Non-invasive weight loss procedure backed by NICE for obesity

A procedure that reduces the size of the stomach by two-thirds to help obese patients to lose weight has been deemed safe and effective by the National Institute for Health and Care Excellence.

New draft guidance from NICE states that evidence shows endoscopic sleeve gastroplasty (ESG) is safe in the short and long term when combined with lifestyle changes.

“One of the benefits is that this procedure can be carried out as a day case”

Jonathan Benger

In addition, it said it could help with weight loss in those with a BMI over 30, who have not lost weight with lifestyle changes alone and are not suitable or do not wish to undergo bariatric surgery.

NICE’s interventional procedures advisory committee reviewed evidence on ESG, which is minimally invasive, takes up to 90 minutes to complete, and usually sees patients go home on the same day.

The stomach is not cut or removed, and the procedure may be reversible, noted NICE, which suggested that it could offer people an alternative to bariatric surgery.

Carried out under general anaesthetic, a surgeon will guide a flexible tube containing a camera and medical instruments through the mouth and into the stomach.

Sections of the stomach wall are folded and stitched together to reduce its size to create a tube-like sleeve, which the aim of reducing the volume of the stomach to make one feel fuller soon.

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Published clinical research, which was cited by NICE, found 59 out of 77 trial participants lost 25% or more of their original weight a year after having the procedure.

A consultation on the draft recommendations has begun and will close on 26 October 2023. NICE interventional procedures guidance applies in England, Wales, Scotland and Northern Ireland.

Professor Jonathan Benger, chief medical officer at NICE, said: “We know people who live with obesity or who are overweight are more likely to be at risk of other conditions such as type 2 diabetes, hypertension or cardiovascular disease.

“A procedure which helps to reduce a person’s weight is one way to lower the risk of developing these conditions, and to improve overall health and wellbeing,” he said.

“Our committee has found endoscopic sleeve gastroplasty for people living with obesity to be a safe and effective procedure which can reduce the size of the stomach and therefore make them feel fuller on a smaller amount of food.”

He added: “One of the benefits is that this procedure can be carried out as a day case, and not involve an overnight stay, reducing the time people spend in hospital compared with other surgical options. Recovery is also quicker.

“Surgical treatment options are in high demand and not everyone wants, or is fit enough, to undergo an operation like bariatric surgery. A non-invasive procedure like endoscopic sleeve gastroplasty could be a welcomed new option for some people.”

The Health Survey for England 2021 estimates that 25.9% of adults in England are obese and a further 37.9% are overweight.

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Overall NICE guidance on treating obesity recommends dietary advice, exercise, lifestyle changes and medication. Bariatric surgery is also as an option in some people who have a BMI of 40 or more.

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