11 September, 2023

ESG vs Vertical Band Gastroplasty

When you are trying to find resources to help you with your weight loss efforts, it is easy to become confused. There are a myriad of different weight loss plans, diets, surgical and non-surgical procedures, and many self-proclaiming experts spiraling around the internet that will find their way into your web search results.

How are you to know which information is accurate, proven effective, or safe? How would you know which diet plan, procedure, or weight loss advice would be best for your circumstances? If you are like most people, the answer is that you will have no idea, which is one of the main reasons you should seek professional help when trying to lose a significant amount of weight.

Simmons MD Weight Loss Solutions strives to become a trusted source of information for individuals like you who would like to learn more about safe and effective weight loss and living a healthy lifestyle. As part of our blog series, we desire to provide content that is helpful and may clarify information or answer some of the questions you may have about obesity or weight loss options.

Today, we would like to provide an overview of two procedures that you may come across during your research: vertical band gastroplasty and endoscopic sleeve gastroplasty. Although they sound very much alike, they are two entirely different procedures.

What Is Vertical Banded Gastroplasty?

Vertical banded gastroplasty (VBG), often known as stomach stapling or gastric stapling, is a surgery that was initially devised in the early 1970s and refined throughout the decades. In 2000, it was further developed by the University of Iowa’s Dr. Edward E. Mason, who is also credited with creating the first gastric bypass procedure.

The development of mechanical staplers made this method viable. VBG was the first procedure performed solely for restrictive purposes to address obesity, and it was developed as a lower-risk alternative to Roux-en-Y gastric bypass (gastric bypass) and jejunoileal bypass.

How Is Vertical Banded Gastroplasty Done?

VBG uses a band and staples to form a tiny pouch in the upper region of the stomach. The goal of this pouch is to limit how much food can be eaten and slow down how fast food can move through the body. This little pouch is then strengthened with a layer of polypropylene netting wrapped around the pouch’s outlet to prevent stretching and provide the feeling of satiety.

The new stomach pouch’s capacity is very small and can accommodate approximately a half-ounce at a time. The contents of the pouch travel through a small hole at its base that is approximately one centimeter in diameter. This allows the pouch’s contents to enter the remaining portion of the stomach and go on to the rest of the digestive tract.

Vertical banded gastroplasty (VBG)

How Often Is VBG Performed Today?

VBG was formerly a common operation for treating obesity, but it is now performed less frequently due to a high number of patients who had very poor long-term weight loss.

Statistics indicate that less than half of the patients who underwent VBG were able to lose half of their excess weight, and a five-year follow-up revealed that only 30% were able to successfully maintain that weight loss.

As of 2019, vertical banded gastroplasties represented less than 5% of all bariatric procedures, and most surgeons have since abandoned the procedure in favor of better options that have become available through medical advancements.

Vertical Banded Gastroplasty Advantages And Disadvantages

Advantages of vertical banded gastroplasty:

  • No risk of dumping syndrome;
  • No risk of nutritional deficiencies.

Disadvantages of vertical banded gastroplasty:

  • It requires very strict patient compliance with the diet;
  • If food is improperly chewed or eaten too quickly, severe vomiting can occur;
  • Nutritious foods that are healthier, more dense, and high in fiber are difficult to process and cause discomfort, while processed foods and junk foods are easier to process and cause no issues, which obviously is counterproductive for weight loss and overall health;
  • The band is not adjustable and is fixed in one setting;
  • Reversing a vertical banded gastroplasty is a far more complicated and extensive surgical procedure than the initial surgery. If the polyurethane band needs to be removed, and depending on how long it has been since the VBG, there may have been significant scar tissue that needs to be removed as well. Also, to restore the stomach to its original configuration, the staples must be removed and the sections of the stomach that had been divided must first be stitched back together. Reversing this surgery should only be considered in cases where there are significant medical issues;
  • Stomach fluid can leak if the staple line is disrupted and result in a serious infection;
  • Over time, the band around the opening to the stomach pouch can become weak and start to stretch. There is also a chance that the band will break or shift, which could make the opening bigger and cause the patient to gain weight;
  • Insufficient weight loss results.

Vertical Banded Gastroplasty vs Endoscopic Sleeve Gastroplasty

While these two procedures sound similar the only thing the two procedures have in common is the word gastroplasty. According to the Merriam-Webster dictionary, the definition of the word “gastroplasty” is “a surgical procedure performed on the stomach to decrease its size or repair a defect.”

Vertical banded gastroplasty is a surgical procedure that has been proven ineffective for weight loss and is associated with long-term complications. Endoscopic sleeve gastroplasty (ESG) does not require surgery and has been proven effective for weight loss with a risk profile of 1%. Let’s look at an overview of ESG.

What Is ESG?

ESG is a non-surgical procedure that assists patients in losing a substantial amount of weight. It provides similar or better weight loss results than the well-known bariatric gastric sleeve surgery. ESG has been in use for a while, but the FDA just recently gave it its green light of approval in the summer of 2022 because of the consistently positive weight loss outcomes observed throughout numerous clinical trials.

Endoscopic sleeve gastroplasty (ESG)

How Is Endoscopic Sleeve Gastroplasty Done?

While the patient is under general anesthesia, an endoscope is used to perform the ESG procedure. An endoscope is a flexible, hollow tube with a small camera and light attached to the end. It provides a pathway for surgical instruments to be lowered down into the procedure area without the need to create abdominal incisions.

Using the camera as a guide, the endoscope is cautiously lowered down the patient’s throat and into their stomach. The surgeon next manipulates and reshapes the patient’s stomach until it is only 25% of its original size and resembles a banana-shaped pouch. The new shape is secured in place with around 7–12 strategically placed sutures.

The entire ESG outpatient procedure is performed from the inside with no incisions, so a hospital stay is not required and patients are discharged to go home on their procedure day.

How Often Is Endoscopic Sleeve Gastroplasty Performed Today?

ESG has been gaining popularity for the past five years and has offered such significant weight loss results that the FDA took notice and approved it as a viable treatment for obesity last summer. The internet is full of ESG before-and-after success stories, and experts are hopeful that insurance companies will soon offer coverage for this non-surgical procedure.

Endoscopic Sleeve Gastroplasty Advantages And Disadvantages

Advantages of endoscopic sleeve gastroplasty:

  • Requires no incisions;
  • Procedure time is shorter; less exposure to anesthesia;
  • <1% risk profile;
  • Outpatient procedure, so no hospital stay is required;
  • Short recovery of only 5-7 days;
  • Since the procedure is done endoscopically, there is no visible scarring;
  • No part of the patient’s stomach is removed;
  • The procedure is reversible;
  • A good option for patients who do not qualify for bariatric surgery.

Disadvantages of endoscopic sleeve gastroplasty:

  • Standard possible complications associated with general anesthesia;
  • Patients might experience mild abdominal pain or experience vomiting for 5 to 6 days after the procedure;
  • Rare chance of stomach perforation <1%;
  • Rare chance of stomach bleeding <1%.
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