Sewing up the tummy for weight loss

[WORLD] Obesity is a complex and growing issue that affects millions worldwide, often requiring more than just diet and exercise for effective management. While traditional methods such as behavioral changes, medication, and exercise can work for mild cases, those with severe obesity often need more invasive treatments. A breakthrough in the medical world has provided a solution that doesn't involve traditional surgery: Endoscopic Sleeve Gastroplasty (ESG). This innovative procedure offers a minimally invasive approach to help patients lose weight, addressing a critical gap for those who are reluctant to undergo full bariatric surgery.

ESG is a minimally invasive weight-loss procedure that uses an endoscope to reshape the stomach, reducing its size without any external incisions. The procedure is performed by stitching part of the stomach, making it smaller and restricting the amount of food that can be consumed. This alteration helps patients feel fuller with smaller portions, ultimately leading to weight loss.

Dr. Lim Shu Yu, a consultant general surgeon, explains the impact of this procedure: "There is a large group of patients who can’t lose weight through lifestyle, diet, and medications alone, but don’t want surgery, so the ESG is intended to fill this gap." According to Dr. Lim, ESG carries a lower risk than traditional bariatric surgery and offers a significantly faster recovery time. Patients are typically able to return to normal activities the following day.

The Procedure

The ESG procedure involves using an endoscope, a flexible tube with a camera, inserted into the stomach through the mouth. This device allows surgeons to access the stomach and place sutures that reduce its size. Dr. Lim elaborates on the process, stating, "In ESG, we fold part of the greater curvature of the stomach and stitch 60-70% of it so that the amount you can eat is perhaps the size of a chicken drumstick and you are full."

This procedure not only reduces the stomach's capacity but also affects how the stomach responds to food, leading to earlier feelings of fullness and reduced hunger. However, as Dr. Lim mentions, "Over time, the sutures will loosen and the stomach can expand again, hence ESG is not a long-term solution."

Benefits of ESG

One of the biggest advantages of ESG over traditional bariatric surgery is the lack of external incisions. This makes the procedure less invasive, reducing the risk of complications and speeding up recovery. Patients can generally resume regular activities within a day. Moreover, the procedure's success rate is an impressive 90%, with patients typically losing around 20% of their body weight in the first year following the procedure.

While ESG is not a permanent fix and does not replace long-term diet and lifestyle changes, it serves as a useful tool for those who struggle with obesity and cannot lose weight through conventional methods alone. Dr. Mandeep Singh Awtar Singh, a consultant gastroenterologist, notes, "Technology has advanced, and the equipment we’re using is more refined." This progress in technology allows for more precise and effective weight loss solutions for patients.

When Is ESG a Suitable Option?

ESG is particularly suitable for patients with severe obesity who have been unsuccessful in losing weight through diet, exercise, and medications. It is also an option for those who want to avoid the risks associated with full surgical procedures like gastric bypass or sleeve gastrectomy. The procedure can be used as a stepping stone for patients who may eventually need bariatric surgery, as it helps reduce the risks and complications of the more invasive procedures by first facilitating some weight loss.

Dr. Lim emphasizes that ESG is not a one-size-fits-all solution. He clarifies, "ESG is not intended to replace diet, lifestyle, and medicines, or bariatric surgery, as patients only lose up to 20% of their weight over a year as a result of this procedure."

Global Acceptance of ESG

While ESG is a relatively new technique in Malaysia, it has been successfully used in Europe for over a decade and is becoming increasingly popular worldwide. Malaysia has recently adopted the second-generation equipment for ESG, which offers more refined technology and improved precision. Dr. Mandeep highlights, "The procedure takes 60-90 minutes, depending on the size of the stomach, and the patient is put under general anesthesia."

Despite being a late adopter of this procedure, Malaysia is one of the first countries in Asia to utilize the second-generation endoscopic equipment, giving patients access to cutting-edge technology. However, ESG is still relatively rare, with fewer than ten trained gastroenterologists in Malaysia.

The Role of ESG in Managing Severe Obesity

For patients with severe obesity, ESG offers a unique advantage by providing a less invasive alternative to bariatric surgery. As Dr. Lim explains, the procedure can help patients shed some weight before undergoing more intensive surgeries, such as gastric bypass, to minimize potential complications. By aiding in weight loss, ESG prepares patients for future surgical interventions that might be necessary for more long-term weight management.

While the procedure is not a permanent solution, it serves as a crucial tool in the fight against obesity, particularly for those who are not suitable candidates for traditional surgery. The procedure’s effectiveness in helping individuals regain control over their weight can dramatically improve their overall quality of life.

Endoscopic Sleeve Gastroplasty (ESG) is a promising solution for those struggling with severe obesity, offering a non-surgical alternative to traditional bariatric surgery. By stitching the stomach from the inside, ESG reduces its size, helping patients feel full with less food. The procedure offers a quick recovery time and a high success rate, making it an appealing choice for those who wish to avoid more invasive surgeries.

However, ESG is not a permanent solution and should be paired with long-term lifestyle changes for lasting weight loss. As Dr. Lim aptly puts it, "ESG is not intended to replace diet, lifestyle, and medicines, or bariatric surgery." It serves as an important step in helping patients regain control of their weight, particularly for those who cannot lose weight through traditional methods alone.

The advancements in ESG technology, coupled with its success rate and reduced risk of complications, make it a valuable addition to the options available for treating obesity. As more patients turn to ESG as a solution, the future of obesity treatment looks more promising, offering a balance between efficacy and minimal invasiveness.