Comparing surgical and non-surgical weight loss procedures

Reviewed by Kate Anderton, B.Sc. (Editor)Jan 6 2020

Losing weight may not be easy, but there are many options available to help with the journey. People often start the weight loss process by trying a commercial diet, like those you see on TV. But when losing weight on your own doesn't work, weight loss surgery, or now, non-surgical medical procedures, can help.

The field of bariatric endoscopy is rapidly evolving and helping to transform how we care for patients. The procedures that we can offer patients, like the intragastric balloon and endoscopic sleeve gastroplasty, help patients to lose 15-20% of their body weight."

Jonah Cohen, MD, Director of Bariatric Endoscopy at Beth Israel Deaconess Medical Center

Additionally, similar to patients who have weight loss surgery, these patients can see an improvement in weight related conditions like sleep apnea and type 2 diabetes. Bariatric endoscopic procedures are done as an outpatient procedure, meaning patients typically do not have to stay overnight in the hospital.

Types of weight loss surgery

Gastric sleeve

Gastric sleeve, or sleeve gastrectomy, has become a popular choice for more and more patients. For this reason, BIDMC performs a high volume of gastric sleeve procedures.

Using a laparoscope, the surgeon removes approximately 60% of the stomach, so you feel full after eating a small meal. "You can think of it as your stomach decreasing from the size of a cantaloupe to the size of a banana," said Jones. "This procedure also helps decrease the hunger signals that go the brain."

Gastric bypass

During gastric bypass, the stomach is essentially divided, creating a small pouch that can hold the equivalent of a small meal. Next, the surgeon attaches a Y-shaped section of the small intestine to the pouch. That creates a bypass for food, as it skips part of your digestive system. "As a result, you can't eat as much as you used to and your body doesn't absorb as many calories," says Jones.

Gastric band

With a gastric band, also called LAP band (short for laparoscopic adjustable gastric band), the surgeon makes a few small incisions in the abdomen. The band is placed around the upper portion of the stomach, limiting the amount of food the patient can eat.

For all three types of weight loss surgery, BIDMC follows a unique approach to recovery after surgery.

"We reduce the need for narcotics by using different types of pain medications and nerve blocks," says Jones. "This means patients are more awake immediately after the procedure, are in less pain and often get to go home the next day. We are using the latest science to make recovery easier."

Getting started with the Weight Loss Surgery program – watch this video.

Types of bariatric endoscopic procedures

Intragastric balloon

Gastroenterologists fill a saline balloon and place it endoscopically into the stomach to limit the amount of food someone can eat.

Endoscopic sleeve gastroplasty

Endoscopic sleeve gastroplasty (ESG), also known as the "accordion" procedure, reduces the size of your stomach without the need for surgery or incisions. BIDMC was one of the first centers in New England to perform this procedure. During the procedure, the doctor will place multiple sutures in your stomach. The sutures change the structure of your stomach, leaving it shaped like a banana or sleeve. This restricts the amount of food you can eat making you feel full faster and learning portion control.

The Center for Bariatric Endoscopy also offers a procedure for select patients who have regained weight after gastric bypass surgery.

Cohen recognizes the weight loss journey is a personal one but is proud of the expertise and capabilities BIDMC can offer patients. "We have an opportunity, here at BIDMC, to offer solutions that can allow people to lose weight they've been trying to lose for a long time but have been unable to do so."