Endoscopic methods in the treatment of obesity

New endoscopic methods in the treatment of obesity have appeared in recent years as an alternative to the surgical treatment of obesity, i.e. the so-called bariatric surgery. Patients with a body mass index of 30 to 45 kg/m2 belong to the group of candidates for this intervention, although guidelines are currently being developed that would further expand the use of these procedures to include patients with BMI> 45 or so-called extremely obese patients. Although surgery has also progressed, and today interventions on the stomach and small intestine can be performed laparoscopically, new endoscopic methods are even less invasive and involve techniques of suturing the stomach wall from the inside, without any external incisions. These techniques include gastroscopy,
i.e. placing a probe with a camera through the mouth and then, with specially designed instruments that are mounted on top of that probe, in the lumen of the stomach, the stomach wall is sutured along the length and width, so that in this way not only the length and width of the stomach is reduced, but also its volume. The procedures are performed under general anesthesia and last about 60-90 minutes
the hospital stay lasts a day and a half. The entire procedure precedes patient selection through work with a multidisciplinary team that includes a bariatric surgeon, gastroenterologist, internist, anesthesiologist, nutritionist, psychologist/psychiatrist, physiatrist. After the intervention, the patient is gradually introduced to a special diet, and additional medicines for
weight loss, such as liraglutide (GLP-1). It is essential that the patient is monitored through a multidisciplinary approach in the following years, usually 2 to 3 years. The percentage of weight loss is about 40-50% of excess body weight (EWL) and about 15-20% of total body weight (TBWL) after a period of one year. BioCell Hospital offers a complete range of endoscopic bariatric therapy, starting with the placement of intragastric balloons and ending with endoscopic restrictive procedures (endoscopic gastroplasty).
Why is a multidisciplinary approach to such patients important, isn’t it enough?
intervention?
The success of a surgical or endoscopic procedure can only be guaranteed if the patient
provide full support from a nutritionist, psychologist/psychiatrist, internist, physiatrist, as well as
other professional figures involved in working with the patient (surgeon, gastroenterologist, etc.).
The process of reducing body weight does not end, but begins with bariatric surgery
intervention. Then follow regular controls after 1, 3, 6, 9 and 12 months, where above all
a nutritionist and a psychologist provide immediate support to the patient and direct him to what is expected
to the goal.
What techniques are most often used?

The most common endoscopic restrictive techniques used are the endoscopic sleeve
gastroplasty (Apollo Overstitch®), endoscopic vertical gastroplasty (Endomina®) and
primary endoluminal bariatric surgery (distal-POSE®).
Are there any contraindications for the procedure?
Before any endoscopic bariatric intervention, it is necessary to perform laboratory,
radiological/ultrasound and endoscopic examinations . If during these preliminary
tests notices some irregularity, then the final intervention can be postponed until
does not solve the problem, for example if the patient has an infection of the stomach lining with H. pylori bacteria,
then the infection is first eradicated with antibiotics, and after a month it is performed
intervention.
If a patient who has already undergone surgery due to obesity gains weight again,
can endoscopic procedures be used again?
With the introduction of endoscopic therapy for the treatment of obesity, the risk of
surgical interventions. This especially applies to patients who have already been operated on and who have
increased risk of any subsequent surgical intervention. Endoscopic suturing of the remaining
part of the stomach and the anastomosis between the stomach and the small intestine solves that problem successfully
patients who regained body weight.
Are there any complications?
Complications of endoscopic bariatric intervention are very rare, minor ones may occur
bleeding or perforation, which are successfully resolved during the procedure. Serious complications are
extremely rare, in any case much less often than with surgical interventions.
Will these procedures be introduced in Serbia?
The idea of the BioCell Hospital team is to introduce these procedures into practice in Serbia as soon as possible
we would offer all patients suffering from obesity a complete spectrum of modern
therapeutic procedures and became a regional leader in this field.