You are overweight. You have diabetes and your blood sugar is poorly controlled. You have a ravenous appetite and pounds keep accumulating despite your best efforts. You live in Houston, the fourth largest city in America, where the biggest medical center in the world has been established, and you are wondering who can help you. Where can you find reliable, ethical, honest, safe, state of the art solution to your obesity problem? Your co-worker had gastric bypass surgery 10 years ago and your neighbor has just had a gastric sleeve. Both are happy with their decisions. Your co-worker has lost a total of 90 pounds and her hypertension and sleep apnea have completely resolved. You are visiting with your neighbor and he is telling you that gastric sleeve surgery is the best and safest option for you. Your PCP however, has a different opinion. You asked for her opinion and she thinks that gastric balloon or maybe a lap band is a safer option for you. Indeed, gastric balloon is non-surgical and fully reversible. You go online and google gastric balloon in Houston and find out that endoscopic sleeve gastroplasty is actually a better option than gastric balloon. This new and exciting procedure is similar to a traditional gastric sleeve but without all the cutting. Next day, as you are having your morning coffee, and thinking about your weight loss options, a TV interview on your local channel attracts your attention. A local bariatric surgeon in your area has just finished training on this exciting new procedure and is offering the procedure at a discounted rate. Most importantly, you find out that the sleeve gastrolasty is performed through the mouth and is reversible and does not burn any bridges in case you wish to convert it to a more traditional procedure like gastric sleeve or bypass. How cool is that?

You decide to further investigate the matter. While at work, you google sleeve gastroplasty and you read more about this procedure. You learn that several studies have been performed with promising weight loss results. Around 40 pounds are lost in the first 6 months after surgery. You pick up the phone and call your PCP asking for referral. Your PCP sends you to a bariatric surgeon she trusts and with whom she has had a good working relationship. You call the bariatric surgeon office to schedule an appointment but you are shocked to find out that sleeve gastroplasty is not a procedure they offer. Determined to find help, you go back to google search to look for surgeons who perform sleeve gastroplasty in the Houston area. As you are conducting your search you come across my blog and you read the following:

The modern bariatric surgeon is constantly bombarded by newer weight loss procedures. Making a decision, however, on which procedure to adopt shouldn’t be difficult. Any weight loss procedure that does not alter the neuro-hormonal system that controls weight, metabolism and hunger is not likely to result in permanent weight loss. More specifically, any bariatric procedure that is purely restrictive like gastric balloon, gastric plication, endoscopic sleeve gastroplasty and the notorious lap band is most likely going to fail. Ghrelin, GLP-1, PYY and other hormones are well-established markers for success after bariatric procedures. Human trials that omit studying these easily measured blood hormones are to be considered weak and unreliable studies. Furthermore, novel weight loss procedures that do not promote gastric emptying are also less likely to result in durable weight loss. Accelerated gastro-intestinal motility is a common feature to all effective weight loss procedures like gastric sleeve and gastric bypass surgery. Finally, weight loss procedures that rely on mucosa-to-mucosa approximation are by definition not durable. Similarly, procedures that force gastric tissue to be plicated, or approximated under tension without proper dissection and release from surrounding connective tissue are not likely to last.

I have developed gastric fundus invagination, GFI, after taking into consideration all these concerns. I believe that GFI is the future of bariatric surgery. Unfortunately, funding for a human trial is still not available to prove its efficacy, durability and most importantly GFI effect on gastric Ghrelin and Leptin secretion. In a future blog, I will explore the relationship between Ghrelin and Leptin secretion by gastric fundus tissue and the effect of these hormones on weight loss.