South Texans experience obesity at rates well above the national average, increasing the risk of diabetes, high blood pressure, fatty liver disease and other serious conditions. While bariatric surgery and GLP-1 medications can be effective, there are still many patients who are hesitant to undergo major surgery or do not respond to medications. For these individuals, UT Health San Antonio offers a suite of innovative endoscopic procedures that are less invasive and offer a quicker recovery.
“These endoscopic procedures are great options for patients who meet the criteria for bariatric surgery but think it’s too risky and want a less-invasive approach,” said Matheus Franco, MD, PhD, gastroenterologist and director of endoscopy at the UT Health San Antonio Multispecialty and Research Hospital.
“These procedures can also be beneficial for patients who aren’t seeing results with medications or are experiencing negative side effects from them, or even those who have responded to weight-loss medications but reach a plateau and want an additional procedure to achieve a better outcome. It’s also an important option for patients with previous bariatric surgery who need a revision because they are regaining weight. Endoscopic procedures can address all of these,” said Franco.
- Intragastric balloon: A well-established endoscopic procedure, the intragastric balloon has been used for nearly two decades. During this outpatient procedure, a soft balloon is placed in the stomach and filled with saline. By reducing available stomach space, the balloon helps patients feel full sooner and promotes steady weight loss over several months. The balloon is then removed after six months, with the stomach left intact.
- Endoscopic sleeve gastroplasty: The endoscopic sleeve gastroplasty, or ESG, is a technique that is similar to a surgical sleeve gastrectomy, but instead of removing part of the stomach, ESG uses internal sutures to reduce the size of the stomach without the cutting or removal of tissue. By reducing the size of the stomach, patients feel fullness sooner and longer and experience delayed gastric emptying. Because the procedure is done entirely though the mouth, there are no external incisions or scars.
- Transoral outlet reduction endoscopy: Another growing group of patients are those who previously had bariatric surgery but started to regain weight, often years later. For these patients, doctors may recommend transoral outlet reduction endoscopy, or TORe. This procedure tightens the opening created during gastric bypass surgery so that when a patient eats, the food stays in the stomach pouch longer, which restores the patient’s feeling of fullness.
Faster recovery, lasting results
In most cases, these are outpatient procedures, said Franco. Patients typically return to work or daily routines within two to three days and follow a guided diet progression over several weeks, supported by a multidisciplinary team of gastroenterologists, dietitians and behavioral counselors to help establish a healthy diet and regular exercise to support long-term weight loss. Many patients may also undergo one of these procedures in conjunction with taking GLP-1 medications for added weight-loss support.
According to Franco, endoscopic procedures typically help patients lose 15% to 20% of their total body weight within one year, which is more than most achieve with medications alone and with fewer risks than surgery. The health improvements can be life-changing, he added, with many patients experiencing better diabetes control, lower blood pressure, reduced sleep apnea, less joint pain and improvements in fatty liver disease.