2023-06-29 16:57:46
First of all, remember that obesity is a multifactorial adipose tissue disease, characterized by excessive accumulation of body fat. Despite regular physical activity and a balanced diet, some obese people are unable to lose enough weight to preserve their health and improve their qualitytee of life. This is why various bariatric surgery operations have emerged: gastric banding, bypass or sleeve gastrectomy, all three recognized by the High Authority for Health and covered by Social Security (source 1 ). In recent years, they have been challenged by new techniques such as l’endosleevealso known as endoscopic gastric plication or endoscopic sleevewhich is intended to be less invasive than traditional procedures.
Definition: what is an endosleeve exactly?
“The endosleeve is an endoscopic procedure that allows reduce the size of the stomach without resorting to surgery to open the abdomen”, explains Dr. Antoine Cracco, visceral and digestive surgeon. Indeed, doctors or surgeons manage to reduce the size of the stomach by plicating and suturing it, in other words, by folding it on itself from inside our body. For this they use a camera and miniature surgical tools which are introduced through the patient’s mouth, which explains why we still speak of endoscopic surgery.
The objective of this intervention? Limit the amount of food that can be ingested through the stomach and allow patients toto arrive at satiety faster. In practice, the expert plicates two-thirds of the stomach, which then takes the form of a vertical tube. The absorption of food is not impacted: following the endosleeve, the stomach continues to function normally. The procedure is usually performed under general anesthesia and lasts approximately one hour.
What are the advantages of the endoscopic sleeve?
Before going further, it is important to remember that the endosleeve is not not a technique validated by the High Authority of Health. “Some clinics offer this intervention outside the official recommendations: for the moment, the health authorities believe that we do not yet have enough perspective to assess the benefits of endosleeve in the long term”, underlines Dr Olivier Foulatier, surgeon visceral and digestive.
In theory, the endosleeve has several strings to its bow. Firstly, it reduces the risks and inconvenience associated with surgery, such as infections, postoperative pain and scarring. And on the other hand, since it does not require an abdominal incision, so recovery time is usually shorter than for a sleeve gastrectomy. Finally, unlike other bariatric surgery procedures, the endosleeve is reversible : if necessary, the original size of the stomach can be restored with another endoscopic intervention.
As a reminder, significant weight loss in obese patients greatly improves their quality of life and above all preserves their overall health. But anyway, the endosleeve is not a miracle solution!
For an optimal and lasting result, it must be carried out within the framework of a regular medical follow-up and accompanied by significant changes in the way of life, in particular in terms of food and sports practice, insists Dr. Cracco.
What is the minimum weight to have an endosleeve?
The endosleeve can be considered when you are moderately obese. “She is rather popular with overweight or obese patients who are not eligible for bariatric surgery due to their IMC says Dr. Cracco. In fact, to consider a sleeve gastrectomy, a bypass or the installation of a gastric band, patients must have a BMI greater than 40 kg/m² or have a BMI greater than 35 kg/m², associated with at least minus one comorbidity.
Who can benefit from endoscopic gastric plication?
As noted above, endosleeve can be considered as a last resort, if you are in a situation of beginner or moderate obesity and your efforts do not allow you to lose weight significantly. It may also be considered if you do not wish to have surgery, or if you cannot for medical reasons. The final decision must be made in agreement with a multidisciplinary team specialized in weight management and following a thorough assessment of your state of health. To sum up, the indications for endosleeve are therefore as follows:
be over 18 years old; have a BMI between 30 and 35 kg/m²; not present any contraindications to anesthesia or endoscopy; and undertake to comply with the pre- and post-operative medical follow-up.
What are the contraindications to endosleeve?
Of the gastric lesions : history of gastric surgery (partial gastrectomy or gastric bypass surgery), untreated peptic ulcers, large hiatal hernia, etc. ;A unstable eating disordersuch as bulimia or binge eating; unstabilized emotional or psychiatric disorder ;L’alcoholism, smoking or drug addiction ;The chronic intake of blood thinners or anti-inflammatories ;A current pregnancy or one desire for pregnancy in the next two years ;Et any other condition preventing adequate medical follow-up following the intervention.
In addition, people with inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, have a higher risk of complications following the procedure.
Where to do an endorsement? Who performs this procedure?
The endosleeve is usually performed by a(e) gastroenterologist doctor belonging to a multidisciplinary team. “But it can be done by an obesity surgeon », assures Dr. Foulatier.
In any case, it is recommended to consult a trusted specialist: start by making an appointment to have your situation assessed, discuss the different treatment options availableincluding endosleeve, and determine if you are a good candidate for the procedure.
Please note: since this procedure is not officially recommended by health authorities, it is not not practiced in all health facilities. In other words, you may have difficulty finding a multidisciplinary team that performs this type of intervention in your area.
How is an endosleeve performed?
The course of an endosleeve may vary slightly depending on the specific practices of the facility and the team performing the procedure. You will be required to submit to a thorough medical evaluation, including blood tests, imaging tests and an assessment of your general health. Your doctor will also give you specific instructions regarding pre-preparation, and you will need to schedule a consultation with the anesthesiologist. THE time between the first consultation and the date of the procedure is regarding a month.
On D-Day, you are placed under general anesthesia or deep sedation.At the start of the procedure, an endoscope (a thin, flexible tube fitted with a camera and miniature surgical instruments) is introduced into your stomach through your mouth. Using its instruments, the specialist then closes and sutures a large part of the stomach to create a narrower sleeve. He / she then ensures that the sutures are solid and that there is no risk of leakage. Once the procedure is complete, the endoscope is gently removed, then you are placed in the recovery room . If the operation was performed on an outpatient basis, you will be discharged during the day (in the absence of complications). If necessary, you will sleep in the hospital for a given time.
If you have any questions, don’t hesitate to ask your team members to be asleep. informed ! Likewise, don’t hesitate to ask any questions that come to mind during your follow-up appointments.
What weight loss can you expect with this stomach reduction?
As indicated at the beginning of the article, the effectiveness of weight loss in the medium and long term is correlated with nutritional and behavioral monitoring of patients. The famous “rebound effect” is inevitable, but one thing is certain: “in view of the current results, we cannot say that the endosleeve is more effective than the sleeve gastrectomy, the bypass or the gastric band”, affirms the Dr Foulatier. An opinion shared by Dr. Cracco, who recalls that the expected weight loss in the context of a sleeve gastrectomy is 45 to 65% in the two years following the intervention.
What are the risks and disadvantages of an endosleeve?
Like any procedure, the endosleeve induces complications… “But to a lesser extent than the sleeve gastrectomy”, recognizes Dr. Foulatier. The most feared complications (besides complications related to anesthesia)? An increased risk of GERD, gastric leakage, or bleeding from ligatures. Much more rarely, it happens that the endoscope perforates the intestine that the new stomach is too narrow or that edema prevents good nutrition. If you notice shortness of breath, abdominal pain, fever, bleeding from the anus or repeated vomiting, consult your doctor quickly!
Price: how much does an endosleeve cost? Is it reimbursed?
As you will have understood, the endosleeve is not recommended by the Haute Autorité de Santé. She is therefore not not covered by Social Security. According to clinics and specialists, count approximately between 5,000 and 8,000 euros at your expense.
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