Obesity is an epidemic, and it is one with few options — medication, lifestyle modifications, and bariatric surgery — until recently. For many patients, lifestyle alterations and drugs are not enough for lasting change. While bariatric options are capable solutions, most patients struggle to meet surgical requirements, and even if they do, they opt out of surgery because of fear and anxiety.
Thankfully, because of recent medical advancements, overweight patients have options outside of lifestyle interventions and invasive surgeries. Endoscopic bariatric and metabolic therapies provide a necessary median between dietary changes and surgical options.
EBMT procedures present fewer risks than traditional bariatric surgeries and are outpatient procedures. The process involves the insertion of a small, flexible scope through the patient's mouth and requires reducing their stomach volume and possible alterations to the digestive tract. The reduced risks and minimal invasiveness mean an entirely new patient pool can receive treatment for obesity and other metabolic diseases.
The Rise of Noninvasive Procedures and Customization
While not a widespread practice at the moment, EBMT procedures are growing in popularity. One of the few institutions currently providing various EBMT services in the Midwest is the University of Michigan's Michigan Medicine program.
According to the program's head, it is a multidisciplinary approach to treatment, using nutritionists, gastrointestinal psychologists, medical bariatrician, and bariatric surgeons. Each medical professional plays a role in developing a personalized plan for each patient, integrating their personal goals and expectations.
The Michigan Medicine program and others like it aim to provide noninvasive options for patients in need and customized solutions to improve the odds of a successful outcome. Unfortunately, because the methods are still new, many insurance providers do not cover EBMT procedures, meaning patients should consider the costs and work with a financial counselor to review options.
Types of EBMT Procedures
There are three popular options for EBMT procedures: intragastric balloon therapy, endoscopic sleeve gastroplasty, and aspiration therapy. Intragastric balloon therapy is for patients with a BMI of 30 to 40. During the procedure, a bariatric surgeon endoscopically inserts fluid or gas-filled balloons through the patient's mouth and into their stomach during a 30-minute procedure. The balloons decrease the available space in the stomach, limiting food consumption. This procedure is reversible, and balloons require removal after six months.
An endoscopic sleeve gastroplasty is intended for patients with a BMI of more than 30. While it is compared to the traditional surgical sleeve gastrectomy, this procedure is minimally invasive and incisionless with a low complication rate. It is an excellent option for nonsurgical candidates and provides the possibility of sustained weight loss.
Finally, aspiration therapy is for those patients with a BMI of 35 to 55 and involves the placement of a tube device and drain. A surgeon places the device through a small incision endoscopically into the stomach, leaving a port valve outside the body. The patient will aspirate or open the drain up to three times per day, 30 minutes after each meal. The valve allows up to 30% of a meal to evacuate the system over 10 minutes. The evacuated contents can be discarded.
Aspiration therapy requires medical monitoring, but it can provide an option for long-term weight loss. Patients will need to maintain hygiene and cleanliness practices to reduce the risk of infection or other issues.
Despite the continued obesity epidemic, medical procedures constantly evolve to help combat the problem and offer a solution to qualified candidates. Have you heard of any other new treatments or procedures for weight loss or management? Comment below.