Maintaining a healthy body weight is one of the most important things we can do to stay active and vital, says Washington University gastroenterologist Dr. Vlad Kushnir. Trying to lose a significant amount of weight may seem like an uphill battle, but there are effective nonsurgical procedures for patients who need help, he says. Both endoscopic sleeve gastroplasty (ESG) and revision of gastric bypass can help patients control food intake. These techniques can help reduce weight safely, and their long-term results are promising, Kushnir notes.
ESG is so named because it uses permanent sutures placed via endoscopy to cinch the stomach into a narrower, sleeve-like shape. It helps control appetite because it decreases the stomach’s size by up to three-quarters, causing the patient to feel full more quickly, Kushnir says. ESG is performed at the Washington University and Barnes-Jewish Center for Advanced Medicine under general anesthesia, and the patient normally returns home the same day. Elaine Lannom of Millersville, Missouri, had the procedure done in June and says she is more than halfway to her goal of losing 60 pounds. “In the past, when I went out walking with someone, I would divert their attention away from me while I stopped to catch my breath,” she says. “Half of my family is overweight, and my doctor said I was heading toward diabetes. But I didn’t want to check my blood sugar all day. That gave me the final push to do something.”
Lannom says the ESG procedure was very manageable for her, and she now can be active without shortness of breath. “My bloodwork is normal, my clothes fit much better and I have more energy,” she says. The patient consumes a liquid diet for a few days after ESG, then switches to reduced-calorie meals under the guidance of a dietitian. Most people can return to work in two or three days, Kushnir says. “The only restriction at that point is a modified diet. There aren’t a lot of foods that are off limits, but you do need to stay away from high-calorie foods,” he notes.
Weight loss amounts vary, but a 12 to 20 percent reduction of total body weight is normal. That’s comparable to other procedures like gastric band surgery, Kushnir says. He says he also is seeing positive results with revision of gastric bypass, another endoscopic technique. “This is for people who had good results with gastric bypass surgery, but the small pouch created at the top of the stomach has stretched and the patient no longer has the typical ‘full’ feeling when eating. That can lead to weight gain,” he says. Revision uses sutures to narrow the opening at the top of the pouch and the pouch itself.
When revision is needed, Kushnir says he and his team first find out if social or lifestyle factors also are contributing to the patient’s weight gain. “We work with a dietitian and behavioral coach to see if there are unhealthy eating patterns or psychological issues to be addressed,” he notes. “Once the revision is complete, we typically see a reduction of 20 to 25 percent of total body weight.” Patients receive lifestyle and diet coaching with the center’s other weight loss procedures, too. “We work closely with our entire multidisciplinary bariatric team to ensure the best outcome for every patient,” Kushnir says.
Washington University Physicians offers a complete slate of services to help patients maintain a healthy bodyweight and lifestyle. Pictured on the cover: Washington University Gastroenterologists and nonsurgical weight loss providers Dr. Michael Bennett and Dr. Vlad Kushnir. For details, visit barnesjewishwestcounty.org/nonsurigical-weightloss or call 314.362.2652.
Cover courtesy of Washington University Physicians
Cover photo: Bill Barrett