VA Offers New Medical Weight-Loss Procedure
Obesity is a widespread condition, with an estimated 35 percent of Americans and 78 percent of Veterans being overweight or obese as of 2014. It is a risk factor for Heart Disease, Type 2 Diabetes, Stroke and some types of cancer.
Considering its impact, it’s exciting for the VA when it can talk about a new procedure to help address it.
“Endobariatrics is a new field within GI endoscopy that allows us to offer weight loss interventions and procedures to patients all through an endoscope, said Dr. Jennifer Kolb gastroenterology, West Los Angeles VA Medical Center. The main treatment option in is an Endoscopic Sleeve Gastroplasty (ESG), , which is a minimally invasive weight loss procedure.”
The first ESG was completed at West LA VA Medical Center in February 2023, and is the first VA in our VISN to perform this.
ESG is a non-surgical procedure that uses a suturing device during an upper endoscopy to place full thickness sutures within the stomach and then pull them tight to gather portions of the stomach together. This gastric remodeling procedure reduces the volume of the stomach, leading to patients to feelfuller earlier and eat less, and resulting in an average total body weight loss of 10-15 percent, said Dr. Kolb.
She said some of the benefits of ESG over traditional bariatric surgery are that its less invasive, and available to patients who either don’t want or don’t qualify for surgery with a body mass index higher than 30. It has a faster recovery time and no scarring, with patients leaving the hospital either the same day, or the next day, and back to work within two to three days. It’s also reversible, whereas the surgery results in a permanent reshaping of the stomach.
It also reduces the comorbidities related to obesity, such as Heart Disease and Stroke.
Kolb said that it can also serve as a bridging procedure, allowing patients to get a knee replacement or hernia replacement that they might have been 30 pounds too heavy for, prior to the procedure.
One of Kolb’s patients, Mark Fisher, who had a large ventral hernia and low thyroid function, found out about the procedure after learning that he needed to lose weight prior to the hernia operation.
Due to the hernia, he wasn’t able to do any exercise other than walking, but thanks to the surgery, he’s been able to lose 72 lbs. He said he’s had no symptoms from the procedure and is basically not hungry anymore.
“This is the only operation I’ve ever had that I don’t regret,” Fisher said. “I came out of it unscathed.”
It’s also important to note that while there may be medical contraindications for weight loss drugs, such as Mounjaro and Wegovy, there are very few medical contraindications for an endoscopic sleeve, mainly an inability to tolerate anesthesia and cirrhosis of the liver.
Undergoing the ESG while taking medication can also have a synergistic effect, especially if your weight loss begins to plateau a few months after the surgery, Kolb said.
She also said that the ESG is part of a multi-disciplinary approach at VA, called MOVE!, which includes dieticians, obesity medicine doctors, mental health professionals, bariatric surgeons, primary care providers and more. Potential patients will complete a number of courses in the MOVE program and participate in individual counseling prior to undergoing the procedure.
Some of the possible complications with the procedure include bleeding, infection, anesthesia related complications, and very rarely, the suturing needle can injure surrounding organs or require an emergency surgery, said Kolb.
Post procedure, she said complications usually only occur when patients don’t follow instructions.
“Typically we'll do a one week follow up, we'll do a follow up at one month, three months, six months, 12 months at least at a minimum with either the bariatric endoscopist or the medicine obesity doctor, and the dietitians are following closely throughout this first six weeks especially, all through the infrastructure of the MOVE program,” said Dr. Kolb. “There is good data to support that the endoscopic sleeve has durability at five years.”
Veterans interested in enrolling in the MOVE program should seek a referral through their primary care manager. For more information on the MOVE program at the West LA VA Medical Center, please call (877) 251-7295.