stomal Reduction (ESR)
Endoscopic stomal reduction or transoral outlet reduction (TORe) is a revisional bariatric procedure. ESR is an ideal alternative to surgery for patients who regain weight after Roux-N-Y gastric bypass. A dilated gastrojejunal anastomosis (stoma) is a major predictor of weight regain. An endoscopic suturing system is used to plicate the stoma and reduce its size to 1.5 cm, thus restoring the restrictive component of the gastric bypass.
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