Endoscopic techniques allow for noninvasive treatment options
UH Digestive Health Institute - Winter 2018
LEENA KHAITAN, MD, MPH
Director, Bariatric Surgery, UH Cleveland Medical Center; Associate Professor of Surgery, Case Western Reserve University School of Medicine
More than 36 percent of Americans are obese, according to Centers for Disease Control and Prevention. With diet and exercise, an individual may lose 10 to 15 percent of his or her excess weight, studies show. With medication, the needle moves to about 20 percent. Unfortunately, most obese patients regain that lost weight.
The American Heart Association and the National Institutes of Health, among others, recommend bariatric surgery as an effective and appropriate weight loss strategy in certain obese individuals, helping people lose up to 80 percent of excess weight. Despite its success rate, only one to 2 percent of qualified patients receive surgery due to limited access, cost and patient choice.
“Between medication and surgery, there's been a void,” says Leena Khaitan, MD, Director, Bariatric Surgery at University Hospitals Cleveland Medical Center. “We know surgery works, but a lot of our patients aren't mentally ready and aren't willing to make the lifestyle changes necessary to ensure long-term success.”
Endoscopy in bariatrics offers two key benefits. It gives surgeons an effective, noninvasive treatment option to help patients lose up to 20 percent of their excess weight. Doctors also have a tool to address any complications that may arise from laparoscopic and robotic surgery. “Oftentimes, we can solve problems by using the endoscope rather than through an incision,” Dr. Khaitan says.
Endoscopic procedures provide a temporary solution while patients receive nutritional and lifestyle counseling. Intragastric balloons are the most popular protocol, with other promising procedures on the horizon.
The Food and Drug Administration has approved three intragastric balloon systems. ORBERA® uses a single balloon that stays in place for six months. During the procedure, an endoscope is used to place an inflatable balloon in the stomach. When filled with a sterile water solution, the balloon expands, causing patients to feel full and consume less food.
With this program, patients begin a 12-month behavior modification program. They will receive information, tools and support to help them maintain a healthy lifestyle and weight. To date, more than 150,000 patients worldwide have used ORBERA.
Obalon® uses three balloons that say in place for six months. Rather than use an endoscope, doctors help patients receive balloons via a swallowable capsule attached to a thin inflation catheter. Once in place, the capsule opens and the balloon fills with air.
“Surgeons place one balloon every two weeks, which helps prevent nausea,” Dr. Khaitan explains. “Because it doesn't involve a procedure, patients have a lot of interest in this device.”
Endoscopic sleeve gastroplasty also shows promise as an effective weight loss solution. During the procedure, physicians use the endoscope to place a set of sutures in the stomach. The sutures create a sleeve that reduces the stomach's size. Unlike sleeve gastrectomy, endoscopic sleeve gastroplasty is reversible.
ADDRESSING COMPLICATIONS NONINVASIVELY
With more endoscopic tools at their disposal, doctors at UH Digestive Health Institute can noninvasively treat complications such as perforated ulcers and fistulas. Dr. Khaitan recalls treating a patient with a perforated ulcer who had 10 prior abdominal surgeries.
"We were able to clip the hole closed and seal the leak, and she went home two days later," she says. "An operation, in her case, would have meant a prolonged hospital stay and extensive adhesions."
Whether as a weight loss solution or as a means to monitor a condition, endoscopic procedures give more patients more choices than ever before. “Losing weight is hard,” Dr. Khaitan says. “As leaders in endoscopic techniques, we want to offer every tool we can to our patients.”
If one of your patients is interested in weight loss, please direct them to our UH Weight Loss Information Session online at uhhospitals.org/bariatric. To reach Dr. Khaitan directly, please call 216-844-4918.