The gastric balloon procedure places a fluid filled silicone balloon in the stomach via endoscopy to occupy volume and causes weight loss through a restrictive process. It takes up room in the stomach and allows for adaptation to smaller meal sizes and increases the feeling of satiety. This is done as an outpatient procedure and typically patients are discharged home after two hours of recovery.

The balloon is left in place for up to six months and patients can expect to lose up to 15 percent of their body weight. The procedure is approved for those with a body mass index (BMI) of 30 to 40.

The gastric balloon procedure is designed to be the start to a comprehensive weight loss program including dietary and lifestyle changes. Patients will have dedicated follow-up from our multidisciplinary team of experts, including a gastroenterologist, nutritionist, endocrinologists, and exercise therapist. Follow-up will continue even after the balloon is removed at six months.

FAQ

How is the balloon inserted into the stomach?

After receiving anesthesia, an initial endoscopic examination is performed. A thin, flexible tube equipped with a camera and light is passed through the mouth into the esophagus, stomach, and small intestine. The unfilled gastric balloon delivery system is inserted into the stomach through the mouth and esophagus under endoscopic visualization. The gastric balloon is then filled with fluid and the delivery tube removed. The insertion of the gastric balloon takes about 20 minutes. You will be able to return home after the procedure.

How is the balloon removed?

The maximum placement period for the intragastric balloon is 6 months. Removal requires an endoscopy and under direct visualization, the balloon is punctured and deflated and then removed from the mouth.

Do I qualify for the intragastric balloon?

Ideal Candidates:

• Have a body mass index (BMI) of 30 to 40; a higher or lower BMI may also be suitable
• Be willing to participate in a medically supervised program
• Have attempted weight-loss through diet and exercise without success

How much weight can I expect to lose?

It is important to understand that the balloon is a tool to aid weight loss and must be used in conjunction with diet, exercise, and a behavior modification program. The amount of weight loss hinges on adherence to diet and adoption of long-term lifestyle changes. On average, patients lost 3 times the weight of those that were on a diet and exercise program alone. In clinical trials, patients lost an average of 15% of their body weight after 6 months. During the first three months of treatment, patients have typically seen the most rapid weight loss. Once the gastric balloon is removed, the weight loss continues if maintaining diet and lifestyle changes. These procedures are best for people that have between 20 to 40 pounds to lose.

Is the Gastric Balloon Safe?

Gastric balloons have been used in the management of obesity for over 20 years and over 280,000 balloons have been placed worldwide. This is a very safe and reliable weight-loss solution. It requires no surgery, is only temporary, and the most common side effects last only for a few days. Among these problems are slight discomfort, nausea, and vomiting while your body adjusts to the presence of the gastric balloon. In some patients it may last one to two weeks. You may be prescribed medication to help minimize these potential effects. Major complications are rare.

Who is not a candidate for intragastric balloon?

Patients with the following are not candidates for the balloon procedure:

• Large hiatal hernia
• Previous gastric surgery
• Heartburn symptoms despite taking heartburn medications
• Prior open or laparoscopic bariatric surgery
• Inflammatory diseases of the GI tract
• Active ulcers in the stomach or small intestine
• Variceal disease
• Unwilling to participate in a medically-supervised diet and behavior modification program
• Alcohol or drug addictions
• Daily prescribed treatment with aspirin, anti-inflammatory agents, anticoagulants or other gastric irritants
• Currently are or may be pregnant or breast-feeding

Endoscopic sleeve gastroplasty is an endoscopic procedure that involves going in through the mouth using an endoscope with a suturing device attached and performing a gastric volume reduction technique that reduces gastric capacity by creating an endoscopic sleeve. This is accomplished by using a series of stitches to fold the stomach on itself, effectively reducing the stomach volume by 70 percent. The result is the creation of a tube-shaped stomach similar to sleeve gastrectomy but without surgery and without removing stomach tissue and no scars. During the procedure, the patient is completely asleep with general anesthesia. Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat. Patients typically lose about 20 percent of their body weight with this procedure, in combination with dietary and lifestyle changes.

FAQ

How is the ESG performed?

After receiving anesthesia, an initial endoscopic examination is performed. A thin, flexible tube equipped with a camera and light is passed through the mouth into the esophagus, stomach, and small intestine. Then a special endoscope with a suturing device attached is passed into the stomach. A series of full thickness sutures are placed through the gastric wall from the antrum to the fundus with the result being the creation of a sleeve shaped stomach. The suturing technique is intended not only to reduce the stomach diameter but also to shorten it substantially through an accordion effect. The procedure takes about 90 to 120 minutes. Most patients return home the same day or the following day after an overnight admission.

Do I qualify for the ESG procedure?

Ideal candidates:

• Have a body mass index (BMI) of 30 to 40; a higher or lower BMI may also be suitable
• Be willing to participate in a medically supervised program
• Have attempted weight-loss through diet and exercise without success
• Do not qualify for, or do not desire, bariatric surgery

What can I expect after the ESG procedure?

After the procedure, you are not allowed to eat or drink for eight hours. Subsequently you are started on a liquid diet, which is continued for two weeks. Then there is progression to small semisolid meals over 4 weeks and eventually to a regular healthy diet. Patients will also continue to follow-up with our multidisciplinary team of experts, including a gastroenterologist, nutritionist, endocrinologist, psychiatrist, and exercise therapist.

How much weight can I expect to lose?

It is important to understand that the ESG is a tool to aid weight loss and must be used in conjunction with diet, exercise, and a behavior modification program. The endoscopic sleeve gastroplasty is one of the most effective endoscopic procedures for primary weight loss. In conjunction with diet and exercise, on average, patients lose 40 to 70 pounds, or nearly 20 percent of their body weight. The most recent data has shown the weight loss achieved with the ESG procedure can last for greater than 2 years. ESG has also been shown to improve obesity related medical problems such as cholesterol, diabetes and high blood pressure. Like other weight-loss procedures, endoscopic sleeve gastroplasty requires commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty

What are the risks of ESG?

This is a very safe and reliable weight-loss solution and recent studies have shown decreased hospital length of stay and a four-fold decrease in complications when compared to laparoscopic sleeve gastrectomy. ESG requires no surgery and the most common side effects last only for a few days. Among these problems are pain and nausea which are managed with medication. Most people feel better after two days. Major complications are rare.

Endoscopic sleeve gastroplasty isn't appropriate for anyone who has gastrointestinal bleeding, a hiatal hernia larger than 3 centimeters or who's had prior stomach surgery.

Who is not a candidate for ESG?

Patients with the following are not candidates for the ESG procedure:

• Large hiatal hernia
• Previous gastric surgery
• Heartburn symptoms despite taking heartburn medications
• Prior open or laparoscopic bariatric surgery
• Inflammatory diseases of the GI tract
• Active ulcers in the stomach or small intestine
• Variceal disease
• Unwilling to participate in a medically-supervised diet and behavior modification program
• Alcohol or drug addictions
• Daily prescribed treatment with aspirin, anti-inflammatory agents, anticoagulants or other gastric irritants
• Currently are or may be pregnant or breast-feeding

Aspiration therapy is a new weight loss modality that is non-surgical and reversible. The AspireAssist works by reducing the calories absorbed by the body, while helping you make gradual, healthy changes to your lifestyle. After eating, food travels to the stomach immediately, where it is temporarily stored and the digestion process begins. Over the first hour after a meal, the stomach begins breaking down the food, and then passes the food on to the intestines, where calories are absorbed. The AspireAssist allows patients to remove about 30% of the food from the stomach before the calories are absorbed into the body, causing weight loss. You’ll also need to chew carefully and eat mindfully, which helps give time for the fullness signals from your stomach to reach your brain.

FAQ

How is the AspireAssist tube placed?

The AspireAssist tube is placed during a 15-minute outpatient procedure. Patients can usually return home within one to two hours, and many return to work very quickly compared to invasive bariatric surgeries. The does not usually require general anesthesia, and instead is typically performed under “twilight anesthesia”. The procedure is very similar to the routine placement of feeding tubes.

How does the aspiration process work?

The aspiration process is performed about 20 to 30 minutes after the entire meal is consumed and takes 5 to 10 minutes to complete. The process is performed in the privacy of the restroom, and the food is drained directly into the toilet. Because aspiration only removes a third of the food, the body still receives the calories it needs to function.

How does this help me lose weight?

The procedure uses a device that reduces the number of calories your body processes. The device also requires you to chew your food very carefully, giving time for the fullness signals from your stomach to reach your brain so you’re less likely to eat too much. This therapy is used in conjunction with lifestyle counseling. This program combines one-on-one counseling and group support meetings to encourage healthier food choices, smaller portion sizes, and increased physical activity. The therapy also requires careful and comprehensive monitoring by a physician to ensure you are losing weight in a healthy manner.

Do I qualify for the AspireAssist procedure?

Ideal candidates:

• Have a body mass index (BMI) of greater than 35 and less than 55
• Be willing to participate in a medically supervised program
• Have attempted weight-loss through diet and exercise without success
• Do not qualify for, or do not desire, bariatric surgery

What can I expect after the AspireAssist procedure?

Over a week or two, the stoma, or the newly-created pathway where the tube is placed, needs to settle around the tube. Most patients return home within an hour or two after the procedure. Your doctor will prescribe pain medications and antibiotics for you to take at home. You may experience some pain or discomfort in the first few days, but the medications will help. Patients can usually begin showering two days after the procedure.

Patients generally return to work and resume regular activities within a few days, but it is likely you will experience some abdominal discomfort during this healing stage.

After about a week, you will return to your doctor’s office to have the button attached to the tube, right at the surface of your skin. This only takes a few minutes and is completely painless. After this visit, you’ll need to wait one more week to begin using the AspireAssist to make sure the stoma has fully healed.

About two weeks after your procedure, your healthcare team will show you how to use the AspireAssist. After this appointment, you will take the AspireAssist kit home with you. This kit includes the small handheld device (about the size of your palm) that helps the food drain from your stomach, and a case to store the device after use. The case is small and discreet so it can be carried in a purse or briefcase.

How much weight can I expect to lose?

By the end of six months of aspiration therapy, patients lose on average about 40 percent of their excess weight.

What are the risks of AspireAssist?

The most common adverse events immediately after the procedure were abdominal discomfort or pain (treated with pain medication), and nausea or vomiting related to the sedation medicine given during the procedure (treated with anti-nausea medication, if necessary).

The most common adverse events related to the device or therapy were skin irritation or granulation tissue around the tube placement site on the abdomen (treated with silver nitrate sticks or medicated lotion). Other less common side effects include infection (treated with antibiotics, or device removal or replacement) and abdominal pain or discomfort (treated with medication). Major complications are rare.

Who is not a candidate for AspireAssist?

The AspireAssist is not recommended for patients who have certain disorders that cause extreme difficulty swallowing or digesting food, previous stomach ulcers that do not resolve with treatment, high blood pressure than cannot be controlled with medication (blood pressure >160/100), blood clotting disorders, bulimia, binge eating disorder, or night eating syndrome, anemia, serious pulmonary (lung) or cardiovascular disease, chronic abdominal pain, or for patients who are pregnant or lactating. The AspireAssist is also not recommended for patients with previous abdominal surgery that significantly increases the medical risks of gastrostomy tube placement, or for patients with physical or mental disability, or psychological illness that could interfere with compliance with the therapy.

Bariatric surgery is an effective tool for weight loss but sometimes patients experience regain of weight. In this setting, endoscopic therapies, such as endoscopic overstitch, have shown to be a great benefit by non-surgically decreasing the size of the residual stomach or surgical connection site to promote weight loss. These incisionless procedures place a scope through the mouth and into the stomach once a patient is under anesthesia. Sutures are put in place internally to tightening the stomach or the surgical connection site where it has stretched. This can restore that feeling of fullness and encourage patients to eat smaller meals again.

Patients who undergo endoscopic revision of bariatric surgery procedures lose 30 to 40 pounds on average. For maximum results, patients should consider therapy before a significant amount of weight is re-gained. When patients feel loss of restriction, notice an increased tolerance of larger meals, or start regaining weight, that is the time to contemplate scheduling a consultation.

Am I a candidate for endoscopic gastric bypass revision? Successful candidates… have regained 20% or more of the weight originally lost with bariatric surgery are willing to participate in a medically supervised weight loss program