We have all been made aware that obesity is a serious global health issue that affects numerous countries and populations around the world. According to the statistics published by the World Health Organization (WHO), obesity rates have been steadily increasing over the past few decades, and it is now considered a major public health epidemic.
Obesity is defined as a condition where an individual has excess body weight resulting from an accumulation of fat and is associated with an increased risk of various chronic conditions, including cardiovascular disease, type 2 diabetes, certain types of cancer, hypertension, a lack of mobility, and mental health issues.
The obesity crisis has steadily become worse year over year, most likely due to the lack of desirable or effective treatments available. While bariatric surgery, such as gastric sleeve surgery, has been an option for weight loss in severely obese individuals, it is not without its inherent risks and limitations. Fortunately, recent advancements in the field of endoscopic bariatric surgery have opened doors to innovative non-surgical approaches that offer an alternative to those seeking a safer and less invasive solution.
Today we are going to talk about a procedure that has been described as a "gastric sleeve without surgery". Also known as endoscopic sleeve gastroplasty, this non-surgical sleeve is gaining popularity as a safe and effective alternative for individuals struggling with obesity who are not keen on undergoing surgery or are ineligible due to various medical reasons.
We will contrast the steps involved in gastric sleeve surgery vs. gastric sleeve without surgery as well as highlight efficacy, safety, and long-term weight loss results.
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Obtaining Results Of Gastric Sleeve Without Surgery Is Groundbreaking
Unfortunately, once an individual reaches a BMI level (body mass index) that qualifies as obese, it is very difficult for them to lose enough weight on their own to bring their BMI back into a healthy range, which requires some form of medical intervention.
Until fairly recently, these individuals had only bariatric surgery as an option for medical intervention. Surgeries like gastric bypass and gastric sleeve became the go-to procedures for weight loss among severely obese individuals. Interestingly, most obese individuals (99%) who qualify for bariatric surgery choose not to have it. Most of the individuals were either afraid of the risks and possible complications of surgery or were not in a position to withstand the long recovery and extended downtime that surgery would involve.
Advancements in medical science have led to the development of alternative options that can be considered instead of surgery. One of the biggest breakthroughs has been in the field of endobariatric techniques, including a procedure called endoscopic sleeve gastroplasty (ESG). It's like a gastric sleeve without surgery and has been proven to be just as effective for weight loss but with significantly lower risks when compared to surgery.
Understanding The Gastric Sleeve Procedure
To better understand the potential the development of the non-surgical sleeve technique can have on the obesity crisis, let’s take a look at an overview of the surgical gastric sleeve procedure.
Gastric sleeve, also known as sleeve gastrectomy, is a surgical procedure performed to help individuals who are severely overweight or obese achieve sustainable weight loss. It involves the removal of a large portion of the stomach, leaving behind a smaller, sleeve-shaped stomach. Generally, the procedure involves the following steps:
- During the procedure, the surgeon typically makes several small incisions in the abdomen and inserts a laparoscope, which is a small, flexible tube with a camera attached. This allows the surgeon to perform the surgery with precision;
- Using the other incisions as access points, the surgeon then removes approximately 75–80% of the individual's stomach, including the outer curved portion;
- The stomach portion that is left behind is surgically stapled closed and looks similar to a long tubular sleeve;
- Patients normally stay in the hospital overnight but may be required to stay for up to three days. Recovery typically takes between six and eight weeks, during which patients have activity restrictions. It is important to follow the surgeon's directions regarding returning to your normal routine to avoid developing complications.
ESG Non-Surgical Sleeve Procedure Overview
ESG has become increasingly popular and was recently recognized and approved by the FDA as a viable weight loss treatment for individuals who suffer from obesity.
Patients who desired help with weight loss but did not want to undergo a surgical procedure are considering endoscopic sleeve gastroplasty, as it is comparable to a gastric sleeve without surgery. The steps involved during a typical ESG procedure include:
Pre-Procedure Prep
Prior to the ESG procedure, the doctor works with the patient to conduct a comprehensive evaluation, which may include physical examinations, blood tests, imaging studies, and consultations with a healthcare team. This evaluation helps determine if the individual is a suitable candidate for the procedure and identifies any potential issues.
Anesthesia
ESG is typically performed under general anesthesia to ensure the patient remains comfortable and unaware during the procedure. Generally, the procedure lasts less than an hour, which is a significant time savings over surgery and can help mitigate the severity of anesthesia-related side effects.
Endoscopy Begins
Once the patient is under sedation, the doctor inserts a long, flexible tube called an endoscope through the mouth and into the stomach. The endoscope has a light source and a camera at its tip, which allows the endoscopist to visualize the procedure on a monitor in real time.
Stomach suturing
The doctor uses specialized tools that are passed through the endoscope to place a series of sutures (stitches) in the stomach. These sutures are strategically placed to reduce the stomach's capacity and create a tube-like structure resembling a sleeve. Since the sutures are administered from inside the stomach, no incisions are made, which significantly reduces the risk of complications.
Completion Of Procedure
Once the sleeve is formed and secured, the endoscope is carefully withdrawn, completing the procedure. The patient spends a few hours in a recovery room for observation and is then released to recover comfortably at home.
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The Way Gastric Sleeve Works vs Non-Surgical Sleeve For Weight Loss
By reducing the size of the stomach, gastric sleeve surgery restricts the amount of food that can be consumed at one time. It also alters the production of certain hormones that regulate appetite, leading to a decreased feeling of hunger and increased satiety.
Gastric sleeve surgery is typically performed as a laparoscopic procedure, which is less invasive and generally associated with shorter hospital stays and a faster recovery compared to traditional open surgery. That being said, it is still considered a major surgical procedure and, as such, carries certain risks and the potential for complications.
A non-surgical sleeve (ESG) provides almost identical benefits to a gastric sleeve without surgery. The stomach is made smaller, which helps patients with portion control as they cannot eat a large amount in one sitting. Also, they stay feeling full and satisfied for a longer period of time because the smaller stomach digests the food more slowly. The comparison chart below highlights some of the noteworthy similarities and differences between the gastric sleeve and the non-surgical sleeve.
<table class="iksweb"><caption>Gastric Sleeve vs Non-Surgical Sleeve (ESG)</caption><tbody><tr><th>Gastric Sleeve</th><th>Non-Surgical Sleeve (ESG)</th></tr><tr><td colspan="2">Technique</td></tr><tr><td>Surgical Procedure</td><td>Non-surgical Procedure</td></tr><tr><td colspan="2">Hospital Stay Duration</td></tr><tr><td>1-3 nights</td><td>The non-surgical sleeve is an outpatient procedure and does not require a hospital stay</td></tr><tr><td colspan="2">Suitable Candidates</td></tr><tr><td>Individuals with a BMI of at least 35 and at least one health condition that is obesity-driven (i.e. hypertension)<br>
or<br>
Have a BMI of 40 or higher.Individuals that do not have medical issues that would preclude them from undergoing surgery.</td><td>Individuals with a BMI of 27+ who are committed to making the necessary lifestyle changes to promote weight loss and maintain a healthy BMI.<p></p><p>Individuals who do not desire to undergo surgery or are not able to have surgery for medical reasons.</p></td></tr><tr><td colspan="2">Procedure Length</td></tr><tr><td>2 – 2 1/2 hours</td><td>Approximately 1 Hour</td></tr><tr><td colspan="2">Alterations To The Stomach</td></tr><tr><td>A large portion of the stomach is permanently removed.</td><td>The stomach is made smaller using stitches, but none of the stomach parts is cut away or eliminated. If necessary, the procedure is reversible.</td></tr><tr><td colspan="2">Recovery</td></tr><tr><td>External wounds (Incisions) take between six and eight weeks to heal and the internal staple line may need up to ten weeks to fully heal.</td><td>Most patients are back to their normal routine in a week. There are no activity restrictions after the procedure.</td></tr><tr><td colspan="2">Are Scars possible?</td></tr><tr><td>Yes between 3 and 5 scars are possible on the abdomen</td><td>There are no incisions, so no scarring is possible</td></tr><tr><td colspan="2">Potential for Weight Loss (average at 2 Year Mark)</td></tr><tr><td>Most patients have maintained weight losses of around <a href="https://www.mayoclinic.org/tests-procedures/sleeve-gastrectomy/about/pac-20385183#:~:text=Results,excess%20weight%20within%20two%20years." target="_blank" rel="noopener">60% of their excess</a> weight after 2 years.</td><td>Individuals who had a non-surgical sleeve procedure lost and maintained about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556490/" target="_blank" rel="noopener">60% – 65%</a> of their excess body weight at the two-year mark.</td></tr><tr><td colspan="2">Results Long-term</td></tr><tr><td>Gastric Sleeve has been around longer and has well-known long-term results, complications, and side effects. Weight loss <a href="https://pubmed.ncbi.nlm.nih.gov/29973112/#:~:text=A%20linear%20association%20between%20preoperative,(all%20p%20%3C%200.05)." target="_blank" rel="noopener">results were approx 61% of Excess body weight loss</a> after five years.</td><td>Non-surgical sleeve (ESG) is a newer technique, but the five-year data shows <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939770/" target="_blank" rel="noopener">results of approx 59 – 61%</a> of excess body weight loss, which is comparable to gastric sleeve without the surgery.</td></tr><tr><td colspan="2">Risk Probability</td></tr><tr><td>Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939770/" target="_blank" rel="nofollow noopener">12%</a></td><td>Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939770/" target="_blank" rel="nofollow noopener">3%</a></td></tr></tbody></table>
With the obesity epidemic growing worse every year, there has been a huge need for safer and less invasive weight loss solutions. The development of the non-surgical gastric sleeve represents a significant milestone in the battle against obesity.
Dr. Batash's World-Class Expertise in Non-Surgical Weight Loss
If you have struggled with your weight and would like to reclaim your health and well-being, Batash Endoscopic Weight Loss Center is here to help. Our team of professionals can help create a plan that is tailored to your specific needs, identifying underlying conditions that may have hindered your previous weight loss attempts.
Dr. Batash will evaluate your medical and weight loss history and find the best combination of solutions to help you reach your weight loss goals. Contact us today to set up your appointment and learn more about the non-surgical sleeve procedure and if it may be a good choice for you!
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