Dr. Eli Penn, a gastroenterologist practicing advanced endoscopy at East Georgia Regional Medical Center, is now performing two nonsurgical procedures aimed at helping people lose weight and keep it off. He is the only physician in the area performing these procedures.

In the intragastric balloon process, a balloon of durable inert material is placed in the patient's stomach, inflated with saline and left there for six months. During that time, the patient begins dietary changes and exercise, and support services including doctor visits continue for a full year.

The other type of procedure, endoscopic pouch and outlet repair, is for people who had gastric bypass surgery but for whom it no longer produces results. This procedure involves internal stitching, but is still considered nonsurgical because no cutting is involved, the work being done with an endoscope inserted through the mouth.

"It used to be that all doctors felt pretty helpless about obesity, and it's the most expensive healthcare problem in America," Penn said. "It's the number-one cause of liver disease leading to transplant. It causes diabetes, hypertension, sleep apnea, coronary artery disease. We had been helpless to tackle it until now. We finally have some nonsurgical options."

Requiring neither an incision nor stitches, the intragastric balloon has been used successfully in Europe for more than 20 years, he said. But the Food and Drug Administration did not approve it for use in the United States until 2015.

Penn, who came to Statesboro and East Georgia Regional Medical Center four years ago, is the first physician offering this program in a large area of eastern Georgia. The nearest other doctor doing it is in Brunswick.

"A whole lifestyle change is required, but we follow the patients for a year," Penn said. "We see them to ensure that they're meeting their goals."

The intragastric balloon is typically suggested for individuals with a body mass index of 30-40, considered obese but not morbidly obese. But it can also be recommended for patients who are not healthy enough for a gastric bypass, as a bridge until they are healthy enough for surgery, Penn said. The average weight loss is 22 pounds, but some patients lose more weight, even 40 pounds, he said.

"So for motivated people, who don't want surgery and sort of need a boost to get started, the balloon is a great tool," Penn said.

Placement of the balloon is entirely an outpatient procedure and actually takes about 15 minutes, he said.

A price tag of about $7,000 includes the procedures to place the balloon and remove it, 12 monthly visits to Penn's office, consultations with a nutritionist and online support. Penn's staff can also refer patients to personal trainers, he said.

Insurance does not yet cover this procedure, but financing is offered through a finance company.

Nurses try it

Two of Penn's first five intragastric balloon patients are licensed practical nurses who work in his office.

Breanna Adams, LPN, is 24 and going back to school to be a registered nurse. She weighed 178 pounds before having the balloon put in May 20. By the last week of July she had lost 21 pounds. Other than diet pills, intragastric balloon is the first medical weight loss method she has tried.

"Now I'm never hungry," Adams said. "It's like you would do a weight loss plan and then diet pills for a little while and then go back to your old habits. Here, the balloon is in for so long you kind of get used to eating small portions."

Adams said she experienced a little nausea at first, but now doesn't have any problems. She is going to the gym a couple of times a week.

Candace Beaver, LPN, is 28 and had tried Weight Watchers, various diets and diet medications. With the balloon, she had already lost 25 pounds, from a previous weight of 249.

"It's been good," Beaver said. "I haven't gotten sick or anything like that. I exercise three or four days a week."

Both paid for the program. They said they knew about it because of where they work but were not given a special deal.

Gastric bypass repair

Endoscopic pouch and outlet repair is just for adults who have had gastric bypass surgery but have seen their eating habits and weight rebound to former proportions.

The bypass procedure called Rue-en-Y, which was the most common bariatric surgery about a decade ago, involves creating a small pouch at the top of the stomach, where the sense of fullness develops, and bypassing the rest of the stomach. Often after eight to 10 years, the pouch stretches, as does the outlet to the intestine, Penn said.

Using a special device that fits over a flexible endoscope, Penn sews sutures inside the digestive tract to repair the stomach pouch and reduce the size of the outlet. The outlet is typically reduced from about the size of a silver dollar to the size of a dime.

The first patient who had this done at East Georgia lost 51 pounds in the first six weeks, according to a hospital press release. After beginning this spring, Penn had performed this procedure on about 15 patients by the end of July, with excellent results, he said.

This does require a brief hospital admission, for observation to make sure the pouch is not too tight. But most people go home the morning after. Insurance plans cover pouch and outlet repair, which is more expensive than the intragrastric balloon program.

Not to be confused with a bariatric surgeon himself, Penn works closely with Dr. Matthew Musielak, a surgeon who does bariatric procedures at East Georgia, to figure out what is best for each patient, Penn said.

"What's amazing to me are the advanced procedures that can be done here, the procedures that are not done in Savannah, they're not done in Augusta, they may be done in Jacksonville or Atlanta, but here in our wonderful little town we can do some really advanced things that save the patients from more involved surgeries," said Cindy Simms, officer manager for Dr. Penn.

Herald reporter Al Hackle may be reached at (912) 489-9458.