By Brooke Bastian, PA-C | Interventional Endoscopy Associates in collaboration with HonorHealth

Obesity presents a pressing public health concern in the United States. More than 41% of U.S. adults are classified as obese, with approximately 17% of children and adolescents aged 2-19 also falling into the obese category. Obesity poses significant health risks to our patients across multiple body systems and is associated with comorbidities such as cardiovascular disease, type 2 diabetes, respiratory issues, digestive disorders, osteoarthritis, chronic pain, mental health disorders, certain cancers and reproductive complications. These health challenges also result in an estimated annual expenditure of $173 billion U.S. dollars on obesity-related healthcare costs.

Today, the mainstay of obesity treatment has been a combination of dietary changes, physical activity and lifestyle modifications, complemented by the use of medication and, in some cases, bariatric surgery. However, recent advancements in bariatric endoscopy have introduced an alternative weight loss solution that is highly effective, providing healthcare professionals additional options to help patients achieve their weight loss goals.

Endobariatrics is a subspecialty of gastroenterology that collaborates with bariatric medicine and concentrates on minimally invasive, endoscopic procedures for the treatment of obesity and metabolic disorders. These procedures offer less invasive alternatives to surgery, providing patients with effective weight loss solutions while minimizing surgical risks and recovery time.

Amar Thosani, MD, an interventional endoscopist, is partnering with the HonorHealth Bariatric Center, a MBSAQIP Accredited Center of Excellence to expand a comprehensive bariatric program on the HonorHealth Scottsdale Shea Medical Center campus.

Endobariatric procedures for weight management now offered at HonorHealth include:

• Endoscopic sleeve gastroplasty (ESG) – a minimally invasive endoscopic weight loss procedure that reduces the stomach capacity by 70-80% by sewing it into the shape of a tube. This gastric luminal reduction causes decreased caloric intake, delayed gastric emptying and favorable changes in the gastrointestinal and metabolic hormones. Due to this procedure’s fundal-sparing approach, it also offers an improved anatomical configuration for significantly reducing the risk of post procedure gastric reflux symptoms.
• Transoral outlet reduction procedure (TORe) – a revision procedure which reduces the size of the outlet of the stomach following a surgical gastric bypass to address problems such as weight regain or inadequate weight loss after surgery.
• Sleeve in sleeve procedure (SIS) – a gastric sleeve revision procedure following a surgical sleeve gastrectomy, which reshapes and resizes the existing sleeve stomach to address problems such as weight regain or inadequate weight loss.

Stomach appearance after ESG:

Recently published was the first prospective, multicenter, randomized trial for ESG for the treatment of class 1 and class 2 obesity. At the 52-week mark, findings revealed that the mean percentage of excess weight loss (EWL) in the ESG group was 49.2%, markedly higher than the 3.2% observed in the control group. In the ESG group, there was a percentage of total body weight loss (TBWL) of 13.6%, contrasting with the 0.8% observed in the control group. Additionally, more than 80% of the individuals in the ESG group experienced positive improvement in metabolic comorbidities, overall speaking to the efficacy of ESG and associated endoscopic procedures.

HonorHealth is excited to introduce the Endobariatric Program, aiming to provide a state renowned comprehensive bariatric center that offers minimally invasive endoscopic procedures to help our patients achieve their weight loss goals and improve their obesity-related health conditions.

To refer a patient to the HonorHealth Endobariatric Program, please call 623-300-9011.

References:

• https://www.cdc.gov/obesity/data/adult.html – Obesity facts.
• Abu Dayyeh BK, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT) a prospective multicenter, randomized trial. Lancet. 2022;400(10350):441–451. doi: 10.1016/S0140-6736(22)01280-6. [PubMed]
• Dave, N., Dawod, E., & Simmons, O. L. (2023). Endobariatrics: a Still Underutilized Weight Loss Tool. Current Treatment Options in Gastroenterology, 21(2), 172–184. https://doi.org/10.1007/s11938-023-00420-6
• Lopez-Nava G, et al. Gut and metabolic hormones changes after endoscopic sleeve gastroplasty (ESG) vs laparoscopic sleeve gastrectomy (LSG) Obes Surg. 2.0020;30(7):2642–2651. doi: 10.1007/s11695-020-04541-0. [PubMed]
• Vargas EJ et al. Effect of endoscopic sleeve gastroplasty on gastric emptying, motility and hormones: a comparative prospective study. Gut. 2022. [PubMed]
• Hedjoudje A, et al. Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2020;18(5):1043–1053.e4. doi: 10.1016/j.cgh.2019.08.022. [PubMed]
• Abu Dayyeh BK, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15(1):37–43.e1. doi: 10.1016/j.cgh.2015.12.030. [PubMed]
• Hajifathalian K, et al. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty. Gastrointest Endosc. 2021;93(5):1110–1118. doi: 10.1016/j.gie.2020.08.023. [PubMed]