Endoscopic Bariatric

Endoscopic Bariatric 

It is estimated that 50% of the adult population living in the United Arab Emirates is overweight. The increased prevalence rates of obesity, and diabetes in the United Arab Emirates is related to lifestyle changes during the past few decades. The economic boom UAE has led to a modern, fast-paced, and technology-driven lifestyle with reduction in occupational and leisure-time physical activity compounded with excessive consumption of calorie-dense and processed meals of poor nutritional value. It is well known that people who are obese have a much-increased risk of developing diabetes, high blood pressure, heart disease, liver disease and cancers.

A common index of obesity is the BMI or body mass index. People above a BMI above 25 are labelled as overweight while those over 30 are labelled as obese. As BMI increases, the risk of diseases also increases. Apart from diet and exercise, there is no other means to lose weight. There are few medications with very limited benefit. Patients with a very high BMI (above 35) usually seek opinion for weight loss surgery. The standard laparoscopic or key hole surgeries offered for weight loss are usually a sleeve gastrectomy or a Roux-en-Y gastric bypass. In these procedures the size of the stomach is reduced and the connections of the intestine are altered leading to reduced food intake and absorption. While these surgeries are quite effective in patients with high BMI, some patients may not be able to undergo these surgeries due to medical reasons. There are others who do want to lose weight rapidly but do not want to undergo a surgery.

At King’s College Hospital London, UAE, we have a well-established endoscopic bariatric or weight loss therapies designed for people suffering from obesity and are looking for non-surgical ways to lose their weight to improve the quality of their life. This multidisciplinary program is coordinated between our weight loss experts and includes gastroenterologists, endoscopists, surgeons, psychological counsellors and dieticians.

Similar to bariatric surgeries such as Roux-en-Y gastric bypass, and sleeve gastrectomy endoscopic procedures reduce the volume of the stomach and/or alter part of the digestive tract in order reduce the number of calories that the body can ingest and/or absorb. Unlike surgery, endoscopic bariatric procedures are performed through the use of a small, flexible endoscope which is inserted through the mouth. The procedures are minimally invasive, reducing the risk of operative complications. Endoscopic bariatric therapy can be performed either as a first-line or primary treatment for weight loss or as a follow-up to a previous weight loss surgery. These endoscopic procedures are generally performed on an outpatient basis with patients returning to regular activities within days of their procedures.

There are certain medical conditions which are related to obesity and get better once weight is controlled. These include diabetes, high blood pressure, fatty liver and polycystic ovary disease (PCOD). There are individuals who suffer from one or more of these medical conditions and have mild to moderate obesity (BMI of 30-35). It may not be ideal to subject these individuals to surgical procedures for weight loss. Endoscopic bariatric procedures may be an attractive option for these individuals.

The two main types of endoscopic bariatric solutions offered by our hospital are:

Endoscopic sleeve gastroplasty: This is a new type of weight loss procedure that reduces the size of the stomach using an endoscopic suturing device without the need for surgery. It aims to achieve results similar to a laparoscopic sleeve gastrectomy. This procedure may be an option if a person is overweight (body mass index of 30 or more) and diet and exercise has not worked. Endoscopic sleeve gastroplasty leads to significant weight loss. It helps lose weight by limiting food intake. The procedure is minimally invasive, and has a low rate of procedure related complications. Endoscopic sleeve gastroplasty is often an option for people who aren’t candidates for other bariatric surgeries. In addition to weight loss, endoscopic sleeve gastroplasty also lowers blood sugar and addresses other serious weight-related problems.

Intragastric Balloon: An extremely popular method of weight loss is a fluid filled silicone balloon placed in the stomach. The balloon occupies space in the stomach and therefore limits the amount of food that an individual can take. Most gastric balloons require an endoscope to be placed into the stomach. A newer type of balloon can be swallowed directly without the need for an endoscopy and then filled with water with the help of an attached tube. There are also balloons that can be refilled and their size increased progressively every 3 months. The amount of expected weight loss after balloon placement is limited to 10-15 kg. Balloons can be kept in the stomach for 6-12 months only following which they have to be removed. Most individuals regain at least half of the weight lost after balloon removal. Balloon placement is a simple out-patient procedure that takes about a half-hour.

Post-bariatric surgery management: We also specialise in management of individuals who have undergone weight loss surgery. Lifelong medical supervision is needed to monitor for metabolic problems (such as diabetes, high blood pressure, high cholesterol), fatty liver disease, digestive issues (nausea, difficulty in swallowing, diarrhea). It is extremely important to continue strict lifestyle measures related to diet and exercise to avoid weight regain. Our multi-disciplinary approach involving gastroenterologists, dieticians and psychologists helps you achieve some of these goals. Some individuals may also develop nutritional deficiencies (iron, vitamin B12, vitamin D, calcium) and need monitoring and supplementation. Untreated, these may lead to osteoporosis (weak bones) and anaemia (low haemoglobin levels). Another specific problem that may develop in individuals who have had sleeve gastrectomy is acid reflux that causes a burning type of pain in the chest. Often this can be quite persistent and requires further assessment.

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