By Laura Freeman
This April, Grandview Medical Center became one of the first in Alabama to offer a new weight loss procedure for bariatric patients called the Endoscopic Sleeve Gastroplasty (ESG), which helps patients eat less and feel full faster. This minimally invasive procedure helps to shorten the length of the stomach by approximately 50 percent and reduce its volume by 75 percent.
Surgeons at Grandview, like Andrew Frey, DO, enter the patient’s stomach using an endoscope to sew a portion of the stomach closed. A small suturing device, attached to the end of an endoscope or camera, goes through the mouth into the stomach while the patient is asleep. Six to eight stitches are placed in a U shape pattern, starting at the bottom of the stomach, and working towards the top. These internal stitches will reduce capacity and change the shape of the stomach, forming a tube. The procedure is reversible, but the goal is for the stitches to stay permanently.
“We can perform this whole procedure with the endoscope without ever making a cut,” Frey said. “Patients can have it done in an outpatient setting so typically, they’re back to work in two or three days.”
After the procedure, it’s important for patients to follow a strict diet and exercise regimen. They start out on a liquid diet and progress to a soft diet. Eventually, they will be back to eating a regular diet with healthier portion sizes. To qualify for the ESG procedure, a person needs to have a BMI greater than 30.
“Our patients have often had weight issues their entire life and have tried multiple diets or even medication like GLP-1 with varying degrees of success. ESG gives us another option to treat both their obesity, as well as other comorbid conditions,” Frey said.
Without any incisions, stapling or external scarring, the ESG procedure helps patients lose weight because the quantity of food that can be eaten is restricted, the number of calories the stomach can absorb is reduced and the stomach empties more slowly, making it feel full longer.
“Patients are losing anywhere from 15 to 20 percent of their excess weight one year after undergoing this procedure,” Frey said. Medical studies also show that patients typically consumed 59 percent fewer calories.
The ESG procedure was pioneered in 2012 at the Mayo Clinic. Since then, it has grown in popularity.
“What we’re seeing, especially with some of the success of medications, is that patients are looking for increased weight loss, but without surgery,” Frey said. “Alabama, in general, struggles with obesity. If you pull up census data over the past 30 years, the entire country has become more obese, but Alabama has around a 40 percent prevalence of obesity.”
Over the last five years, Frey has seen a significant increase in bariatric medications on the market. While many of these medications have helped patients, he’s also seen patients coming back to look for more options because of pharmaceutical side effects or because of financial reasons.
“We know that obesity is a disease,” Frey said. “It’s caused by a variety of factors including biology, genetic risk, the environment and the foods that are around us. So our team is trying to address all of this. We have to meet with dietitians, and we have to develop exercise plans. To me, it’s about more than just the pounds the patients are losing. I’m rewarded by them coming off chronic medications, like blood pressure medications or insulin for our diabetic patients, and by increasing their cardiovascular health. That gives them stamina to participate in all aspects of their life.”
