Obesity Management - Endoscopic Sleeve Gastroplasty

Hello!

I am Dr. Atul Sharma. I will be discussing today endoscopic sleeve gastroplasty for the management of obesity. Obesity is a big financial burden to Indian population and to the authorities. Its prevalence in India is around 11 to 36% that means one-fourth of the Indian population is having obesity. It is more common in females compared to male and it can give rise to many cardiovascular disease that is nowadays seen most of the time in young population also. There are different options for the management of obesity. On the one hand, we have diet, exercise and medical management and on the other hand, we have endoscopic and surgical methods. For Surgical management, we have more invasive like laparoscopic sleeve gastrectomy, adjustable band technique, etc. However, the indication for the surgeries is very few like, if the BMI is more than 40 or it is more than 35 with abnormality then only the surgical management can be done. That means it can be done only in 2-5% percent of the population and 95% of the population with obesity are deprived of any definite treatment.

For endoscopic management, we previously used to place intra-gastric balloon but nowadays a new technique which is known as endoscopic sleeve gastroplasty is available. In this technique, we pass a thin tube over that tongue which has adjustable suture device over it which sutures opposite walls of the stomach and reduce the volume of the stomach by about 70% and it is shaped into a banana. In this technique, the benefit is that there is no external suture, no external scar, same day or next day discharge is available. The indication is if the BMI is between 30-40 then patient can easily undergo this treatment. This treatment is practically irreversible, however, if patient wants to get it reversed this can be reversed within 6 weeks. Before endoscopic sleeve gastroplasty, a detailed history by dietitian and a medical person is taken. If patient is already on anti-coagulant then that is to be stopped for a few days.

This procedure is totally under anaesthesia and the total duration of the procedure is around 1-1.5 hours. After that patient is kept for observation for 3 to 4 hours and if the required patient can be discharged on the same day or next day morning. The post-procedure patient is kept on liquid diet for 6 weeks and there is activity restriction, patient cannot do full activity because he is taking liquid diet and energy may be less. After 6 weeks gradually patient can increase the workload. The expected weight loss in this procedure in three months is 10% and over 1 to 2 year it is expected to be more than 25%. Risk associated with Endoscopic sleeve gastroplasty is very minimal. In literature it has been mentioned only 2% and in our practice, we haven't seen any risk associated. That means 98% of the population doesn't have any risk and this is considered to be much safer than the surgical procedure. Endoscopic sleeve gastroplasty is considered to be a very promising and safe procedure. It is expected that in next one decade it will replace all the surgical procedures that is available except maybe in the morbid obesity. In India this is being done in very few centre. In Artemis Hospital, Gurgaon we have recently started this treatment and we are having a very good response here.

Thank you so much!