Transoral sleeve gastroplasty provides alternative to bariatric surgery

Developing new tools to help manage obesity is an ongoing challenge and health care priority. The worldwide incidence of obesity and associated metabolic comorbidities has more than doubled since 1980. In the United States, one-third of adults have a body mass index (BMI) greater than 30. For many of them, bariatric surgery is the only modality offering clinically significant and sustained weight loss.

But high-cost, high-risk bariatric procedures will not be able to meet the current burden of disease, especially for people with mild to moderate obesity, according to Mayo Clinic gastroenterologists with extensive endoscopy experience.

Most patients will need something more effective than medications but not as invasive as surgery, and endoscopy is well-positioned to assume that role. Altering various segments of the intestinal tract in gastric bypass can induce changes in neurohormonal signals, leading to improved satiety, increased metabolism and reduction, if not resolution, of diabetes. Endoscopy now provides the tools to replicate some of those benefits.

Transoral sleeve gastroplasty

One of the most promising endoscopic weight-loss procedures is transoral sleeve gastroplasty, which uses an endoscopic suturing device to mimic surgical sleeve gastrectomy. Creating an endoscopic vertical gastroplasty reduces stomach capacity by 80 percent while avoiding the micronutrient deficiencies and surgical risks associated with gastric bypass surgeries.

Although it is reversible, sleeve gastroplasty is not intended to be temporary. Mayo endoscopists experienced in performing this procedure liken it to orthodontics — a lifelong process requiring a series of periodic interventions, in this case to address suture integrity and increased meal capacity.

Mayo Clinic researchers recently completed a small pilot feasibility study of endoscopic sleeve gastroplasty. The results, published in the September 2013 issue of Gastrointestinal Endoscopy, demonstrated safety and feasibility. A second trial studying the procedure's metabolic effects is underway.

The trial's first six patients experienced about a 30-pound weight loss at six months, representing a 36 percent reduction in excess body weight — a loss that has been maintained up to one year. Mayo endoscopists have observed that rapid weight loss can be an effective trigger for better lifestyle choices. As people see they're losing weight, they become motivated to follow a diet and initiate exercise, which are essential.

Endoscopic sleeve gastroplasty is an outpatient procedure. Patients resume their normal lifestyle in a day or two, and side effects are minor. The cost is roughly one-third that of bariatric surgery.

Mayo Clinic also offers qualified patients endoscopic revision after a bariatric procedure through reduction of the gastrojejunal stoma diameter and gastric pouch size. The procedure can take patients who have gained some weight back to the same level of restriction they felt after the initial surgery. Mayo endoscopists note that patients undergoing the revision procedure average a 25-pound weight loss over six months.

For more information

Abu Dayyeh BK, et al. Endoscopic sleeve gastroplasty: A potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointestinal Endoscopy. 2013;78:530.