From the Guidelines
Endoscopic gastric remodeling is a minimally invasive procedure that reshapes the stomach to help with weight loss and metabolic disorders without traditional surgery, with the most recent and highest quality study suggesting its effectiveness in achieving significant weight loss 1.
Overview of Endoscopic Gastric Remodeling
Endoscopic gastric remodeling involves using an endoscope (a flexible tube with a camera) inserted through the mouth to access the stomach, where various techniques can be applied to reduce stomach volume or alter its function.
Common Methods
Common methods include:
- Endoscopic sleeve gastroplasty (ESG), which uses sutures to create a tubular stomach shape
- Intragastric balloons that occupy space in the stomach
- Aspiration therapy using a tube to remove food after meals
- Devices that affect stomach emptying
Procedure and Recovery
The procedure typically takes 30-90 minutes under sedation or anesthesia, with patients usually returning home the same day. Recovery is faster than traditional bariatric surgery, with most patients resuming normal activities within a few days.
Mechanism and Effectiveness
This approach works by restricting food intake, slowing digestion, or altering hormonal signals that control hunger, making it an option for patients with BMIs of 30-40 who haven't succeeded with lifestyle changes alone but may not qualify for or want traditional bariatric surgery, as supported by a recent study in JAMA 1.
Adverse Effects
Adverse effects include nausea, vomiting, abdominal pain, and risk of bleeding, but severe complications are rare, with no report of leaks, need for surgery, or mortality in recent studies 1.
FDA-Approved Procedures
Currently, two bariatric endoscopic procedures are FDA-approved: intragastric balloons and endoscopic sleeve gastroplasty, with the latter achieving 13.6% weight loss compared to 0.8% with lifestyle modifications alone in a recent RCT 1.
From the Research
Definition and Overview of Endoscopic Gastric Remodeling
- Endoscopic gastric remodeling is a minimally invasive procedure that aims to reduce the size of the stomach, thereby inducing weight loss in obese individuals 2, 3, 4, 5, 6.
- This procedure is considered a safe and effective alternative to traditional bariatric surgery, with several studies demonstrating its efficacy in achieving significant weight loss and improving obesity-related comorbidities 3, 5, 6.
Types of Endoscopic Gastric Remodeling Procedures
- Endoscopic sleeve gastroplasty (ESG) is a type of gastric remodeling procedure that involves reducing the size of the stomach using endoluminal suturing or plication techniques 3, 5.
- Primary Obesity Surgery Endoluminal (POSE) is another type of endoscopic bariatric therapy that focuses on gastric remodeling, involving the placement of full-thickness plications in the gastric body to reduce the width and length of the stomach 6.
- Intragastric balloons are also a type of endoscopic weight loss therapy, but they are not a form of gastric remodeling 2, 4.
Efficacy and Safety of Endoscopic Gastric Remodeling
- Studies have shown that endoscopic gastric remodeling procedures can achieve significant weight loss, with percentages of total weight loss ranging from 10% to 20% at 1 year 2, and up to 53% of excess body weight lost at 6 months 5.
- The procedures have also been shown to improve obesity-related comorbidities, such as hypertension, diabetes, and obstructive sleep apnea 5, 6.
- The safety profile of endoscopic gastric remodeling procedures is generally good, with low rates of serious adverse events reported in the literature 3, 5, 6.