MN GI - Bariatric Endoscopy

Choose the Metabolic and Bariatric Endoscopy Program at Mayo Clinic in Rochester, Minnesota, for trusted experts and the latest in state-of-the-art, incisionless procedures. Our care goes well beyond weight loss, and we’re here to support you every step of the way.

We offer metabolic and bariatric endoscopic therapies — called endobariatrics — to improve your health, reduce or even eliminate the need for certain medications, and enhance your quality of life, including sleep, energy, and mood.

Endobariatric procedures may be a good option if you:

Tried nutritional and physical activity changes that didn’t work or weren’t sustainable.
Want to avoid long-term obesity medications.
Did not tolerate or see a response to obesity medications.
Are taking obesity medications and your weight loss stalled.
Saw weight return after you stopped taking obesity medications.
Saw weight return after bariatric surgery.
Worry that bariatric surgery is too invasive, drastic, or risky.
Want to avoid prolonged downtime for recovery after surgery.
Are tired of fad diets and weight loss trends.

Endoscopic sleeve gastroplasty (ESG): ESG is F.D.A.-authorized for adults with obesity who have a body mass index between 30–50 kg/m². ESG is a 60-minute procedure that involves suturing the stomach into a shorter, narrower tube (a “sleeve”) that is about 70–80% smaller than the original stomach. This helps patients feel full from a smaller amount of food and stay full for longer, promoting weight loss.

Patients typically lose around 15–18% of body weight within 12 months after ESG. The sutures are permanent, completely safe, and essentially become part of the stomach wall. ESG is a technically challenging procedure and should only be performed by those with extensive experience in endobariatrics.

Fundus ablation also cuts down levels of our hunger hormone, ghrelin, which is made in the surface lining of the fundus. Ghrelin is a potent appetite stimulator that rises during periods of fasting, stress, or sleep deprivation. Our bodies also adapt to weight loss by increasing ghrelin to maintain or increase body weight. By reducing ghrelin, we can help decrease the intensity of hunger and cravings, which supports weight loss.

In early trials with this combination of fundus ablation and ESG (GFMA-ESG), patients lost around 23–24% of their body weight within 12 months. GFMA-ESG is still investigational, and the procedure, which takes about 90 minutes, should only be performed by experienced interventional gastroenterologists.

Transoral outlet reduction (TORe): TORe is an FDA-authorized procedure for adults with a body mass index between 30–50 kg/m² who have seen weight come back after a gastric bypass surgery (specifically, Roux-en-Y gastric bypass). TORe involves endoscopic sutures to narrow the surgical connection between the stomach pouch and small intestine (called the gastrojejunostomy, stoma, or “outlet”), as well as to reduce the size of the stomach pouch itself. This helps improve fullness during and after meals and helps patients lose around 15% of their body weight within 12 months. TORe can also be used off-label to manage dumping syndrome.

Vertical sleeve gastrectomy revision (VSG-R). In the years after patients undergo a vertical sleeve gastrectomy (“surgical sleeve”), some patients experience weight and hunger increases after successful weight loss. This can be accompanied by dilation (stretching) of the surgical sleeve. We can revise this by narrowing and shortening the dilated sleeve, essentially performing a procedure similar to the endoscopic sleeve gastroplasty, called a vertical sleeve gastrectomy revision (VSG-R). VSG-R can be a meaningful alternative for patients looking to avoid surgical revisions or committing to long-term obesity medications. VSG-R helps patients lose about 15% of body weight within 12 months.

Small bowel therapies: The small intestine plays an important role in regulating what we absorb from our meals and our blood sugar, so it has been a target for emerging procedures in patients with obesity and/or type 2 diabetes. Our program offers various outpatient endoscopic procedures (e.g., bypass liners and ablation treatments) to patients with these conditions through clinical trials. If you have type 2 diabetes and would like to learn more about your options for small bowel therapies, please let us know.

Mayo Clinic is a leader in scientific inquiry, discovery, and innovation, especially in metabolic and bariatric endoscopy, including gastric mucosal ablation and small bowel therapies. Our team is consistently involved in studies that evaluate novel endoscopic treatments for obesity and related medical conditions, such as type 2 diabetes and metabolic dysfunction associated steatotic liver disease (“fatty liver disease”). We are actively recruiting for the following study:

Assessing the Safety and Efficacy of Endoscopic Intestinal Re-Cellularization Therapy in Individuals with Type II Diabetes

Clinical trials can provide patients access to cutting-edge treatments and help advance the field to help patients globally. If you are interested in participating in a clinical trial for weight loss or a related medical condition, let our team know, and we can review if you are a candidate for any ongoing trial or make you aware of upcoming trials at Mayo Clinic.

Endobariatrics isn’t just our expertise. It’s our passion.

Our program is led by Eric Vargas-Valls , M.D., M.S., and Daniel B. Maselli, M.D. Both are nationally recognized leaders in the field who publish widely, participate in clinical trials, lecture at scientific meetings, and teach other doctors how to perform endobariatric procedures.

Dr. Vargas and Dr. Maselli are advanced endoscopists and assistant professors in the Division of Gastroenterology & Hepatology at Mayo Clinic, as well as triple-board-certified in internal medicine, gastroenterology, and obesity medicine.

Get extra-specialized support, provided with compassion.

Advanced practice providers Maggi Gmehlin, P.A.-C., and Kathryn Swenson, APRN, C.N.P., D.N.P., M.S.N., have extensive experience managing patient care for advanced endoscopy, the most complex endoscopic procedures within the field of gastroenterology. They have further subspecialty training in endobariatrics, and provide dedicated, compassionate, and detail-oriented care to our patients before and after endobariatric procedures.

Our comprehensive approach is focused on long-term success.

Obesity is a complex, chronic disease. We offer comprehensive, long-term care by obesity and metabolic disease experts including endocrinologists, surgeons, dieticians, behavioral psychologists, exercise physiologists, advanced practice providers, and more.

Minimally invasive weight-loss options. Life-changing results.

Get world-class care in metabolic and bariatric endoscopy at Mayo Clinic in Minnesota.

Leaders in minimally invasive endoscopic procedures.

Get access to clinical trials for the latest treatments.

Most insurance plans accepted.

Meet your team.

Contact us to request an appointment.