Endoscopic Sleeve Gastroplasty Pioneer Advances the Field Again

  • Endoscopic sleeve gastroplasty is a minimally invasive approach to weight loss surgery.

  • Endoscopic suturing technology replicates a surgical sleeve gastrectomy without actual surgery, reducing the risk of complications.

  • On average, patients achieve 15 percent total body weight loss six months postprocedure, 18 to 20 percent after 1-2 years, and sustained loss of 15 percent after five years.

4 min read

Cleanses, medications, nutritionists, programs—Judy Fernandez-Everett tried every weight-loss approach she could think of. But the results were always the same for the Rockland County, New York, resident. She would hit a plateau and return to her starting point: an average weight of 163 pounds on her five-foot, two-inch frame.

It did not help that Mrs. Fernandez-Everett, 44, had been diagnosed with hypothyroidism, resulting in the removal of her left thyroid goiter in 2011. She also underwent a total C5-C6 disc arthroplasty in 2016 and a left knee Fulkerson osteotomy in 2017. In 2018, she was diagnosed with a chondromalacia patella in her right knee, resulting in pain that made walking, running, climbing stairs, or sitting for long periods of time difficult. She also experienced loss of thigh muscle strength in her right leg, limiting her mobility to the point that she was dismissed from her job as a police officer under early retirement in 2019 due to her medical disability.

“I became more determined to lose weight and started researching surgical options,” Mrs. Fernandez-Everett says. “I was interested in bariatric surgery, but the doctors I saw told me I did not meet the necessary body mass index threshold of 40 to undergo the procedure. I did not know what to do until I reached out to Nikhil A. Kumta, MD, MS, at Mount Sinai.”

An Associate Professor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai, Dr. Kumta helped pioneer endoscopic sleeve gastroplasty, assisting on the first case in New York City in 2013. He says the procedure is ideal for patients, such as Mrs. Fernandez-Everett, who are obese with a body mass index of 30 or higher, have obesity-related comorbidities, or have not been able to achieve their weight loss goals through diet and exercise alone.

“The procedure takes advantage of endoscopic suturing technology, which enables us to replicate a surgical sleeve gastrectomy without the need for actual surgery, thus reducing the risk of complications,” says Dr. Kumta, who has performed more than 100 bariatric endoscopy procedures. “On average, patients achieve 15 percent total body weight loss six months postprocedure, 18 to 20 percent total body weight loss after one to two years, and sustained weight loss of 15 percent after five years.”

Candidates such as Mrs. Fernandez-Everett undergo a detailed screening process that includes an initial consultation; extensive testing such as blood work, physical exam, and an electrocardiogram; and an assessment by a multidisciplinary team of specialists, including an endocrinologist, bariatric nutritionist, bariatric surgeon, and psychiatrists. Patients are excluded if they are pregnant, or if they have a history of gastric cancer in their family, an underlying bleeding disorder, an inability to take an acid suppressant, advanced cirrhosis of the liver, or severe cardiovascular or pulmonary disease. “We want to ensure that all candidates are not only physically and mentally suited for the procedure but also committed to the dietary and lifestyle modifications necessary to achieve and maintain their weight loss goals,” Dr. Kumta says.

Once successfully vetted, patients undergo the procedure, which starts with anesthetization and the insertion of an endoscope equipped with a suturing device into the mouth. Once the endoscope is advanced into the stomach, Dr. Kumta performs full-thickness suturing of the stomach wall, reducing its size and reconfiguring its shape to resemble that of a banana. “We typically reduce the stomach volume between 60 and 70 percent,” Dr. Kumta explains. “We use full-thickness sutures to ensure that we penetrate the entire stomach wall, including the muscle layer. This minimizes the risk that the sutures will break when the stomach contracts to push food into the small intestine.”

This video includes an animated demonstration of endoscopic sleeve gastroplasty, followed by video from an actual procedure.

The procedure typically takes less than an hour to complete and patients are discharged home the same day. Dr. Kumta says fewer than 2 percent of patients who undergo the procedure experience complications such as peri-gastric leak and bleeding. To prevent post-procedure gastroesophageal reflux, nausea, and infection, Dr. Kumta prescribes a regimen of an acid suppressant, anti-nausea medications, and antibiotics, and patients are required to maintain a liquid diet for two to three weeks. Follow-ups begin with a consultation call two weeks postprocedure and continue with in-person appointments at the month-one, month-three, month-six, month-nine, and one-year milestones, with semiannual appointments after that.

“Success is more than how well we perform the procedure; it is about monitoring patients’ recovery, making sure we administer the right medications to prevent complications, and helping them implement good nutritional and lifestyle practices,” Dr. Kumta explains. “For these reasons, we follow our patients aggressively because we want them to achieve their weight loss targets and keep that weight off over the long term.”

Mrs. Fernandez-Everett underwent her endoscopic sleeve gastroplasty in June 2019 and, with the support of Dr. Kumta and the multidisciplinary care team at Mount Sinai, she has lost more than 30 pounds. No longer experiencing chronic knee and back pain, she has enrolled in yoga and salsa dancing classes and is able to be more active with her children.

“I am doing things that I have not been able to do for a very long time,” she says. “From the start, Dr. Kumta made me feel confident that I was going to have the outcome I wanted, and I did.”

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Nikhil Kumta, MD, MS

Nikhil Kumta, MD, MS

Associate Professor of Medicine (Gastroenterology)