Metabolic and bariatric endoscopy

Welcome to North American Gastroenterology.  We offer gastroenterology services and weight management services. Dr Abdulhadi A Quadri is board-certified in Gastroenterology, Obesity Medicine, and Internal Medicine.

Weight management

Intragastric Balloons (four different kinds) are part of a comprehensive 12-month weight loss program.  We offer balloon placement as part of a 1-year physician-guided weight management regimen.  Used by over 220,000 patients in 80 countries, over 20 years, studies have shown that the balloon allows for 3 times the weight loss of diet and exercise alone.

For patients who have regained weight after gastric bypass, endoscopic gastric bypass revision (transoral outlet reduction) can address outlet dilation.  We offer the procedure in combination with physician-guided weight management.

Bariatric endoscopy: lose weight without surgery

One of the most effective tools for treating obesity is weight loss surgery. Unfortunately, some patients don’t qualify for surgery because they have mild obesity that doesn’t meet criteria for surgery, some people who lose weight with weight loss surgery gain weight back, and some people don’t want to have surgery.

Bariatric endoscopy includes procedures and devices that are placed during an endoscopic procedure where we go through your mouth to get to your stomach. We have a number of device and procedure options that range from short-term and reversible to long-term procedures.

The Metabolic and Bariatric Endoscopy Program at North American Gastroenterology specializes in treating patients who don’t qualify for, or don’t want to undergo, weight loss surgery. We also treat patients who have regained weight after weight loss surgery.

Our specialized treatments

Intragastric balloon therapy involves placing into the digestive tract medical-grade silicone balloons that are filled with liquid or inert gas. After a set period of time the balloons are then drained and removed from the patient.

Balloons offered

ReShape Integrated Dual Balloon System®. Two balloons are placed during an endoscopic procedure. After six months, patients return to the clinic to have the balloons removed.

Orbera Balloon System. Your physician places a single intragastric balloon. Patients return to the clinic after six months to have the balloon removed.

Obalon Balloon System. In this therapy, the patient swallows a capsule that contains a balloon. The balloons are inflated with a nitrogen-mix gas. Second and third balloons are swallowed 2 weeks and 8 weeks after the first balloon. All balloons are removed six months after placement of the first balloon.

Am I a candidate?

Candidates for intragastric balloons must meet these criteria:

  • Are at least 22 years old
  • Are at least 30 pounds overweight
  • Are willing to participate in a medically supervised weight loss program
  • Have no previous weight loss surgery
  • Do not have an eating disorder
  • Do not have poorly-controlled stabilized diabetes type II
  • Do not have heart burn symptoms when taking heart burn medications
  • Have attempted weight-loss through diet and exercise without success
  • Have not been diagnosed with ulcers in the stomach or small intestines
  • Have not been diagnosed with severe chronic obstructive pulmonary disease (COPD)
  • Have not been diagnosed with inflammatory bowel disease
  • Have not had previous surgeries on the stomach
  • Are not on blood thinners or nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, Aleve)

Lifestyle therapy

Lifestyle therapy helps you make long-term changes to maximize the weight loss you see with intragastric balloons and helps you keep the weight off. All of the intragastric balloon packages include Lifestyle therapy.

The components of Lifestyle therapy include:

  • Diet
  • Exercise advice
  • Behavior coaching
  • Lifestyle therapy will be administered by a team including your physician, registered dietitian, and behavior coach throughout the 12-month program.
  • 6 months with the balloons in place.
  • 6 months after the balloons are removed.

Aspiration therapy involves use of the AspireAssist device. This device is made up of various components that create a pathway to allow aspiration of gastric contents out of the stomach for external disposal.

Am I a candidate?

Candidates for aspiration therapy must meet the following criteria:

  • Are at least 50 pounds overweight
  • Have not been able to lose weight or maintain a weight loss with diet and exercise alone
  • Do not have a stricture in your esophagus, inflammatory bowel disease, severe gastroparesis, or a blockage in your stomach
  • Do not have stomach ulcers that wouldn’t heal in the past or ulcerations in your stomach now
  • Do not have uncontrolled high blood pressure
  • Do not have severe heart failure
  • Have normal blood clotting
  • Do not have anemia
  • Are not pregnant or lactating
  • Have not been diagnosed with an eating disorder
  • Do not have chronic abdominal pain
  • Do not have cirrhosis in your liver or severe kidney disease

This procedure creates a sleeve in the stomach without any external incision. Sutures are placed in the stomach during an endoscopic procedure to reduce the size of the stomach and change the shape of the stomach into a sleeve. No external incisions are made, and most patients go home the same day as the procedure.

Am I a candidate?

Candidates for this procedure must meet these criteria:

  • Are at least 22 years old
  • Are at least 30 pounds overweight
  • Are willing to participate in a medically supervised weight loss program
  • Have no previous weight loss surgery
  • Do not have an eating disorder
  • Do not have poorly-controlled diabetes type II
  • Do not have heart burn symptoms when taking heart burn medications
  • Have attempted weight-loss through diet and exercise without success
  • Have not been diagnosed with ulcers in the stomach or small intestines
  • Have not been diagnosed with inflammatory bowel disease
  • Have not had previous surgeries on the stomach

Endoscopic gastric bypass revision is for patients who have regained weight lost after a Roux-en-Y Gastric Bypass procedure. This is an outpatient procedure that takes about an hour.

If the outlet is found to be dilated during endoscopy, it can be restored endoscopically (without surgery). This is called transoral outlet reduction (TORe). The outlet is sutured to a smaller size – the size it was after the gastric bypass – which can restore satiety (fullness). The procedure has proven effective for stopping weight regain or inducing weight loss in a high-quality randomized trial (RESTORe). More recently, with more advanced devices, the procedure has shown meaningful weight loss.

During the endoscopic procedure, we use a suturing device to tighten the connection between your gastric pouch and small intestine. This makes you feel full earlier in a meal to help you eat less.

Complications after bariatric surgery include abdominal pain, bleeding, ulcers, fistulas and leaks, strictures, weight regain, lap band slippage and erosion, and biliary stones.

NAGE’s Metabolic and Bariatric Endoscopy program uses a multi-disciplinary approach for management of these problems with involvement of gastroenterologists, surgeons and radiologists.

Many of these complications after weight loss surgery can be managed endoscopically, often without need for another surgery:

  • Post bariatric surgery fistulas and leaks can be managed with endoscopic suturing, stents, and drains; while strictures can be treated with endoscopic dilation, stent therapy or stricturoplasty.
  • Lap-bands that have slipped or eroded into the digestive tract can also be removed endoscopically.
  • Bile duct stone formation after rapid weight loss from gastric bypass presents a unique challenge due to the difficulty in endoscopic access to the bile duct in these patients due to surgically altered anatomy.

Our interventional gastroenterologists are experienced in specialized enteroscope-assisted ERCP procedures or lap-assisted ERCP that may be required in these situations.