I Want To...
I Want To...
Find Research Faculty
Enter the last name, specialty or keyword for your search below.
School of Medicine
I Want to...
Endoscopic Options for Weight Loss
If you struggle with your weight, you just have to watch television (ads for workout programs and diet plans) or stand at the supermarket checkout (magazine headlines about “the best” way to lose the weight and keep it off) to know that weight loss is a goal for a lot of women. There’s good reason for that: More than two out of every three adults in the United States are overweight or obese.
While diet and exercise can help maintain a healthy weight, some people find it hard to achieve weight loss with these methods alone. For individuals with other conditions, including type 2 diabetes, high blood pressure and heart disease, losing the weight can be critical. Weight loss surgery like gastric bypass has long been recommended in these cases. But not everyone wants or is eligible for this type of surgery. What do you do if you need to lose the weight but traditional weight loss surgery isn’t suitable?
That’s where endoscopic weight loss techniques come in. Vivek Kumbhari, M.D., director of bariatric endoscopy at Johns Hopkins and part of the Johns Hopkins Digestive Weight Loss Center, explains how these minimally invasive techniques work, and why you might choose them over weight loss surgery.
What is endoscopy?
Endoscopy is a procedure where doctors insert a thin, flexible tube equipped with a camera through your mouth into your digestive tract. This allows them to access your digestive system without open surgery, which carries higher risk. Before the procedure, the doctor provides medication to make patients sleepy so they don’t feel any discomfort.
Endoscopic weight loss procedures work by allowing doctors to place special devices or medications into the gastrointestinal tract to limit how much you can eat. “Endoscopic weight loss procedures are a great option between medication and surgery,” says Kumbhari. “They work better than medication, but are less invasive than surgery and carry fewer side effects and risks.”
Unlike bariatric weight loss surgery, which can require months of prep and several days of recovery, endoscopy is a one-day procedure. “While the amount of weight loss isn’t as dramatic as with surgery, the entire process typically takes just a few hours,” Kumbhari says.
Insurance does not cover endoscopic weight loss procedures, nor does it cover nutritional counseling that helps keep patients at a healthy weight afterwards.
#TomorrowsDiscoveries: Discoveries with Weight Loss – Vivek Kumbhari, M.D.
Dr. Vivek Khumbari and his team are developing safe and simple outpatient procedures using a device known as an endoscope that brings similar benefits to bariatric surgery.
One of the most common endoscopic weight loss procedures is the gastric balloon. This treatment places a silicone balloon in the stomach to take up volume. With less room in your stomach, you eat less. Doctors may use a single balloon or a newer model that looks more like a dumbbell.
“Gastric balloons work by making you feel fuller longer. The delay in gastric emptying also helps with fullness,” says Kumbhari.
Doctors leave the balloon in place for about six months and patients can expect to lose up to 15 percent of their body weight. The procedure is approved for people with a body mass index (BMI) of 30 to 40. People who have a hiatal hernia or previous gastric surgery are not eligible for the gastric balloon. It’s also not good for people with acid reflux, since it can make symptoms worse.
Aspiration therapy is a new procedure that lets you remove calories from the stomach after you eat. During the procedure, an endoscopy specialist places a small tube with an access port into your stomach. Two weeks later, doctors connect the port to the skin surface, allowing the patient to empty about 30 percent of calories from the stomach after each meal.
The procedure is ideal for obese people with a BMI greater than 35, and patients typically lose about 16 percent of their body weight during the initial one-year treatment period. Weight loss is more gradual than with gastric balloon. “It’s very simple and extremely safe,” says Kumbhari.
He says the device also helps people learn better eating habits that last after the device is removed. “Aside from removing calories, patients learn to drink more water, chew food more vigorously and snack less,” he says. Drinking more water and chewing food more completely helps the device function better. People also tend to eat less when they know they will have to make a special trip to the bathroom afterward.
Endoscopic Sleeve Gastroplasty
During an endoscopic sleeve gastroplasty, a specialist places stitches inside the stomach to reduce its volume by 70 percent. The patient is completely asleep under general anesthesia for the procedure. The stitches last about a year before the body reabsorbs them.
Patients typically lose about 20 percent of their body weight with this procedure, which has more predictable results than a gastric balloon.
“While some people lose a lot with the balloon, other people lose just a little,” Kumbhari says. “Endoscopic sleeve gastroplasty seems to work well in almost everyone.”
Gastric injections work by freezing the stomach muscles, which slows digestion and helps patients feel fuller faster. This treatment helps with more moderate weight loss goals, typically leading to a 5–10 percent weight loss.
It’s also one of the least invasive procedures, requiring a single series of injections in the stomach that you can repeat after six months.
“It takes 10 minutes and is completely painless,” says Kumbhari. “It’s a good option for those pursing weight loss for cosmetic reasons, such as weight gain after pregnancy.”