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Endoluminal Surgery

Before and After BMI

October 14, 2014

Endoluminal Surgery

Endoluminal surgery:

An exciting new technology is emerging in bariatric surgery involving the endoscopic platform. These procedures are done trans-orally using a gastroscope and afford the patient of the potential benefit of a procedure which can be done without incisions. THAT’s RIGHT! Surgery without an incision!

These options are being used or evaluated for both revision and primary surgery.

Revision Surgery:

Revision surgery is a difficult proposition for surgeons and patients alike.  The degree of difficulty in the operating room is much higher that on initial procedures. This can be due to scar tissue, altered anatomy,  foreign material (mesh or bands), and decreased or altered blood supply. These factors mean that there are higher risks of complications. Traditionally surgeons have been very selective in taking a patient for a revision as the risk can easily out-weigh the benefit in some of these cases. Endoluminal revision although not risk free, is certainly safer then traditional surgical revision. Depending on the type of operation you had, you may be a candidate for endoluminal revision.

At BMI of Texas we perform the overstitch revision of gastric pouch, outlet, and sleeve. This is done using the Overstitch device ( Apollo Endosurgery- Austin, Tx).

The procedure is done in the operating room under general anesthesia.  A protective tube is placed through the patient’s mouth and into the esophagus. We then pass our scope with the suturing device attached to the end through this tube and into the pouch or sleeve. We use the device to close down and dramatically narrow the size of the pouch, outlet, or sleeve. This usually requires multiple sutures. After the procedure, most patients can go home the same day. You will be on a liquid protein diet for 2-3 weeks after the procedure to allow time for healing.

Primary surgery:

Endoluminal sleeve plication

This is a procedure under trial which makes use of the same endoscopic suturing device (Overstitch- Apollo endosurgery Austin, Tx) to create an internal plication of the gastric wall. This effectively reduces the size of the gastric lumen by plicating (folding or pleating)the gastric wall together. Working form distal to proximal, the surgeon can create a tubular stomach similar to that seen in sleeve gastrectomy, although it is not known yet if patients experience the same neuro-hormonal changes seen after sleeve (increased GLP1, decreased ghrelin, etc)

Endoluminal barrier sleeve

This is a plastic liner which is inserted using a scope placed down a patients mouth and anchored into the GI tract. It functions to prevent contact of the ingested food with the lining of the gut and thus create a virtual bypass of the upper GI tract.  This is currently under trial although we hope to see US release in 2015.

Gastric balloon

This is not a new technology and has been trialed in the US. This is an inflatable balloon or double balloon that is placed using again the scope placed down the mouth and deploying the device into a patient’s stomach. The balloon system is then inflated which takes up space in the stomach. The goal is to create satiety or fullness with a small amount of food. This device can be removed in the same way it was put in.

BMI of Texas is on the forefront of these new technologies and we will have them available to our patients after our internal evaluation process.  As always, all patients undergoing revision or endoluminal surgery will need to be actively engaged in our medical weight loss program.

– Dr. Michael Seger

Do I Qualify for Weight Loss Surgery Quiz