For people who need to lose a significant amount of weight, but who don’t qualify for weight-loss surgery, Wyoming Medical Center offers non-surgical, outpatient procedures.

These procedures are done endoscopically, that is with small, tubular instruments inserted down the throat and into the stomach. Patients typically go home on the same day of the procedure. No surgical incisions are required.

Like all weight-loss plans, surgeries and procedures, these are tools to help you pursue a healthier lifestyle. A commitment to healthy diet and exercise habits are required for long-term success.


Non-surgical procedures like those listed below may be appropriate for people with:

  • A BMI of 30 or more
  • A BMI of 25 or more on a case-by-case basis
  • An inability to achieve sustained healthy weight loss despite prior weight-loss efforts.

Determine your BMI using the CDC’s Body Mass Index Calculator.

  • Below 18.5 = Underweight
  • 18.5 – 24.9 = Normal
  • 25.0 – 29.9 = Overweight
  • 30.0 and Above = Obese

Weight-loss surgery may be appropriate for adults with a BMI of 40 or more, or 35 or more accompanied by at least one obesity-related health problem. See surgical options here.

Non-surgical weight-loss procedures


Gastric Balloon is an outpatient procedure offered in Wyoming only at Wyoming Medical Center.

Non-surgical options

The Orbera balloon is inserted through the patient’s mouth and into the stomach. The balloon is filled with saline and left in the patient’s stomach for six months, helping the patient feel full during meals and slowing digestion. Patients learn about portion control and how much food their bodies need for fuel.

Patients also undergo intensive dietary support, both while the balloon is in the stomach and for six months after it is removed. Like other weight-loss procedures, surgeries and programs, patients must commit to a healthier lifestyle for long-term success.

The amount of weight loss depends on the long-term changes to the patient’s diet and exercise habits. On average, patients with a gastric balloon lose 3 ½ times more weight than those who are on a diet and exercise program alone.

The Gastric Balloon is approved by the U.S. Food and Drug Administration. Some patients experience nausea or abdomen pain in the first week, but it can be managed with medication and typically resolves. The procedure is completely reversible, and there is no change in a patient’s anatomy like surgical options for weight loss.

Endoscopic sleeve gastroplasty (ESG)

The endoscope is inserted through the mouth and throat and sutures are used to create a thin stomach pouch that is shaped like a shirt sleeve. The smaller stomach pouch limits the amount of food that can be consumed at a sitting and decreases appetite. Unlike sleeve gastrectomy surgery, the excess stomach tissue is not removed, but is sealed off via the sutures.

Like the Gastric Balloon, patients getting an endoscopic sleeve will undergo intensive dietary support for at least a year. Long-term success requires a lifetime commitment to healthy diet and exercise habits. On average, patients can expect to lose 15 to 25 percent of their total body weight with endoscopic sleeve gastroplasty.

Non-surgical revisions

While laparoscopic Roux-en-y Gastric Bypass is still considered the gold-standard in weight-loss surgery, some patients do regain the weight over time or experience complications such as leakage at the connection sites.

Wyoming Medical Center offers non-surgical endoscopic revision procedures for patients who have previously had either a gastric bypass or sleeve gastrectomy surgery.


This is a non-surgical option for people who have already undergone a gastric bypass operation in the past, but have not been able to maintain the weight loss. In some patients, the small egg-sized stomach pouch created in the original surgery can stretch or reconnect to the larger stomach portion that was bypassed in the surgery. Other patients might have complications with their previous surgery that can be fixed through endoscopic revision.

The revision procedure is done with an endoscope, inserted through the mouth and into the stomach, so there are no surgical incisions. The physician uses sutures to re-create the egg-sized stomach pouch and to fix any complications that have developed. This is an outpatient procedure and no hospital stay is required.


Patients who have gained significant weight after a Sleeve Gastrectomy may undergo an endoscopic sleeve revision, or may opt for an endoscopic bypass revision.

For some patients, the stomach “sleeve” stretches over time reducing the effectiveness of the surgery. An endoscopic revision can reshape the stretched stomach sleeve and make it smaller, without an incision or hospital stay.

Julien Fahed, M.D.

Non-surgical options

Julien Fahed, M.D., is a board-certified gastroenterologist specializing in advanced bariatric endoscopic procedures. He helped expand the Bariatric Program at Wyoming Medical Center by offering new non-surgical, weight-loss procedures including Gastric Balloon and Endoscopic Sleeve Gastroplasty. He also offers endoscopic revisions for previous Gastric Bypass and Gastric Sleeve surgeries.

Wyoming Medical Center is proud to deliver big city bariatric care close to home. Our Comprehensive Bariatric Center is the only such center to be accredited in the state.

To learn more about our non-surgical, endoscopic weight-loss procedures, schedule a consultation with Dr. Julien Fahed. Call (307) 233-2700.