In both the United States and elsewhere around the world severe obesity has been on the rise for many years. During this time, standard approaches to long-term weight loss—primarily a restrictive diet and an exercise program—have not generally been effective at reducing the prevalence of obesity and various obesity-related health conditions. In light of this, a range of endobariatric and bariatric procedures have been developed that are designed with long-term success in mind. Two such procedures that have similar mechanisms for weight loss but use different techniques are gastric bypass surgery and endoscopic sleeve gastroplasty.
Overview of Gastric Bypass
Until about 10 years ago, Roux-en-Y gastric bypass was the most commonly performed version of the most common type of weight loss surgery. Today, however, sleeve gastrectomy has become more common, but gastric bypass procedures are still used regularly. In both cases, the goal is to alter some of the organs of the digestive system in order to promote weight loss. The “Y” in the name refers to the Y-shaped configuration of the small intestine that is achieved through the surgery.
In the first phase of the surgical procedure, a bariatric surgeon separates the stomach into a small stomach pouch about the size of an egg and a larger lower section. The lower part of the stomach is closed with sutures, and the stomach pouch is surgically attached to a part of the small intestine called the jejunum. This represents one side of the Y, and it is done in order to dramatically reduce the size of the stomach and therefore limit the amount of food that can be eaten in one sitting.
The other side of the Y involves the lower part of the stomach. Even after being separated from the stomach pouch, it still produces valuable digestive juices. Additionally, this section is still connected to the duodenum, where other digestive enzymes from the liver and pancreas are introduced to the gastrointestinal tract. The stomach remnant and duodenum are then reconnected to the small intestine down the line from the stomach pouch, thereby bypassing a large section of the small intestine’s absorptive capacity.
Overview of Endoscopic Sleeve Gastroplasty
Endoscopic sleeve gastroplasty (ESG) is designed to promote weight loss in a similar way as gastric bypass, though it is actually closer to gastric sleeve surgery in terms of the changes made to the digestive system. Instead of a small pouch, the stomach is reformed into a sleeve shape that is about 20-30% of its original size. Rather than separating the stomach into two sections, however, the sleeve gastroplasty procedure keeps the stomach whole but closes off the majority of the volume by suturing it from the inside in accordion-like folds.
How Do the Two Procedures Compare?
Both the gastric bypass procedure and the endoscopic sleeve gastroplasty procedure have been able to help many people lose weight and keep it off over time. There is also substantial evidence that they both can have a positive impact on obesity-related conditions like type 2 diabetes, heart disease, metabolic syndrome, liver disease, sleep apnea, and high blood pressure. On a more practical level, they’re also both permanent procedures and not reversible. Yet for all their similarities, the two procedures have a number of important differences:
Type of Surgery
- GB: While once performed as an open surgery, gastric bypass has long since been performed using laparoscopic surgery techniques. This involves several small incisions in the abdominal cavity through which the laparoscope can be used to alter the digestive tract. Because of this, the patient is under general anesthesia during the surgery.
- ESG: ESG is known as an endoscopic bariatric procedure (or endobariatric) because it is performed with an endoscopic suturing device mounted on the end of a flexible tube and inserted through the esophagus. Because the procedure uses endoscopy, it doesn’t require any incisions (and subsequent stitches) to access the targeted area of the digestive tract. The procedure is performed while the patient is under twilight sedation.
Mechanism of Weight Loss
- GB: One of the reasons gastric bypass is so effective is that it has two different mechanisms for promoting weight loss. The first is related to the small stomach pouch; by being such a small size, the patient is limited in how much food can be eaten, and this leads to changes in the feelings of hunger and satiety that play a huge role in the tendency to overeat. The other mechanism is related to bypassing the small intestine; since the jejunum is where the vast majority of nutrients are absorbed by the body, bypassing it means that overall fewer nutrients (and thus calories) can be consumed.
- ESG: By contrast, endoscopic sleeve gastroplasty only involves limiting stomach volume. At 20% of the original size, though, this mechanism alone is capable of leading to significant excess body weight loss.
- GB: As an inpatient weight loss procedure, gastric bypass typically requires several days of a hospital stay and a recovery time of 2-4 weeks. As far as diet, the roughly 10-day period directly following the procedure calls for a liquid diet; by 3 weeks the patient can move to soft foods, and by 7 weeks they can reintroduce solid foods.
- ESG: As a minimally invasive procedure, ESG is much gentler on the body than gastric bypass. No incisions means an overall shorter and easier recovery time for this outpatient procedure; after only about an hour of recovery, the patient can go home to rest and can return to most normal activities within a few days. At True You, our nutrition guidelines call for individuals to focus on liquids for the first two weeks, followed by purees, then soft foods, and by day 50, you are able to resume a regular diet.
Complications and Side Effects
- GB: Though overall relatively safe, gastric bypass is known to have a variety of potential complications related to surgery like infection and blood clots. Yet there is also the potential for digestive problems like dumping syndrome, stomach ulcers, acid reflux, or a bowel obstruction. Moreover, because of how the small intestine is modified, there is a chance of malabsorption of nutrients that can lead to vitamin and mineral deficiencies that require dietary supplements.
- ESG: Generally speaking, any of the risks related to ESG are much lower than gastric bypass. Directly after the procedure, there is a chance of minor gastrointestinal issues like bloating or abdominal pain, but these symptoms usually subside in a few days.
Who Is a Good Candidate for These Procedures?
Though gastric bypass and endoscopic sleeve gastroplasty are different in several ways, they both generally follow the same guidelines for qualifying. To be a good candidate, a patient has to have a body mass index (BMI) of 35 or higher; patients with BMI between 30-35 can also qualify if they also have an obesity-related condition like heart disease or diabetes. Another standard criteria is that the patient has already attempted without success to drop excess weight with lifestyle changes or a traditional weight loss program.
Contact True You Weight Loss for More Information
Gastric bypass was once considered the “gold standard” of weight management interventions, but advances in medical technology have made alternatives like endoscopic sleeve gastroplasty much more appealing to many people. At True You Weight Loss, we are passionate about helping our patients find a new path to long-term weight loss. If you’d like to learn more about ESG or how our skilled and compassionate team can help you find freedom, please contact us today to request a consultation.