07:00 am
Tuesday 08 March 2022
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Endoscopic, minimally invasive surgery that does not leave scars on the skin expands the range of treatment options available to patients with complex and chronic obesity, offering them hope for treatment if other weight loss methods fail or when surgery is no longer an appropriate medical option, Or for any other reasons, according to a medical expert from the global health care system “Cleveland Clinic.”
Dr. Roberto Simons-Linares, director of the Department of Bariatric Endoscopy at Cleveland Clinic, said that dietary and lifestyle modifications, medications, and weight-loss surgeries were the traditional foundations of bariatric treatment, noting that the past decade has seen the emergence of endoscopic operations. and a flexible tube with a light and camera passed through the mouth.
Dr. Simons-Linares added that endoscopy bridges the gap between medication and surgery, noting that the general rule is that “the more invasive the approach, the greater the weight loss,” but he made it clear that medications and lifestyle modifications are at the limit. Below the penetration scale, these may not work for many people.
He added, “At the upper end, we have surgery, which is very effective, but not everyone qualifies to undergo surgery. Also, we found that only 1% of eligible patients actually undergo bariatric surgery, and this is due to several reasons, including the inability to It is important to choose what is right for the patient. Thus, minimally invasive endoscopic procedures, which are performed on the same day, provide important additional treatment options for obese patients.”
BMI
The patient’s eligibility for bariatric surgery is determined by looking at his body mass index (weight in kilograms divided by the square of height in metres), and whether he has any weight-related medical conditions, such as high blood pressure or diabetes. A patient who is eligible for bariatric surgery must have a BMI of 40 or higher, or even higher than 35 if he or she has comorbidities.
The medical expert added that a person is classified as obese if his body mass index is 30 or more, which leaves many patients ineligible for obesity surgery, considering that endoscopic procedures “provide a viable alternative.”
Three endoscopic solutions
There are currently three primary endoscopic solutions available to patients, and this is expected to increase in the future. The current operations reduce calories consumed and are performed in outpatient clinics, but the time to perform them varies from one operation to another.
The first operation, which is endoscopic sleeve gastrectomy, aims to create a permanent solution represented by suturing the stomach to reduce its size to the size of a banana, similar to the result achieved by surgical sleeve gastrectomy. As for the second operation, it includes a stomach balloon, which occupies a space and stimulates satiety and is used for a period of six months, and is implanted and removed laparoscopically.
The third solution is to place a small suction tube in the stomach through endoscopy, which enables the patient to remove up to 30 percent of the contents of the stomach following eating a meal, and this tube can be removed following reaching the target weight.
secondary operations
Dr. Simmons-Linares said that endoscopic methods are also useful as secondary weight loss procedures in cases where the patient has gained weight following undergoing bariatric surgery. Various endoscopic techniques ensure that the patient does not have to repeat the original surgery or undergo a more invasive surgical modification if the patient’s stomach has been stretched following a previous operation.
Before deciding to undergo surgery, the patient undergoes a full assessment of eligibility conducted by a multidisciplinary team, during which the presence of any comorbidities, such as diabetes or obstructive sleep apnea, and any other factors such as eating disorders, which in turn require treatment, are also determined. Lifestyle modifications are the cornerstone of any obesity treatment.
The expert stressed that there is no one-size-fits-all treatment for obese patients; Because it is a complex disease with many forms and causes, pointing out that sometimes there is a need for complex treatments. He said that diverse genetic, biological, developmental, behavioral and environmental factors contribute to weight gain and the development of obesity.
He added, “There is no quick solution to the treatment of obesity. Rather, all treatment methods require care and effort on the part of patients. The endoscopic procedures we have mentioned represent additional tools for treating obesity and mitigating its significant impact on the health of the population, and are not considered simple treatments.”
Patients should adjust their diet and lifestyle over the long term in order to maintain their weight loss. It is also important that they have the support of a multidisciplinary team of doctors and other experts, including nutritionists and psychologists, according to Dr. Simons-Linares, who emphasized that obesity is a chronic condition that may experience relapses, calling on patients to continue to communicate with their doctors regularly. After the operation, they can address any problems as they arise.
According to the World Health Organization, around 650 million adults and an increasing proportion of children worldwide are obese.
The disease is widely known as an epidemic and is associated with many types of cancer and metabolic diseases such as type 2 diabetes, cardiovascular disease, hyperlipidemia, fatty liver, hypertension and osteoporosis.
