Singapore, 10 September 2020 – Ms Nur Shahida Suhaimi has been trying without success for a third child as her dream is to have a big family. At her doctor’s advice, the 35-year-old who weighed 106kg tried losing weight to up her chance of conceiving. That proved to be a big challenge as Ms Shahida’s weight refused to budge despite diet and exercise under supervision. Having had two previous caesarean delivery, she was not keen to undergo bariatric surgery.

Each year, 50 per cent of patients seen at the Obesity Centre (formerly known as the Obesity and Metabolic Unit) at Singapore General Hospital (SGH) are like Ms Shahida who declined weight loss surgery despite meeting the criteria of having a body mass index (BMI) above 32.5. There are also those who are not recommended due to high surgical risk, or do not qualify for bariatric surgery.

The Centre now offers two non-surgical weight loss options to help these patients – ingestible gastric balloon, and endoscopic sleeve gastroplasty (ESG).

"Besides fertility issues, we have had overweight patients coming to the Obesity Centre, wanting to lose some weight so that they can better manage their chronic conditions, or simply to avoid the onset of illnesses such as diabetes. But for one reason or another, they were unable to do so after exhausting many options, and do not want, or cannot have, bariatric surgery," said Dr Lim Chin Hong, Consultant, Department of Upper Gastrointestinal & Bariatric Surgery, SGH.

"However, the ingestible gastric balloon and endoscopic sleeve gastroplasty are not quick fix solutions. Like other weight loss procedures, patients need to be committed to a healthier lifestyle, and be supported by a team of experts, including dietitians, psychologist and physiotherapists, to keep the weight off."

Ingestible 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 swallow a gastric balloon with just a glass of water. No surgery, endoscopy, or anaesthesia is required, and she was fully awake throughout the procedure which took about 20 minutes at SGH’s Ambulatory Endoscopy Centre.

The balloon was in a capsule attached to a thin catheter. Once an x-ray confirmed that the capsule was in the stomach, her doctor filled the balloon with 550ml of purified water via the catheter which was later removed. After 16 weeks, the grapefruit-sized balloon will empty the water via its time-activated release valve, and passed out naturally. Ms Shahida has lost nearly 15 kg so far as the balloon has reduced her food intake, and will likely lose another five to 10 kg in next two months. She has also become more mindful of her food choices.

Endoscopic Sleeve Gastroplasty (ESG)

For patients who prefer a more permanent, yet reversible, option than the balloon, they can consider an endoscopic sleeve gastroplasty (ESG). It is performed using an endoscope attached with an endoscopic suturing or stitching device inserted down the throat into the stomach. Surgeons will stitch up the stomach using about six to 12 stitches to reduce its size by about 70 per cent. This will restrict the amount of food patients can eat.

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

The one-hour procedure is performed under general anaesthesia inside an operating theatre. It carries a lower risk of complications compared to similar stomach shrinking procedures such as vertical sleeve gastrectomy done laparoscopically (keyhole), and allows patients to return to daily activities sooner.

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