Endoscopic Bariatric Therapy (EBT)

Minimally Invasive Procedures for Weight Loss

Adults struggling with obesity or weight-related health problems need options for achieving significant, long-lasting weight loss. Endoscopic bariatric therapy (EBT) may be an excellent option for people who have decided not to pursue weight loss surgery, and for those who have had weight loss surgery and are now experiencing problems or weight regain.

What is Endoscopic Bariatric Therapy?

Like bariatric surgeries (such as Roux-en-Y gastric bypass, sleeve gastrectomy and adjustable gastric banding), endoscopic bariatric procedures reduce the volume of the stomach or alter part of the digestive tract to reduce the number of calories that the body can ingest or absorb.

Unlike those bariatric surgeries, endoscopic bariatric procedures are performed through the use of a small, flexible scope which is inserted through the mouth. The procedures are minimally invasive, reducing the risk of complications.

Endoscopic bariatric therapy can be performed either as a first-line treatment for weight loss (primary therapy) or as a follow-up to previous surgical procedures (secondary therapy).

These endoscopic procedures are generally performed on an outpatient basis with patients returning to regular activities within days of their procedures.

About Primary Endoscopic Bariatric Therapy

In the last decade, new endoscopic procedures have been developed for people who are not candidates for weight loss surgery or who prefer a less invasive, non-surgical alternative. This often includes adults who are overweight or obese who have not been successful at losing weight through diet and exercise programs.

Michigan Medicine is one of only a few centers in the region with doctors trained to perform these three innovative options:

  • Intragastric Balloon
  • Endoscopic Sleeve Gastroplasty (ESG)
  • AspireAssist®

Each of these procedures is performed on an outpatient basis. Given these are new endoscopic procedures, they may not be covered by your health insurance.

The Intragastric Balloon – is a silicone balloon placed in the stomach and filled with saline, limiting the amount of food the stomach can hold. The balloon and a tiny camera are inserted endoscopically, through a thin tube placed in the mouth and into the stomach. Guided by the camera, the doctor positions the balloon and fills it with saline solution. The outpatient procedure takes about a half-hour. 

The balloon device is FDA-approved for patients with a body mass index (BMI) of 30 to 40.

Intragastric balloon therapy is a reversible procedure. Balloons are intended to be left in place for a period of time and then removed endoscopically.

Endoscopic sleeve gastroplasty (ESG) – like the traditional surgical sleeve gastrectomy procedure, in an ESG the doctor sutures the stomach to make it smaller. ESG is performed without an incision, through a thin tube inserted into the mouth and into the stomach.

ESG is intended for patients with a body mass index greater than 30.  It is an outpatient procedure, and takes less than two hours to perform.

Michigan Medicine’s program was the first in the state to perform an ESG.

The AspireAssist® device - is an FDA-approved tube device inserted into the stomach to drain (aspirate) a portion of the stomach contents after meals. The device is inserted into the stomach with an endoscope through a small incision in the abdomen.

A button-shaped port valve connected to the tube device remains outside the body, resting against the skin. Twenty to 30 minutes after each meal, the patient can open the button and attach a small handheld device that facilitates emptying of stomach contents. The process, which takes approximately five to 10 minutes, removes about 30 percent of the meal.

The AspireAssist® is an outpatient procedure intended for adults with a body mass index of 35 to 55.

Primary procedures are elective, and patients considering these options do not need a physician referral to make an appointment. At your first clinic consultation, you will meet with one of our doctors to discuss whether a weight loss procedure is the right choice for you, and whether you are a good candidate for an endoscopic bariatric therapy. The doctor will also review each of the available endoscopic procedures with you in detail.

As part of the program, you will also meet with a nutritionist to review dietary requirements before and after the procedure, and with a gastrointestinal psychologist to discuss expectations.

Since these procedures are not always covered by medical insurance, patients who elect bariatric endoscopy are also referred to a Michigan Medicine financial counselor to review the costs involved.

About Secondary Endoscopic Bariatric Therapy

Endoscopic bariatric therapy is commonly performed as a secondary or corrective procedure, to resolve adverse events from previous bariatric surgical procedures. Patients experiencing adverse events after a gastric bypass, sleeve gastrectomy or adjustable gastric banding procedure, as well as those who have regained weight after gastric bypass surgery, can receive the latest corrective endoscopic treatments.

Secondary procedures to resolve surgical adverse events may be covered by insurance. Check with your insurance provider.

Michigan Medicine is a high-volume center for secondary bariatric endoscopy.

A doctor’s referral is usually required for patients needing a secondary or corrective procedure.

Make an Appointment

Patients who wish to schedule an initial consult with the Michigan Medicine Endoscopic Bariatrics program for a primary procedure can call 888-229-7408

Doctors wishing to consult with a Michigan Medicine bariatric endoscopist or refer a patient to the program for a secondary, corrective procedure can contact M-Line, Michigan Medicine’s 24/7 physician-to-physician connection, at 800-962-3555.