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Non-Surgical Weight Loss at Surgical Institute with Endoscopic Sleeve Gastroplasty

Oct 15, 2020 02:07PM ● By Med Magazine

Obesity is associated with a wide range of serious medical issues, from high blood pressure and reflux to poor sleep, diabetes, and heart disease. Weight loss - whether through diet and exercise or a medical intervention - can reduce, eliminate, or prevent many of these issues. Recognizing this, insurance companies routinely cover the cost of weight loss surgery for people with a BMI over 40 or those with a BMI over 35 with comorbidities. 

Unfortunately, says board certified general surgeon Bradley Thaemert of Surgical Institute of South Dakota, those cutoffs exclude a number of high-risk individuals. 

"Once you have a BMI above 35, the chance of keeping the weight off with diet and exercise is less than five percent," says Dr. Thaemert. "But you can be 50 or more pounds overweight, with a BMI of 37, and if you don't have other medical conditions, you don't qualify for surgery, according to insurance companies. These people are stuck in a gray zone because they are failing at diet and exercise but insurance won't pay for surgery."

Thaemert is involved in the clinical trial of a new minimally invasive weight loss procedure that could offer hope to these individuals. Endoscopic Sleeve Gastroplasty (ESG) involves inserting a suturing device into the stomach by way of the mouth and placing sutures to limit the stomach's capacity. The outpatient procedure leaves no scars and can be revised if the stomach starts to stretch over time. 

Before the development of ESG, Dr. Thaemert was already using the suturing technology to repair holes in the bowel or stomach. He was enthusiastic to have the chance to put it to use for his weight loss patients, too. 

"I've always been fascinated with advanced technology," says Thaemert. "The main thing that limits me and other surgeons is having the right tools to do more."  

SI is now the only institution within a five-state area offering ESG. Twenty SI patients underwent the $14,000 procedure at no cost as part of the MERIT trial. At a year and four months in, Thaemert says most of them have already lost 30 to 50 lbs. 

"Our patients are doing really well," says Thaemert. "We are getting the results we expected with positive outcomes and very low complication rates."

If the trial - which also includes heavy-hitters like Mayo Clinic, Johns Hopkins, and Brigham & Women's Hospital - achieves its aim, insurance companies will recognize the advantages of ESG and agree to start covering it for those 'gray zone' obese patients. 

And ESG is not the only leading-edge non-surgical weight loss option at SI. The ORBERA™  intragastric balloon is a grapefruit-size, saline-filled device, that can be placed in the stomach for up to six months to facilitate rapid weight loss. It is placed and removed endoscopically in about 30 minutes. 

In addition to decreasing the stomach's capacity, ORBERA™  causes gastroparesis (slower stomach emptying) and triggers the release of satiety hormones. ORBERA™ patients receive an individually tailored 12 month support program to help them stay motivated and on track toward their goals. Thaemert says most patients lose 30 to 50 pounds and keep about 70 percent of those pounds off at one year. 

"There is no procedure that you can't out-eat if you don't play by the rules," says Dr. Thaemert. "But these procedures give people the benefit of stomach restriction, and that increases their odds of success."