ESG Consultation 11/28

[BubblesCT 83]

Hi. I have been researching bariatric procedures for weight loss for a few years. I'm 45 year old woman whose weight fluctuates between 170-190 lbs. I have met with a couple of bariatric surgeons to explore the balloon and lap band. I'm not impressed with the balloon, and the complications associated with the lap band scares me. The ESG seems like a good fit for me, however, there are no long term studies to prove it's effectiveness and safety. My body over produces scar tissue, so that is my biggest concern with any surgical procedure. I have been struggling with an autoimmune disease which is exacerbated by my weight and poor food choices. I need to lose weight and I'm unable to do it on my own. In 2005 I was able to get down to 120 lbs and maintain it until 2011 with the help of phentermine. I was buying it online and the formula was very strong. I maintained the weight loss until the online phentermine was discontinued. The phentermine prescription I now receive from my doctor must be formulated differently because it has little effect. I want to lose weight and get off the medication.

In 2011 I began suffering from various immune related ailments. The doctor's believe it is Burchett's disease. I'm prone to illness and infection. The foods I eat and extra weight I carry is literally killing me. I'm a single mom of two girls, ages 13 and 16. I need to be the healthiest I can be for them . I'm desperate and scared.

I have a consultation next week with Dr. Reem Sharaiha at The Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center. I will continue to post my experience through this journey to help those researching procedures. Thanks for all who share, it has been immensely helpful to read the process others have experienced.

[hope4momof4 162]

I am almost in exactly the same boat as you. I am 43 and have been looking into bariatric procedures for years now but my BMI doesn’t qualify me for any of them. I also thought about the balloon but the reviews on its effectiveness were not stellar. In addition it is an expensive procedure to pay for that seems to only yield minimum weight loss. I, too became excited when esg became available here in the US. It seemed like exactly what I was looking for. It’s noninvasiveness coupled with impressive weight loss numbers (better than lap band) was a perfect fit for me. However, just like you I am concerned about it’s long term effectiveness. If I am getting to go through with any procedure I don’t want to have to “revise” it and I don’t want reassurance that I could always then go for a full sleeve or bypass later. I don’t like that this revision talk is always part of the conversation about esg. Any bariatric procedure should be an only one in my opinion. I think we’ll go through enough the first time around not to already discuss a second time. Yes I know that any procedure will need revision if you don’t put in the work that you need to put in to succeed but it worries me that it automatically is discussed when esg is brought up. I like you would like to hear more about the actual percentage of esg patients who actually needed revision. This procedure was done in other countries for years (although probably not endoscopicly, which is what makes esg so appealing to me) but there should be some data on this as I would like to know what I’m getting into. I was very close to getting a gastric balloon until I saw that the results of several who had it were not what I expected it to be. Maybe waiting for more data on this is the best way to go. I’m unsure as well and hope that I can finally reach a decision too.

Good luck and please keep us posted. Remember how much you wanted to hear about this procedure from those who have done it and please be honest about your feelings on whether or not it was worth it for you. All my best.

[BubblesCT 83]

Hi hope4momof4, thank you for sharing your story with me. I will ask the doctor when I meet with her next week if she has any information on long term data of ESG procedure performed in other countries. I'm also curious to know what the revision would entail and the cost. I'm happy to answer any questions and share as much detail as possible to help those that are considering the procedure. It takes a village.

I will update after my appointment next week.

[hope4momof4 162]

That sounds wonderful! I would greatly appreciate any information you can share especially since Dr. Sharaiha is the doctor who pioneered this procedure. I am hoping to schedule a consultation in the next month with Dr. Sadek in central NJ. Once again it will depend for me on getting as much feedback from the brave souls like yourself who start the process and actually go through with it. I will be anxiously awaiting your post next week. I thank you again in advance.

[AmyAlexis 81]

Hi Bubbles. I just had the procedure done with dr shariah two weeks ago. I can tell you how happy I am to have done it. I love dr shariah and the staff, nurses and other doctors at Weill Cornell are fantastic.

If you want, I’d be happy to talk to you on the phone about my experience. Just send me a private message.

Btw I started at 159 and have already lost 14lbs.

[BubblesCT 83]

Thank you AmyAlexis, for reaching out. It is so helpful to get your input on Dr. Shariah and the staff at Cornell. Congratulations on your 14lb weight loss! I will private message you so we can connect on the phone. Your kindness is most appreciated.

[hope4momof4 162]

Hi AmyAlexis,

Congratulations on that impressive 14 pound weight loss in only two weeks! Those are outstanding results and you should be proud of your accomplishment. I had posted to Bubbles about asking Dr. Sharaiha how many esg procedures need revisions later on down the road. Like Bubbles, I am looking to have this procedure done but am concerned about the lack of long term data available since it is fairly new. So I was wondering if you happened to ask this question during consultation. She pioneered this procedure and I believe that even if data in the Us is not available, surely there must be some data available from other countries who have been performing this procedure. I think countries like Mexico and Brazil have been doing this for years although it was the laparoscopic version with incisions and may have been called gastric plication. Thanks for any info you can provide.

One other thing, did you post your starting weight at 159 lbs.? That seems like a low starting weight. What was your BMI if I’m not being too personal? I’m at a 32 BMI and if someone with a low weight like yours can lose 14 lbs. in two weeks then I definitely believe this is the right procedure for me. Thanks again and I wish you continued success.

[AmyAlexis 81]

Hi Hope4mom
Dr shariah might have mentioned long term results but I don’t remember to be honest. It’s so new that I’m not sure you’re going to get much data.
As for my weight, I’m 5’1 so that gives you a bit more context. BMI 30. I’ve been overweight all my life. as high as over 200 about 17 years ago and last few years been in the mid 150s down to high 120s and back again. Was sooo tired of this neverending battle, and never feeling satisfied or full unless stuffed. And that lead me to this non surgical procedure I had seen on nightly news.

[Tex Slim 66 94]

Bubbles, you are asking all the right questions, here are some further thoughts I hop can be helpful in your decision making. In my initial consultations I did the same thing and received a lot of information from my Dr, this encouraged me to go forward with my procedure. Be prepared, it's always good to start with asking your Dr. how many ESG's they have done. My Dr. had done ~50 procedures when I first consulted with him this summer.

Hope4momof4 has a great follow-up to this question around what complications (frequency and severity) does your Dr experience with ESG operations? Building on this I would also ask your Dr. to compare ESG complications to Vertical Sleeve Gastronomy (VSG) their patients have experienced? In my experience with the 3 Dr' I spoke to their answers were the same or less number of complications (lack of an incision being the primary factor of ESG having fewer complications than VSG. None of the 3 had experienced more severe complications with ESG.

Since the ESG procedure is fairly new, I looked for other questions to learn more about the Dr's experiences:

• How frequently do they use endoscopes
  • 2 days per week in OR completing multiple procedures was my Dr's response
• Do they also do Vertical Sleeve Gastronomy
  • My Dr. has done VSG for years, many hundreds of procedures

In this discussion with my Dr. I learned the internal stitching technique (OverStictch) done on the stomach walls was the same for ESG and VSG. This made me more comfortable about their experience level.

Ask your doctor about

[hope4momof4 162]

Nice to hear from you Tex. I hope you are still doing well so soon after your procedure. Is it true that at day 3 post op you start to feel much better than the first two days? How has this Thanksgiving been for you? Your posts are definitely encouraging and it seems like you are feeling well enough to update us and even answer some questions. One thing I am also asking Bubbles to do is ask the doctor if they have had to do any revisions yet. I think that is also an important question to ask during the consultation. Did you ask your doctor about this by any chance? All my best and I wish you continued success.

[Tex Slim 66 94]

Hey hope4momof4, yes I definitely feel stronger and better today at day 3 than yesterday. My headaches are gone and I'm not at all groggy like on Day 1 and 2. I have completed taking most of the anti-nausea meds that were prescribed today. Dr. and lead nurse said to just take these meds and not wait until I was feeling nauseous. If you wait in taking these meds it takes a long time to recover. Really good advice form my Dr. and nurse, I followed it and it worked!

I feel really good about Thanksgiving today I stuck to my clear liquid diet, no cheat and frankly not interested in cheating at this point. There's so much of an opportunity for me to get back into a healthier life that I'm not going to miss this chance.

The holiday season may seem like a strange time to have an ESG, however for me it was important to start in this season and prove to myself I can do it. Thanksgiving to New year's eve has always been one of the worst times of the year for my weight. In the past couple of years I have gained up to 30 pounds in each of these 6-8 weeks only to work the rest of the year to lose some of it. It's not going to happen that way again!

Great question about revisions, agree this is one to cover in consultations, I did have a good discussion with my Dr. about revision. In our first session I asked about revisions, since I had read this was possible online. Dr. Wilson was clear that the basis for the ESG procedure is permanent. One of the main focuses of the initial weeks of liquid and then Protein diet is to allow the new sleeve to get settled and for tissue to build around the internal sutures. Doing this right in the first several weeks is key to maintaining that smaller area of our stomach following the procedure which provides the feeling of satiety. In speaking with a couple of other Dr's who also performed the ESG procedure I heard a similar rationale that ESG was not intended as a reversible procedure.

My Dr. has not had an ESG patient where a revision was necessary.

Happy Thanksgiving to all!

[hope4momof4 162]

Great to hear that you’re doing well. Also great to hear about the revisions. I was concerned about this but you have reassured me. Keep up the good work and you are very determined to have had this done before the holidays. You are absolutely right about gaining more weight during this time of year. Great choice 👍🏻 Keep us all posted.

[BubblesCT 83]

I'm so happy to hear your recovery is going well. Your suggestion are so helpful, I will add them to the list I have compiled for Tuesday. It's reassuring to know that your hunger has subsided, hunger is my biggest challenge. When I'm hungry my will goes out the window. Great to hear from you. Rest up and look forward to your updates.

[AmyAlexis 81]

Bubbles good luck on your consult tomorrow!

[BubblesCT 83]

Thank you Amy Alexis for your support and encouragement. I will keep you updated. I'm equally nervous and excited! I fear that for some reason I will not be a candidate. This procedure is a glimpse of hope from my current state of being held hostage in a overweight, unhealthy body, that lacks control over eating. I will post an update tomorrow. Thank you Tex Slim for sharing your experience, knowledge and insight. Hope4momof4, you ask great questions, I have gained invaluable information from you asking others about their experiences. So grateful for this forum and all if you guys!!