Comprehensive Esophageal Health Center opens with more convenient, streamlined care
Performed on an outpatient basis using an endoscope, endobariatric procedures offer an important alternative to bariatric surgery. Depending on the endobariatric procedure, different techniques are used to reduce the size of the stomach, change the way food is processed or reverse and correct a previous weight loss procedure.
The bariatric endoscopy unit, which is integrated into Ohio State’s wider bariatric program, was developed by Hamza Shah, DO, a gastroenterologist who’s been performing the relatively new nonsurgical procedures since 2018. Another endobariatric expert, Raj Shah, MD, will be joining Ohio State in December 2023, further expanding patient access.
“By 2030, one in two Americans will be diagnosed with obesity,” Dr. Hamzah Shah says. “Surgery is a tremendous tool for many of these patients, but less than 2% of patients with obesity are seeking surgical intervention.
“Knowing that there’s an average of more than 260,000 bariatric surgeries done each year, you can see the tremendous gap between the number of people who could benefit from surgery versus those who want or are willing to have surgery. Endobariatrics can help us close that gap by offering a less-intimidating outpatient option, and Ohio State is one of the few health care centers in the country with experience in these procedures.
“Ultimately, endobariatrics can be a real game changer. The incisionless procedures take just one or two hours, and most patients fully recover in a week and then go on to lose 15-20% of their weight the first year. With every endobariatric procedure, we also provide diet and exercise coaching to support long-term success.
Endobariatric options
To be considered for an endobariatric procedure, patients must have a body mass index of 30 or higher and commit to developing a healthier lifestyle, which includes changes to diet and regular exercise. One or more of these factors must also apply to their situation:
- Has been unable to lose or maintain weight loss with diet and exercise alone
- Isn’t a candidate for or doesn’t want bariatric surgery
- Had previous weight loss surgery, but has regained the weight despite ongoing lifestyle changes with diet and exercise
- Has a complication or needs revision of a prior bariatric procedure
The incision-free procedures offered at Ohio State include:
- Endoscopic sleeve gastroplasty (ESG) – Sutures are placed endoscopically to form a tubular-shaped, or “sleeve,” stomach that reduces the size of the stomach up to 70%. By reducing the size of the stomach, the amount of food that can be eaten is limited.
- Gastric balloon placement – A small gas- or fluid-filled balloon is placed to fill up approximately one-third of the stomach. The patient feels fuller, the stomach empties more slowly and hormones key to weight loss are increased. The balloon remains in the stomach for six months and is removed with a short endoscopic procedure.
- Revision of prior weight loss procedures:
- Transoral outlet reduction (TOR-e) – This is an endoscopic procedure performed in patients with a prior gastric bypass surgery who are struggling with weight regain. Sutures are placed endoscopically to retighten the gastric pouch and gastric outlet after they’ve expanded.
- Revision of sleeve gastrectomy (also called sleeve-in-sleeve) – This is a procedure performed only in patients who’ve already undergone prior surgical sleeve gastrectomy and struggle with weight regain. When weight regain occurs, the sleeve can become dilated or stretched. Endoscopic revision is performed by placing endoscopic sutures to restore the tightness of the sleeve to original size after surgery.
- Endoscopic management of surgical complications – A wide variety of endoscopic devices and techniques, such as suturing, stents and clips, are used to diagnose and manage gastrointestinal concerns after surgery, including gastrointestinal strictures, fistulas, leaks or perforation. Using endoscopic ultrasound, we can also alleviate bile duct, pancreas and gallbladder issues after gastric bypass surgery.
“All these procedures are effective and safe with durable results,” Dr. Shah says. “But this is just the beginning; there are more procedures coming down the pipeline.” In addition to his specialization in bariatric endoscopic therapies for patients struggling with obesity or experiencing postsurgical complications, Dr. Shah also treats people with a variety of GI issues and offers therapeutic endoscopy procedures as part of management for pancreatobiliary disorders and GI cancers. His research interests center on advanced endoscopic procedures, innovation in endobariatric treatments and obesity.
“Being at an academic medical center gives our patients the opportunity to participate in clinical trials, and because we’re adding a clinician-scientist to the endobariatric team at the end of the year, I expect even more innovations and an expanded research component for our program that will result in new endoscopic procedures that will further enhance the field,” he says.
A comprehensive approach to weight loss
The new endobariatric procedures are the latest in a full range of advanced endoscopy procedures available at Ohio State.
“These nonsurgical weight loss options are an important advancement in care,” says Bradley Needleman, MD, who’s the medical director for the Comprehensive Weight Management, Metabolic and Bariatric Surgery program at Ohio State and a bariatric surgeon.
“We complete more than 600 bariatric surgeries a year at Ohio State and 96% of those are minimally invasive. But surgery isn’t always the best option for everyone,” Dr. Needleman says. “Weight loss is a complex challenge, so our program’s broad multidisciplinary approach brings together a team of experts from various medical specialties, including gastroenterology, surgery, psychology, nutrition, endocrinology and exercise physiology. By adding endobariatrics into the mix, we’re really able to tailor treatment to the individual for lasting weight loss.”
Dr. Shah emphasizes the collaboration between him and other specialists in Ohio State’s weight loss program.
“Because we work so closely together, we can seamlessly refer a patient to the right specialist for additional care. A patient may have a consultation for bariatric surgery first, but if endobariatrics seems a better fit, the surgical team can transfer care to our group and vice versa. In either scenario, the patient doesn’t have to start all over,” Dr. Shah says.
“Weight loss is typically a lifelong struggle, so we have the breadth and depth of services that may be needed,” Dr. Needleman says. “And it’s all provided in an environment that’s compassionate, encouraging and responsive.”
Patient referral
You can refer a patient to Ohio State’s Comprehensive Weight Management Program, or contact Dr. Shah directly for questions or information about endobariatrics at Hamza.Shah@osumc.edu.
Endobariatric procedures for weight loss aren’t typically covered by insurance for now. Most patients pay out-of-pocket, and Ohio State offers finance options. For certain patients with obesity-related comorbidities, we’ll seek insurance coverage approval based on the procedure being a lifesaving medical intervention.
