CPMC Endoscopic Bariatric Procedures

Thanks to advancements in endoscopic technology, you now have several non-surgical options for weight loss. CPMC’s Interventional Endoscopy Service (IES) offers these newer endoscopic weight loss procedures as alternatives to traditional weight loss surgery.

Endoscopic procedures pass a flexible tube with a camera and light through the mouth and down the esophagus to examine your stomach and intestinal tract. You’ll receive sedation during the procedure and typically go home the same day.

Endoscopic Sleeve Gastroplasty (ESG)

The IES team is the first in Northern California to perform an innovative weight loss procedure called endoscopic sleeve gastroplasty (ESG). This scar-free, non-surgical technique places sutures endoscopically to reduce stomach size by creating a small “tube” or “sleeve” that is 70 percent smaller than a typical stomach. This restricts the amount of food you can eat and also alters hunger-regulating hormones.  

ESG may be an option for you if you don’t qualify for weight loss surgery or you don’t want to undergo an operation. Adults with a body mass index of 30 kg/m2 or more and without a history of prior stomach surgery or large hiatal hernia may be eligible for this endoscopic procedure.

 Benefits of ESG include:

• Fewer risks and lower cost than traditional weight loss surgery.
• Quicker recovery time.
• An average weight loss of 18 to 20 percent of current weight (for example, 40 pounds weight loss for a person who weighs 200 pounds). Importantly, people who achieved these results were also actively engaged in a medical weight loss program.

While ESG is safe, most people experience some pain and nausea that may last for several days after the procedure. Your medical team can give you oral medications to manage pain when you go home.

In coordination with ESG, doctors in the Sutter Health network will continue to support you through the Sutter Weight Management and Metabolic program to ensure long-term success. This program will help you learn how to eat with a smaller stomach and make permanent healthy changes to your lifestyle.

Intragastric Balloon Therapy (IGB)

Intragastric balloon therapy (IGB) places temporary silicone balloons inside the stomach. The balloon is inflated with sterile fluid or gas, taking up space in the stomach. The balloon acts to increase feelings of satiety (fullness) and decreases the rate at which the stomach empties into the intestines, further enhancing satiety and improving portion control and weight loss.

The balloons may be placed endoscopically or they may be swallowed. You’ll undergo another endoscopy in six months to remove the balloon(s).

IGB therapy, used for several decades outside the United States, has a long track record of efficacy and safety. It may be an option if you have a BMI greater than 30 kg/m2, have had difficulty losing weight with diet and exercise and haven’t had prior esophageal or stomach surgery.

As with any endoscopic weight loss procedure, balloon therapy requires a commitment to a healthy diet and regular exercise to achieve lasting results. You’ll continue to be supported through the Sutter Weight Management and Metabolic program to ensure your success.

Endoscopic Revision of Weight Loss Surgery

Unfortunately, many people experience weight regain following weight loss surgery such as gastric bypass or sleeve gastrectomy. More than 20 percent of patients regain significant amounts of weight, which may lead to return of diseases such as high blood pressure, diabetes, sleep apnea, high cholesterol and joint disease. People may feel that they “failed” and feel stigmatized for “wasting” the operation.

It’s now known that dilation or stretching of the surgically created gastric pouch and outlet of the pouch (gastric bypass) or sleeve (sleeve gastrectomy) does sometimes occur and can lead to weight gain. When this occurs, people often complain of being able to eat more food at meals or that they are increasingly hungry between meals and end up grazing throughout the day.

While traditional revision operations are one way to reestablish weight loss, they carry increased risks compared with the original operation — so both patients and doctors may be reluctant to pursue this approach.

Endoscopic revision benefits:

• It offers a less invasive, safe and effective alternative to surgical revision.

• Nearly all patients achieve weight stabilization (the weight gain stops).
• Most people lose 20 to 50 percent of their excess weight.
• The operation is well-tolerated. Most people are discharged home the same day and return to work shortly thereafter.

While endoscopic revision of gastric bypass or sleeve gastrectomy can help you eat less and eliminate ongoing feelings of hunger, it’s best seen as a tool to help reinvigorate weight loss rather than as a second primary operation. It’s important to reconnect with bariatric support groups, visit with a dietitian in the Sutter Health network and refocus on establishing healthy lifestyle choices.

To make an appointment, please contact us:

1101 Van Ness Ave, 4th Floor
San Francisco, CA 94109
(415) 600-1151