Evolving bariatric options
Endoscopic Sleeve Gastroplasty
[edit | edit source]Replicates sleeve gastrectomy anatomy through endoluminal full-thickness suturing. Anterior and posterior walls suctioned together, then a sleeve is sutured.
- Slows gastric emptying for solids but not liquids
- Earlier satiety
- Decreased total caloric intake
- No changes to gut hormones
Thought to be a good option for less comorbid patients
Weight loss in 1000 consecutive patients at 6, 12 and 19 months was 14, 15 and 15%
Duodenal Mucosal Resurfacing
[edit | edit source]Essentially ablates the duodenal mucosa to aid in diabetes management
- Duodenal mucosa thought to play an important role in glucose homeostasis/insulin sensitivity
- Expect an HbA1c reduction of ~1% at six months
Duodenal-jejunal bypass liner
[edit | edit source]Plastic sleeve that is anchored between duodenal bulb and proximal jejunum
- Fully reversible, placed endoscopically
- Prevents food and chyme contacting duodenum
- Somewhat analogous to RYGB in functional effect
- Meta-analysis - total weight loss of 19% at explant (1 year - should not be left in longer due to risks of side effect), and EWL of 37%
- Also appears to help with diabetes
Adverse effects - pain, nausea, vomiting
- Sometimes severe, leading to early removal
- Migration/obstruction, liver abscesses, pancreatitis have been reported
Intra-gastric balloon
[edit | edit source]- Typically leave it in for six months to prove a point, then remove
- Aim to lose 15-20kg