New treatment options spare people who need to lose weight the knife.

Ms Nur Shahida Suhaimi needs to lose weight if she hopes to have a third child. After trying unsuccessfully to diet and exercise, she was offered bariatric surgery. But after two deliveries by Caesarean section, she was not keen to undergo another invasive procedure. Meanwhile, Mr Desmond, another overweight patient, did not qualify for surgery.

The two are not unique. About half of patients seen at Singapore General Hospital’s (SGH) Obesity Centre (formerly known as the Obesity and Metabolic Unit) meet the criteria of having a body mass index (BMI) of at least 32.5, but cannot or will not sign on for bariatric surgery — which involves making changes to the digestive system to lose weight, and is offered when medication, diet and exercise have not worked, or when the person has serious health issues because of his weight.

There are those who, like Ms Shahida, have exhausted non-surgical options. Some are not eligible because of surgical risks, or do not qualify for bariatric surgery. For these patients, the Obesity Centre offers two non-surgical weight loss options to help them — ingestible gastric balloon and endoscopic sleeve gastroplasty (ESG).

“However, the ingestible gastric balloon and ESG are not quick-fix solutions,” said Dr Lim Chin Hong, Consultant, Department of Upper Gastrointestinal and Bariatric Surgery, SGH.

“Like other weight-loss procedures, patients need to be committed to a healthier lifestyle, and be supported by a team of experts, including dietitians, psychologists and physiotherapists, to keep the weight off.”

New gastric balloon

Conventional gastric balloons require patients to be sedated so that an inflatable balloon can be placed inside the stomach via endoscopy, where a flexible tube with a video camera is passed down the throat.

In June 2020, Ms Shahida became the first patient in SGH to undergo the ingestible gastric balloon procedure. This involves the patient swallowing a gastric balloon with just a glass of water. The balloon is in a capsule attached to a thin catheter. Once an x-ray confirms that the capsule is in the stomach, the balloon is filled with 550ml of purified water via the catheter (to feel full), and is later removed. After 16 weeks, the grapefruit-sized balloon will empty the water via a timeactivated release valve, and is passed out naturally.

<<The patient swallows the gastric balloon in a capsule attached to a thin catheter with a glass of water.>>

 <<Once an x-ray confirms that the capsule is in the stomach, the balloon is filled with 550ml of purified water via the catheter, which is later removed. The grapefruit-sized balloon will empty the water via a time-activated release valve and is passed out naturally after 16 weeks.>>

No surgery, endoscopy or anaesthesia is required. Ms Shahida was fully awake throughout the procedure, which took about 20 minutes at SGH’s Ambulatory Endoscopy Centre.

“For two to three days, I could only drink water (instead of a liquid diet),” said Ms Shahida, adding that she recovered after a week. She now eats small portions of food, more slowly than before, and exercises at least 10 minutes every day. She has cut out carbohydrates, eating mostly protein.

“It is really about transforming your life. We will try for another child. Weight is not a factor against me, and I am all ready to go through the in vitro fertilisation (IVF) process to be pregnant again,” said Ms Shahida.

Stitching the stomach

ESG is performed using an endoscope fitted with a suturing or stitching device at the tip. The surgeon inserts the device down the patient’s throat and into the stomach, where he makes six to 12 stitches to the stomach to reduce its size by about 70 per cent. This restricts the amount of food the patient can eat. If the patient chooses to reverse the procedure afterwards, the stitches can be cut and the stomach will return to its original size.

Since undergoing ESG in 2019 at SGH under a pilot programme, Mr Desmond has shed 20kg. He has struggled with weight issues since he was young, and weighed 108kg at his heaviest. Like Ms Shahida, the diet and exercise plan he was prescribed did not help. Furthermore, he did not qualify for bariatric surgery.

<<Although diet and exercise failed to help Mr Desmond, he managed to lose 20kg after undergoing endoscopic sleeve gastroplasty.>>

SGH performed its first ESG procedure in August 2019. The one-hour procedure is performed under general anaesthesia. It carries a lower risk of complications compared to other stomach-shrinking procedures, such as vertical sleeve gastrectomy done laparoscopically (keyhole), and allows patients to return to daily activities sooner.

Mr Desmond stayed in hospital for three days. He then rested at home for one day and went back to work the day after. He resumed gym activities the following weekend.

ESG usually results in weight loss of 15 to 18 per cent in one year, according to overseas studies.

“Before that, my weight was 107kg. Now I am at 87kg. During my first consultation with Dr Lim, my blood pressure was on the high side. It has also gone down,” said Mr Desmond.