Emerging Bariatric Technology
Meet Dr. Joshua Long:
Our Bariatric Surgeon
A nationally renowned and double-board-certified Denver bariatric surgeon, Dr. Long uses a partnership care model with each patient to tailor care to their individual needs. Patients routinely thank Dr. Long for his warm, compassionate bedside manner. He’s considered to be at the top of his field, having performed over 1,000 bariatric surgeries. Peers praise his technical skill, and he has some of the lowest complication rates among bariatric surgeons in the nation. Dr. Long and the staff at the Bariatric and Metabolic Center of Colorado consider it an honor to serve every patient with the highest quality of care.
Dr. Joshua Long
MD, MBA, FACS, FASMBS
What Are Emerging Bariatric Technologies?
The field of bariatric surgery is constantly evolving as we discover new procedures that are safer and less invasive. At the BMCC, we’re committed to innovatively incorporating cutting edge treatments and technologies when they are safe, effective, and can provide additional benefit for you.
Some emerging bariatric therapies and technologies, such as the SADI-S surgery, are already being implemented because they are safer and more effective for some patients than historical alternatives*. Others, such as the ReShape Duo Balloon™ and the Endoscopic Sleeve Gastrectomy (ESG), are novel approaches with some possible future promise. They are useful today in certain limited or short-term settings. However, more information and refinement will be needed before they can be viewed as effective long-term treatments.
We feel that it’s important that you have access to the latest information and new developments about bariatric surgery, so that you can make the most informed decisions about your health.
Most emerging bariatric procedures are known as endoscopic bariatric therapies (EBT) because most of these treatments are completed with an endoscope that uses novel surgical instruments. This is all placed down the throat, removing the need for surgical incisions.
Reshape Duo Balloon™
These products are FDA approved for short 3-6 month periods only. These balloons are only approved for temporary use due to concerns about device durability and downstream migration resulting in obstruction if left in place long-term. Once the balloon is removed, nearly all patients will regain all of their weight within a short timeframe*.
While these balloons can help patients temporarily reduce their excess weight by approximately 28% (significantly less than surgical approaches)* in the short-term, we now understand that these balloons create a significant problem if future bariatric surgery is anticipated. The balloons cause reactive thickening of the stomach. Stapling this thicker stomach is more likely to result in a staple line leak, leading to concerns about the safety of using these balloon systems as a transition to surgery.
At this point in time patients should see these balloon devices as temporary 3-6 month weight loss only, which may make future surgery unsafe. If you are even remotely contemplating surgery as an option in the future, then having a balloon placed may decrease the safety of a future operation and additionally is unlikely to result in permanent weight loss.
VBLOCTM (EnteroMedics) is an implantable electrical nerve-blocking device. It works by blocking some of the nerve signals from the stomach to the brain, which decreases hunger. Although this device is FDA-approved, at this time the device is expensive and results in significantly less weight loss (only 24% excess weight loss*) than more standard surgical approaches. There may be durability concerns as well, as long-term studies are lacking. With time and refinement, however, the VBLOC may improve in terms of cost and effectiveness.
Endoscopic Sleeve Gastroplasty
Endoscopic Sleeve Gastroplasty (ESG) also called Transoral Sleeve Gastroplasty, is an endoscopic procedure that involves placing stitches inside the stomach to reduce stomach size, similar to a traditional sleeve gastrectomy. The procedure is performed endoscopically, down the throat. This makes the surgery less invasive than even laparoscopic surgery.
This procedure is still in its early stages, but initial results indicate two concerns:
1) Weight Loss: weight loss is only about half that of the operative sleeve gastrectomy (35% excess weight loss)*.
2) Durability: endoscopic sutures are more likely to pull through with time, which can negatively impact long-term weight loss and perhaps even cause other complications*.
Due to these concerns, we don’t recommend the endoscopic sleeve gastroplasty or the VBLOCTM to our patients at this time. However, as these therapies continue to evolve, our ongoing assessment will also continue. If they become more beneficial to patients, our recommendation may change.
The StrettaTM is a device that also uses an endoscopic rather than surgical approach to treat heartburn, reflux, or GERD. It used RF (radio frequency) energy to thicken the lower esophageal valve, which provides an increased barrier to acid refluxing from the stomach into the esophagus. While not quite as successful as standard anti-reflux surgical approaches, the StrettaTM can allow up to 84% of patients to remain off of antireflux medications to 4 years and up to 64% to remain off of antireflux medications up to 10 years and perhaps longer*. Ultimately, this means improved reflux symptoms, satisfaction and quality of life*.
Because up to 20% of patients may experience increased reflux following a sleeve gastrectomy and may not anatomically be able to have standard anti-reflux surgery following the sleeve, the StrettaTM device can be an important solution to improve reflux symptoms in many cases without the need for revisional surgery*. If you are struggling with ongoing reflux please call us today or send us a message to schedule a consultation to determine if you would be a good candidate for the StrettaTM procedure to treat your reflux.
Similarly, the LINXTM anti-reflux management system is a device designed to decrease GERD symptoms in patients where more traditional approaches are no longer available, such as after a sleeve gastrectomy. The LINXTM uses a traditional laparoscopic surgical approach to place a ring of titanium beads with magnetic cores around the lower esophagous to increase the barrier to reflux. More than 90% of patients show symptomatic improvement of their reflux following LINXTM placement*.
Uses in Revisional Bariatric Surgery
These emerging bariatric technologies and therapies rarely replace initial bariatric surgery, but are increasingly being used in revisional bariatric surgery. After a gastric bypass, for instance, the gastric pouch can sometimes stretch, resulting in weight regain. Revisional bariatric surgery can correct this problem*. Two emerging bariatric surgeries, the Endoscopic ROSE (Restorative Obesity Surgery, Endolumenal) and the APC (Argon Plasma Coagulation) can help with this revisional surgery*.
The ROSE and the APC are procedures that shrink the distended gastric pouch down to the size it’s supposed to be. The ROSE procedure involves adding stitches to shrink down the stoma or pouch. The APC surgery involves using an Argon laser to burn the stretched stoma, which causes it to scar and shrink back to its normal size. Both of these procedures can restore the restrictive effect of the stretched stoma or pouch, which will make you to feel full earlier and (with behavioral modification) may help you to lose some of the regained weight*.
These procedures are endoscopic, which means they’re performed by inserting tubes into the esophagus. In the revisional setting, this may be safer and less invasive than traditional laparoscopic surgerical approaches*.
To learn more about other revisional bariatric surgeries, visit our revisional bariatric surgeries page.
This page was medically reviewed by Dr. Joshua Long, MD, MBA, FACS, FASMBS. Dr. Long is a double-board-certified bariatric surgeon and bariatric medical director for Parker Adventist Hospital.
Full Bio: Dr. Joshua Long, MD, MBA, FACS, FASMBS
Page Updated: February 24th, 2020
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*Please note that individual results can vary and are not guaranteed.