Had an endoluminal sleeve procedure? Here’s what you should know

Over the past few years, you may have heard about the possibility of an incision free surgery called the endoluminal sleeve, EndoBarrier, or gastrointestinal liner. It is said to offer the same benefits of weight loss surgery but without the need for any incision, but how does it work and what are the risks?

What you should expect from an endoluminal sleeve operation

An endoluminal sleeve is a thin plastic sleeve, approximately 60 cm long which is implanted and removed under anaesthetic by way of the mouth. It is passed through the stomach to the upper part small intestine where it is fixed in place with a sprung metal anchor.

Once the endoluminal sleeve is in place, it creates a lining on the upper part of the small intestine along the first part of the jejunum and duodenum. This means that foods will not be digested within the upper part of the small intestine but will instead be absorbed further down. This, in turn, causes the body to alter its response to certain hormones which can result in changes in metabolism.

It is reported that patients who have had an endoluminal sleeve fitted feel fuller after a smaller meal which in turn leads to weight loss. Additionally, the endoluminal sleeve alters the way the body manages blood sugar and may therefore provide a solution for type II diabetes.

Whilst the endoluminal sleeve is advertised as being a safer option than a gastric bypass, it is not completely risk-free. In early trials of the device, a small percentage of patients found it became dislodged and had to be removed. Whilst the spring anchor device has since then been improved, there are still reports of device migration. Additionally, there is also, as with any procedure, a risk of infection or bleeding which can necessitate early removal of the device.

For patients undergoing an endoluminal sleeve procedure, it usually takes approximately 30 minutes and would be done as an outpatient appointment. Depending however on an individual’s health and situation it can take up to two hours.

The risks associated with an endoluminal sleeve

Because of the way in which the device is implanted, there are risks specific to the insertion and removal which can include:

  1. GI tract laceration (cut to the gastrointestinal tract which includes the oesophagus, stomach, small intestine, large intestine (colon), rectum, and anus)
  2. Oropharyngeal perforation (a hole or tear in the area of the throat just behind the mouth)
  3. Oesophageal perforation (a hole or tear in the throat)
  4. Gastric perforation (a hole or tear in the wall of the gastrointestinal tract)
  5. Bowel perforation
  6. Bleeding
  7. Aspiration (when you inhale food, stomach acid, or saliva into your lungs or when food travels back from your stomach to your oesophagus)
  8. Infection
  9. Sore throat
  10. Deep vein thrombosis
  11. Headache
  12. Dizziness
  13. Reaction to antibiotics
  14. Adynamic ileus (the failure of appropriate forward movement of bowel contents without any bowel obstruction being present)
  15. Hepatic abscess (an abscess within the liver)
  16. Pancreatitis (inflammation of the pancreas)
  17. Biliary disease
  18. Alopecia (hair loss)
  19. Abdominal pain
  20. GORD (gastroesophageal reflux disease, also known as acid reflux)
  21. Flank and back pain
  22. Hypoglycaemia (low blood sugar levels)
  23. Hyperglycaemia (high blood sugar levels)
  24. Diarrhoea
  25. Constipation
  26. Vitamin and mineral deficiencies
  27. Nausea and vomiting

The device can also cause the following additional complications whilst it is in place:

  1. Small bowel obstruction
  2. Bezoar (a mass that forms in the gastrointestinal system)
  3. Erosion
  4. Dehydration which could lead to compromised renal function
  5. Bloating
  6. Gastroenteritis
  7. Flatulence
  8. Oesophagitis (inflammation of the oesophagus)
  9. Pseudopolyps (projecting masses of scar tissue that develop from granulation tissue during the healing phase when there are repeated cycles of ulceration or inflamation. These are particularly common in individuals with irritable bowel disease)
  10. GI pain and cramping
  11. Peptic ulcer disease
  12. Duodenitis (inflammation of the first part of the small intestine just below the stomach)
  13. Local inflammatory tissue reaction
  14. Intestinal intessuseption (when part of the intestine folds into the section next to it. It typically will involve the small bowel although, less commonly, it can involve the large bowel)
  15. Hypotension (low blood pressure)
  16. Hypertension (high blood pressure)
  17. Adhesions (bands of scar tissue that form and can stick organs together)

If you experience any pain, nausea, vomiting or any other unexpected symptoms following the implantation of an endoluminal sleeve, it is vitally important to return to your doctor as soon as possible for a checkup and to discuss these.

Some patients find the endoluminal sleeve is sufficient to help with weight loss and control of type II diabetes whilst others will trial it before undergoing a gastric bypass or other surgical option.

What to expect after surgery

Medical professionals report that it is common to experience some discomfort after the procedure is performed but advised that typically, this discomfort would only be present for the first week or so. Eating too much may cause vomiting but there should not be any risk for dumping syndrome (when undigested food in the stomach is passed into the small intestine too fast. This process is accompanied by nausea and abdominal cramps).