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Obesity is a complex chronic disease that has reached pandemic levels and requires long-term, multispecialty management. Roberto Simons-Linares, MD, Director of Bariatric Endoscopy at Cleveland Clinic, joins Butts and Guts to discuss treatment options and the personalized care provided in our Bariatric Endoscopy Program.

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All About Cleveland Clinic's Bariatric Endoscopy Program

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi everybody. And welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, I'm very pleased to welcome Dr. Roberto Simons-Linares, who is the Director of Bariatric Endoscopy in Cleveland Clinic's Digestive Disease and Surgery Institute. We're going to talk a little bit about today exactly just that, Bariatric Endoscopy Program. Roberto, thanks so much for joining us here on Butts and Guts.

Dr. Roberto Simons-Linares: Thank you so much. Dr. Steele, it's a pleasure.

Dr. Scott Steele: So give us a little bit about your background, where are you from, where do you train, how did to the point that you're here at the Cleveland Clinic?

Dr. Roberto Simons-Linares: I'm South American. I grew up, I always joke about in the middle of the Amazon Rainforest with monkeys and palm trees. And then, I actually was lucky to start my medical studies there and then I went to Stratford University in France. I finished med school there, and then I came to the U.S. I've done on my training here at Cleveland Clinic, GI advanced endoscopy. And then I was lucky to train in bariatric endoscopy at the Brigham's Hospital in Boston.

Dr. Scott Steele: That's fantastic, and we're so glad that you're able to come back here to join us. And so on today's episode, we're going to discuss Cleveland Clinic's Bariatric Endoscopy Program. So to start, give us that 10,000 foot overview. What is bariatric endoscopy and what does this surgery entail or procedure entail? How does this technique differ from other bariatric surgery procedures?

Dr. Roberto Simons-Linares: So I think we should start by defining endoscopy itself for the audience. So endoscopy is a minimal invasive procedure, scarless or incisionless, where we use technology of an endoscope, which is a small, flexible tube that has a camera at the tip. And that allow us to place small tools and actually deliver treatments or therapies in bariatric endoscopy. So we use endoscopy, which is this flexible endoscope, go through your mouth, inside your esophagus, stomach, first portion of endoluminum, and be able to deliver therapies that are for weight loss and improvement of metabolic diseases. And I like to call them endoscopic bariatric metabolic therapies, which are EBMTs.

Dr. Scott Steele: So along those lines, who is the ideal candidate for this type of procedure or surgery and are there different types of patients who could benefit from this treatment?

Dr. Roberto Simons-Linares: Absolutely. Obesity as a disease is a complex disease. It's not a cosmetic problem, but it's a real disease. And we divide and obesity as a disease in class one, class two, and class three. We use one of the tools to diagnose that, is called the body mass index, or BMI. In a nutshell, if you do not qualify for bariatric surgery, which is patients with obesity class three or obesity class two with comorbidities, then you are left with nonsurgical candidates such as obesity class one or class two without comorbidities. So those are the ideal candidates where before the time of bariatric endoscopy, those patients who do not qualify for surgery, will be left with only medications as an option. And lifestyle modification is a cornerstone throughout the treatment of obesity, regardless of other interventions. So the ideal candidate will be those patients with obesity class one or two. Now, having said that, less than 1% of patients who actually qualify for bariatric surgery actually get surgery. So there's still room to actually meet our patients need, preferences to try to basically beat this obesity pandemic.

Dr. Scott Steele: So go into a little bit more in terms of the other sides, restriction for those who qualify. Is there a age limit to this? Is there a weight limit either on the low or the high side? And what about overall health for these type of procedures and how does that differ from, for example, a sleeve gastrectomy?

Dr. Roberto Simons-Linares: Honestly, I love the Cleveland Clinic approach. I'm so lucky to be in integrated in this weight management team, where we really tackle obesity. Not only as I said as a cosmetic disease and not only as a physical maybe, metabolic disease, but also there's other factors. So if someone qualified, we always assess for any, for example, eating disorders, any other psychological factors. We have a wonderful team of psychologists will help us with that, and patient will benefit from basically a multidisciplinary approach, rather than just a quick procedure or a quick surgery. So other things to consider are obviously, other diseases of the upper GI tract where we're enabled to perhaps, put a enterogastric balloon or suture and create an endoscopic sleeve. So those are things that we go over in clinic, where we assess the overall health and the status of the patient. Now, is not one size fits all, Dr. Steele.

So we try to really personalize the care. For example, patients may have different priorities, different needs. Such as get to a try transplant surgery, get to a hip replacement where they may not need to lose that much weight to start with. So that's where we also enter the field where they may not be an ideal candidate to get a gastric bypass for example, but they really need that hip replacement. Their hips are just about to give up and we need to give them some weight loss to actually get through that surgery, improve their overall health. And that's where bar endoscopy procedures can play a very important role.

Dr. Scott Steele: So now that we've got a little bit of background about the program itself, how does somebody find you guys and what happens? How does it become a part of this program?

Dr. Roberto Simons-Linares: Calling our programs number, which is a 216.444.8460. And we're updating our website so stay tuned and there will be multiple resources there to also actually get in touch with us and basically come see us in clinic where you see dietitians and you will see also psychologists, and basically anything that you actually need at that point. We work with endocrinologists, cardiometabolic cardiologists that we are able to meet all our patients needs to improve the overall obesity. As I said, it's no one size fits all. Obesity's a long-term disease that is hard to beat. And I always tell my patients, "There's no magic endoscopy procedure, or medication, or even surgery. This is all going to be your hard work. And the rest are tools for you to use, and we are here to guide you to use those tools in the best way. And many times, we need combination therapy." So we really personalize the care of each patient that comes and see us.

Dr. Scott Steele: That's fantastic. So Truth or Myth. With recent surgical advances, weight loss surgery is extremely safe. Truth or Myth?

Dr. Roberto Simons-Linares: It's truth, because it's very safe to get surgery or endoscopic procedures. Yes.

Dr. Scott Steele: So what are some of the risks of this program? You have to know going into it that not everything always straightforward, that some complications can occur. What are they?

Dr. Roberto Simons-Linares: Absolutely. So like in any procedure or endoscopic procedure, there's a small risk. The overall risk of perhaps for example, endoscopic sleeve gastroplasty, the most effective bariatric endoscopic procedure. Multiple studies show less than 2%, and those are things like bleeding, infection, poking a hole unintentionally, a leak, but those things again, are very safe. Less than 2% in overall status, which is pretty safe. Now, it depends as I said, on the personalized patient and we go over everything in detail and we are very transparent. Like you said, it's not to scare patients, but it's to make them aware to take an informed decision. And like I say to all my patients, "I treat you like my own family member. If you were my brother, my mom, this is what I will do." Keeping things transparent, really meet those needs that patients are looking for, and make them feel really entrusted, because they're entrusting us their health. So we go over all that.

Dr. Scott Steele: Truth or Myth: If you diet and exercise, you don't really need any of these procedures or surgery.

Dr. Roberto Simons-Linares: Well, I think it's a myth because we do have one really good study called the look ahead trial. And basically in 10 years of intense lifestyle modification... And this is intense coaching with different really psychological dietitian and exercise schedule. In 10 years, they have to stop this trial, which is the best evidence we have until now. People only... Patients lose about 6% during all that time. So, that is not enough to improve your health, to decrease. And the most important, is decrease cardiovascular risk and mortality or risk of dying from these complications of obesity. It did not help. So that tell us that just diet and exercising that is not going to cut it. So we need to really go and help you and give you more tools.

Dr. Scott Steele: Final Truth or Myth here. You can't have children... For our younger obese patients, you can't have children after weight loss surgery. Truth or Myth?

Dr. Roberto Simons-Linares: Myth. Actually, fertility will improve with weight loss and your overall health. We have quite a few patients that are struggling with that. And many times, fertility experts will recommend, "You know, you need to lose some weight." That's actually a total myth, it's actually going to help you.

Dr. Scott Steele: That's fantastic. So how do you see Cleveland Clinic's Bariatric Endoscopy Program expanding in the future in terms of either new surgical techniques, faster recovery, advances research, where are you taking this program?

Dr. Roberto Simons-Linares:Yeah. So we are really personalizing care for all the patients. Integrating with our surgeons, our obesity medicine specialists, and actually trying to, with this minimal invasive procedures, to actually reach more patients. And our goal with this new line of service, new actual spectrum of procedures... I said before, it was surgery or medication. Now, we have endoscopy kind of in that sweet spot in between, and we're hoping to continue to growing and reach more patients and actually beat obesity. That's our whole motivation and passion to actually help more patients. And we're working on that very closely with the whole team.

Dr. Scott Steele:So now, it's time for our quick hitters where we'll go over a few questions to get to know you a little bit better. So what's your favorite food?

Dr. Roberto Simons-Linares:Well, favorite food is a Brazilian food called feijoada.

Dr. Scott Steele:For our listeners who aren't as familiar, what is that?

Dr. Roberto Simons-Linares:It's like a stew with multiple meats and chorizo, beans, and a little bit of farofa, or kind of like a powder made of yuca, which is like a potato in South America.

Dr. Scott Steele:Fantastic. What's your favorite sport to play or to watch?

Dr. Roberto Simons-Linares:Soccer. I'm a crazy soccer fan. I used to play it. And whenever I get a chance, I'm trying to follow what's going on there in soccer. My favorite team is the Real Madrid in Europe in Champions League.

Dr. Scott Steele:Fantastic. And so tell us about a place or a memorable place that you were able to travel to.

Dr. Roberto Simons-Linares:There is a small place in South America where I'm from, it's called Titicaca Lake. It's the biggest lake at the high altitude in Bolivia. It's shared between Bolivia and Peru and it's a very mystic place. It gives you that piece of, really meditation place. I can never really explain in words, you guys have to go there and find it by yourself, by your own.

Dr. Scott Steele:Wow. I'll definitely have to look it up. I'll go through it next time I see you and then finally, you've lived all around the world. Why don't you tell us something that you enjoy about here in beautiful Northeast Ohio?

Dr. Roberto Simons-Linares:Well, as I was saying, there's still... I grew up in the Amazon Rainforest, so I'm an outdoor person. So I love the Metro parks, hiking, being outdoor. That's really my passion. And whenever I get a chance, I just like to be outdoor. Even if I have to work and I can do it outside, I will choose that a million times. So I love that from Cleveland in Northeast Ohio.

Dr. Scott Steele:Well, we're glad to have you here. And so what's a final take home message for our listeners regarding this bariatric endoscopy program?

Dr. Roberto Simons-Linares:We're looking forward to taking care of you all, because the first step is to really recognize that this is not a cosmetic problem. This is your health. Come see us, we'll guide you through it. We really have all the tools available and we're really looking forward to connecting with you, taking care of you like our own family. So, that's our mission. That will be my main message. Come see us. We're here for you, we'll walk this with you together. We'll beat obesity together.

Dr. Scott Steele:Well said. So remember the first step in your weight loss journey is participating in our free seminar to learn about endoscopic weight loss options. You'll meet our patient navigators, as well as what to expect before, during, and even after the endoscopic procedure. So to watch our seminar, visit;clevelandclinic.org/bariatrics. That's Cleveland clinic.org/B-A-R-I-A-T-R-I-C-S, bariatrics. And to make an appointment with a bariatric and metabolic institute specialist, please call 216.444.8460. That's 216.444.8460. And again, you always hear me say it but please remember it's important for you and your family to continue to receive medical care, regular checkups, and screenings. And rest assured here at the Cleveland Clinic, we're taking all the necessary precautions to sterilize our facilities and protect our patients and caregivers. Roberto, thanks so much for joining us here on Butts and Guts.

Dr. Roberto Simons-Linares:Thank you so much, Dr. Steele. It's been a pleasure and an honor.

Dr. Scott Steele:That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.

Butts & Guts

Butts & Guts

A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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