Surgical Vs Endoscopic Sleeve

What is Endoscopic Sleeve Gastroplasty (ESG)?

Weight loss Drugs vs Endoscopy vs Surgery

What is a Surgical Sleeve?

Surgical sleeve or Laparoscopic Sleeve Gastrectomy (LSG) is the most common weight loss surgery in Australia. It is aimed at removing a large part of stomach, leaving behind a stomach remanent that resembles a sleeve. This allows one to eat less to achieve satiety (feeling of fullness). It also reduces the hunger hormone Ghrelin in the body, hence has a double fold effect on weight loss.

Pros:
Very efficacious/More weight loss
Considered a safe procedure
Commonly performed and expertise is readily available

Cons:
- Permanent change of anatomy
- Though considered quite safe, there is a 1-3% risk of serious complication like GI bleeding and leak from staple line
- Can make reflux/GORD worse or bring on new-onset GORD

What is Endoscopic Sleeve Gastroplasty (ESG)?

Endoscopic Sleeve Gastroplasty (ESG) is a minimally invasive endoscopic procedure that involves remodelling of the stomach using an endoscopic device called Overstitch. The idea is to reduce gastric lumen to shape it into a tube/sleeve without need for surgery.

With the advancements in endoscopic techniques and devices, new weight loss modalities are becoming available to the Australians. ESG is one of such newer techniques. It has been practiced and researched thoroughly over the last 10 years. Results are very encouraging.

For more information click here.

Why ESG? The unmet need

For a long time individuals with obesity only had limited weight loss therapies available to them. This included
1- Weight loss drugs

2- Surgery:
Less than 2 % of eligible individuals eventually undergo surgery though. This is due to

- Concern regarding permanent change in anatomy
- Lack of access to surgery
- Fear of surgical complications
- Surgery is considered too high risk
- Reluctance due to prolonged recovery phase/down time.
- Borderline BMI (30 to 35)

Hence there was a large unmet need to fill the gap between medical and surgical therapy. This has been filled with endoscopic weight loss therapies like ESG.

Individualised approach?

When it comes to weight management, one size doesn't fit all. Many factors are relevant when deciding the best weight loss therapy. These include but are not limited to:

Patient preference i.e. acceptance of anatomy altering procedure
Amount of weight loss required
Recovery time after weight loss intervention
Medical history i.e history of pre-exisiting reflux
Surgical history i.e complex abdominal surgeries, VP shunts etc.

There is no alternative to a thorough consultation and assessment to decide what treatment suits you best.

Weight loss Drugs vs Endoscopy vs Surgery

Obesity is a chronic disease, like type 2 diabetes and hypertension. This means it has to be managed life long. It is hence good to have different options available to you for fighting this fight long term. While deciding what option to chose first, remember the following general principles:

Class 1 Obesity (BMI 30-35) are much more likely to benefit from weight loss drugs or endoscopic intervention (Endoscopic Sleeve Gastroplasty) ALONE.
Higher BMIs (35 and above) need to lose more weight, and hence likely to need a more aggressive strategy. This can include either a weight loss surgery alone Or a combination of Endoscopic Sleeve Gastroplasty and weight loss drugs.
It is also quite reasonable and practical in many cases to use these treatments in a sequence.

What will work best for me?

Request an Appointment with Dr Fazal for a detailed consultation. He will recommend a weight loss plan that suits your circumstances best. You will need a referral letter from your GP