Advanced Surgeons Introduces Endoscopic Procedure for Obesity

For people fighting to lose 40 to 50 extra pounds, weight loss strategies are definitely not a one size fits all proposition. They often find themselves in the unenviable “in between” position of being too heavy to sustain their efforts long enough to reach their goal weight and settle into maintaining it—and not heavy enough to qualify for weight loss surgery—or, at least, not before a creeping scale moves even higher.

Until now, there hasn’t been much available in the U.S. to help these people lose weight. However, in August the FDA approved an endoscopic procedure that has been used successfully for two decades in Europe, Australia and South America, and it is being introduced in Alabama by Scott Pennington, Jr, MD FACS and John Touliatos, MD FACS of Advanced Surgeons at Grandview Medical Center.

“I’ve been watching the ORBERA intragastric balloon for ten years and following the results it has achieved in other countries,” Touliatos said. “Whether we’re doing bariatric surgery or general surgery, we prefer to use the least invasive approach possible. With the balloon, there’s no incision and no surgical scars. Now we have a way to help people with a BMI of 30 to 40 kg/m2 succeed in their weight loss efforts without surgery.”

“We’ve been searching for something less invasive that will help patients without altering their anatomy,” Pennington said. “This device fills that niche and gives them a jump start to help them make progress toward their goal. It isn’t just a procedure. It is done within the context of support and counseling with our dietician and exercise therapist. The balloon comes out after six months, and the counseling continues for another six months to help them stabilize at their new weight and become accustomed to a new normal with better habits in how they eat and exercise.”

The ORBERA intragastric balloon from Apollo Endosurgery features significant improvements in design and materials over air-filled balloons used for weight loss in the past

“The silicone is much more durable, and the design is smooth without rough edges to irritate the gastric tissue,” Touliatos said. “It’s a bit like a breast implant. Patients only require light sedation as we position the balloon with an endoscope, then fill it with saline and seal it. Leaks are very, very rare, so the possibility of an obstruction is less of a concern. After six months, we use an endoscope to remove the saline and retrieve the balloon, which should be well before leaks from wear might become a concern.”

During the first few days, patients may experience some nausea and slight discomfort as they become accustomed to the balloon, but following dietary guidelines and volume recommendations in filling the balloon should reduce or prevent side effects.

Pennington said, “Generally, using 500 to 600 CC of saline is enough to help people feel full without feeling too full when they follow their food plan. If they are already in a program like Weight Watchers, they can continue with support from our nutritionist and trainer. If they aren’t on a program, we guide them toward more protein while avoiding simple carbs. When the quantity you can eat is limited, the quality of the nutrients is important.”

Not everyone who falls within the BMI range approved for this procedure is necessarily a candidate for it. It is not suitable for people who have had prior gastric surgery, Crohn’s Disease and similar chronic conditions, or those who require blood thinners or medications that might be irritating to the digestive system. Other conditions involving the esophagus, stomach and abdominal organs should also be evaluated in determining whether a patient is a good candidate for the procedure.In the clinical studies that led to FDA approval, participants who received the ORBERA intragastric balloon lost approximately three times as much weight over six months as a control group that received behavior modification counseling alone. Exactly how much weight an individual is likely to lose varies from patient to patient according to each person’s metabolism and the type of diet and activity plan followed.“Everyone’s body is different,” Pennington said. “The balloon helps with volume and gastric motility so patients are more satisfied with less. However, a person who drinks sweet tea every day isn’t likely to lose as much as someone who chooses unsweet and is more active.”

Motivation to lose weight is a key trait Pennington and Touliatos look for when evaluating patients. At this time, the procedure is not covered by most insurance plans. Costs in countries where the procedure has been available for many years typically range between $6,000 and $7,000 including both placement and removal of the balloon and counseling support with a dietician and trainer for a year.

Compared to the emotional, economic, and health costs of being seriously overweight, and to the cost of other elective procedures performed to improve a patient’s appearance and confidence, an intragastric balloon can be a good investment for patients prepared to take full advantage of the boost it can offer in helping them make long-term changes.With January near, the time of year when physicians see more patients resolving to take better care of their bodies, there is at last something the medical community in Alabama can offer. There is a way to help those who need more than medications, but a less invasive alternative than surgery sustain their resolve through the coming year.