It is no secret that the obesity epidemic has become gradually worse over the past few decades. There are numerous factors that have contributed to this situation and researchers continue to seek solutions.
In July 2022, the FDA approved a procedure that was first performed in 2012 but has progressively evolved and improved over the past decade. The non-surgical endoscopic sleeve gastroplasty or ESG as it is commonly referred to, is the latest weight loss technique and has been proven safe and effective.
Today we are going to talk a bit about the history of this procedure and why it has been nicknamed the “non-surgical sleeve.”
A Quick Look Back At The Origin Of Gastric Sleeve Surgery
Back in 1990, the first sleeve gastrectomy was performed as the first half of a two-part surgery to treat an obese patient. This complicated surgery, biliopancreatic diversion with duodenal switch (BPD-DS), was cumbersome and lengthy and therefore was divided into two different procedures. Then, in 1999, technology had progressed to the point that this first stage of surgery could be performed laparoscopically.
The BPD-DS was still being conducted in two parts using two separate surgeries. However, while the patient was recovering from the first part of the surgery so they could safely undergo the second part, they lost a significant amount of weight. In 2008, laparoscopic sleeve gastrectomy (LSG) became a “stand-alone” procedure for weight loss.
Because it was easier to perform than other types of bariatric surgery and resulted in fewer complications, it quickly became the most commonly performed surgery for weight loss in the U.S.
How Much Weight Is The Average Loss After Gastric Sleeve?
Since gastric sleeve surgery has been around for over two decades, there has been a great deal of data collected regarding its efficacy.
A review and comparison of patient data were conducted between patients who underwent gastric bypass surgery and gastric sleeve surgery. Three to five years after their surgeries, the patients all showed an overall average weight loss of about 60% (excess body weight loss).
Both sets of patients also showed much improvement or resolution of their pre-existing obesity-related illnesses (diabetes type II, hypertension, etc.). Longer-term data showed that gastric bypass surgery resulted in a greater amount of weight loss but both procedures showed the same instance of improvement in regards to their comorbidities.
New Techniques Bring The Non-Surgical Sleeve – ESG
Dr. Christopher Thompson, who hailed from Brigham and Women’s Hospital and the advanced endoscopy program at Massachusetts General Hospital, is credited with the first ESG procedure performed on a human. The surgery took place in April of 2012 in Calcutta, India using a new second-generation endoscopic suturing device (Overstitch) developed by Apollo Endosurgery.
Dr. Thompson was instrumental in the field of endoscopic procedures and it was his early years of training that ultimately shaped his career. He was using an endoscopic suturing device called an EndoCinch to treat patients with GERD and thought to himself that there could be other uses for this tool.
As bariatric surgeries began developing, his department was continually seeing patients who were having complications resulting from their surgery and they were looking for solutions for anastomotic leaking, fistulas, and even weight regain.
In 2003, he encountered a patient who had undergone a gastric bypass but was gaining weight and suffering from GERD. The patient had a gastro-gastric fistula (an abnormal opening) under their esophageal sphincter. Because he was well experienced using the Endocinch tool to treat reflux, he spoke to the bariatric surgeon overseeing the patient and suggested he try to close this fistula using the tool. The procedure was successful and the patient improved.
This avenue of endoscopic correction continued to be pursued and improved and it is now known as the endoscopic transoral outlet reduction (TORe) procedure that is used today for bariatric revision.
Techniques progressed and Dr. Thompson even patented some of his techniques for endoscopic weight loss. He continued to research and develop different techniques, teaching and publishing his findings. This led to the creation of an early form of endoscopic sleeve gastroplasty.
At the time, they called the procedure TRIM, and they were using a suturing device that was not capable of placing full-thickness sutures, so the effects of the procedure were only short-term. The news made the Boston Globe’s front page on June 28, 2008, titled “Obesity Surgery: It Requires No Knife.” This was the precursor to the “non-surgical gastric sleeve.”
Today’s Endoscopic Sleeve Gastroplasty
Now that we have learned a bit about how this procedure came to be, let’s look at what it involves today.
ESG is a procedure that stitches part of the stomach together to create a stomach that is smaller and more narrow, which is what is known as a “sleeve.” This new sleeve shape reduces the capacity of the stomach similarly to the surgical gastric sleeve, hence the name “non-surgical sleeve”.
Unlike the surgical sleeve, none of the stomach is taken out and there are no incisions created in the abdomen, so recovery time is easier and quicker.
ESG is done under general anesthesia and is completed by placing an endoscopic suturing device called Overstitch into the stomach through the patient’s mouth. The Overstitch device is used to place sutures into the stomach from the inside to form a narrower space for the food to pass through.
Reducing the stomach size by about 75–80% allows the patient to eat only small portions and the food that is ingested takes longer to digest, so they stay satisfied and full longer.
Endoscopic sleeve gastroplasty carries a recovery time of only 2–3 days and can be reversed if desired. The weight loss results from the ESG procedure average around 60% of the patient’s excess body weight, which is comparable to that of the surgical sleeve.
The improvement in techniques and in endoscopic suturing devices (the ability to place full-thickness sutures) has made the ESG procedure an effective solution for weight loss.
With the recent approval by the FDA of this non-surgical sleeve gastrectomy, it is sure to surpass the popularity of traditional LSG at some point in the future.
ESG Requires Double The Expertise
One of the barriers to utilizing the ESG procedure for weight loss is that it takes a particular skill set to perform. The procedure is done endoscopically, which is a primary specialty of gastroenterologists and not of bariatric surgeons.
Gastroenterologists, unlike bariatric surgeons, are not typically trained in the complexities of obesity and its comorbidities. At Simmons MD, we have a gastroenterologist who has completed additional clinical subspecialty training in the complexity of obesity, associated medical conditions, and management from Cornell, an Ivy League institution with renowned leaders in obesity management, such as Dr. Louis Aronne and Dr. Reem Shariaha.
For some physicians, the issue that may present is that there is a rather complex endoscopic procedure that needs to be performed, but because the issue being addressed is bariatric in nature, it may take a very special combination of the two medical specialties to ensure proper, safe, and effective treatment of the patient.
Where Can I Get The Non-Surgical Sleeve Procedure?
Looking for a qualified doctor to perform ESG can be quite challenging. During your due diligence, keep in mind that not all doctors who are advertising this procedure have the experience or expertise in both endoscopy and obesity management.
Be selective when making your choice and choose a doctor like Dr. Okeefe Simmons with Simmons Advanced Weight Loss Solutions. Dr. Simmons’ expertise in both endoscopy and the care and treatment of patients with obesity is among the best in the country.
His proven track record clearly shows that you will be in good hands while undergoing ESG in Miami, Florida.
If you would like to hear more about the non-surgical sleeve and find out if you would be a good candidate for the procedure, set up an appointment today at Simmons Advanced Weight Loss Solutions. Our experts are happy to answer your questions and discuss your options for safe and effective weight loss.