Bariatric Times - June 2008 - (Page 29)

Bariatric Times • June 2008 Emerging Technologies 29 FIGURE 6. VBLOC Maestro generator and lead placement. (Courtesy of Enteromedics) FIGURE 7. The actual device now being used in the EMPOWER study. The round generator is implanted with the leads. The black “battery” is worn on a belt to power the device. (Courtesy of Enteromedics) term success. As with many of the endoluminal therapies, these devices are in varying stages of development; none of the techniques using these devices have been demonstrated to be efficacious. However, studies evaluating safety are ongoing for some of the devices. One technology company that may offer a combined approach to bariatric procedures is BaroSense (Menlo Park, California). They are developing techniques for transoral procedures for gastric restriction with or without combined malabsorptive devices for surgical weight loss. weight after gastrectomy and truncal vagotomy. As ghrelin is reduced after this operation, so is the appetite-stimulating effect, thereby making the neurohormonal mechanism of satiety appealing.22 There are pre-clinical publications in this area,23 but no clinical work has been published in this area. Devices of interest include the Valen TX, VBLOC, and TEVX by EndoVx. A large, multi-center study is currently being performed to evaluate vagal blockade (EMPOWER Study) as a means to promote weight loss (Figures 6–7). Outcomes studies of endoscopic vagotomy or pacing are appropriate targets for future research. surgical treatments for this complex disease. Adoption and implementation of any new technology should be based on safety, efficacy, and benefit over existing procedures. Nevertheless, techniques for endoluminal approaches are developing quickly, suggesting that the future of bariatric surgery can be appreciated by “looking inward.” 13. 14. 15. 16. REFERENCES 1. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health. Obes Res. 1998;6 Suppl 2:51S–209S. Centers for Disease Control. Available from: www.cdc.gov/mmwr/preview/mmwrhtml/mm553 6a1.htm?s_cid=mm5536a1_e#tab. Santry HP, DL Gillen, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909–17. Buchwald H, et al. Bariatric surgery: A systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. De la Fuente SG. New developments in surgery: Natural Orifice Transluminal Endoscopic Surgery (NOTES). Arch Surg. 2007;142(3):295–7. Schauer P, Chand B, and Brethauer S. New applications for endoscopy: The emerging field of endoluminal and transgastric bariatric surgery. Surg Endosc. 2007;21(3):347–56. Hogan RB. A double-blind, randomized, shamcontrolled trial of the gastric bubble for obesity. Gastrointest Endosc. 1989;35(5):381–5. Gostout CJ, Rajan E. Endoscopic treatments for obesity: Past, present, and future. Gastroenterol Clin North Am. 2005;34(1):143–50. Wahlen CH. The BioEnterics Intragastric Balloon (BIB): How to use it. Obes Surg. 2001;11(4):524–7. Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment-resistant obesity: Safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005;61(1):19–27. Malik A. Endoluminal and transluminal surgery: Current status and future possibilities. Surg Endosc. 2006;20(8):1179–92. Awan, A.N. and C.P. Swain, Endoscopic vertical 17. 18. 2. NEUROLOGIC AND ELECTROMOTOR TECHNIQUES Gastric pacing has been shown to have effect as a weight loss procedure in some patients.21 Several companies are working to develop endoscopically-placed pacing systems. Some of the devices include the Medtronic Implantable Gastric Stimulator (IGS), the Tantalus Meal activated device, and Intrapace. All of these procedures are being studied, but there is currently no published data available. Laparoscopic truncal vagotomy (and/or blockade) has been suggested as a less invasive approach to morbid obesity.11 Historically, it has been demonstrated that patients with peptic ulcer disease temporarily lose 3. 19. LOOKING INWARD FOR FUTURE SURGICAL OPTIONS The future possibilities of bariatric surgery are rich as many new techniques and devices for weight loss surgery are being developed and employed. In general, the majority of these techniques focus on proven surgical concepts of restriction and malabsorption, but with a less invasive approach. Fueling development of these advances is the tremendous need for safer, more effective, and lower cost treatments for the millions of people afflicted with obesity and its confounding medical illnesses. Surgical approaches will continue to be an important treatment modality given the poor record of non- 4. 5. 20. 6. 21. 7. 22. 8. 23. 9. band gastroplasty with an endoscopic sewing machine. Gastrointest Endosc. 2002;55(2):254–6. Deviere J. Safety, feasibility and weight loss after transoral gastroplasty: First human multicenter study. Surg Endosc. 2008;22(3):589–98. Hu B. Transoral obesity surgery: Endoluminal gastroplasty with an endoscopic suture device. Endoscopy. 2005;37(5):411–4. Felsher J. A novel endolaparoscopic intragastric partitioning for treatment of morbid obesity. Surg Laparosc Endosc Percutan Tech. 2004;14(5):243–6. Thompson CC. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-enY gastric bypass: A possible new option for patients with weight regain. Surg Endosc. 2006;20(11):1744–8. Schweitzer M. Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Surg Tech A. 2004;14(4):223–6. Starpoli AA. Prospective feasibility study of gastrojejunostomy anastomotic size reduction by endoluminal gastroplication in patients with postgastric bypass recidivism. Gastrointest Endosc. 2005;61:AB240. Rubino F. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9. Rodriguez-Grunert L. First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve. Surg Obes Relat Dis. 2008;4(1):55–9. Cigaina V. Long-term follow-up of gastric stimulation for obesity: The Mestre 8-year experience. Obes Surg. 2004;14 Suppl 1:S14–22. Le Roux CW, Halsey TJ, Small CJ, et al. Ghrelin does not stimulate food intake in patients with surgical procedures involving vagotomy. J Clin Endocrinol Metab. 2005;90(8):4521–4. Yin J, Chen JD. Retrograde gastric electrical stimulation reduces food intake and weight in obese rats. Obes Res. 2005;13(9):580–7. 10. 11. ADDRESS FOR CORRESPONDENCE: Aurora D. Pryor, MD, 3116 N. Duke St., Durham, NC 27704; Phone: (919) 6602229; Fax: 919-660-2256; E-mail: Pryor002@mc.duke.edu. 12. In many cases, endoluminal revision may help minimize some of the difficulty in standard revisional surgery by AVOIDING ADHESIONS IN THE NEW OPERATIVE PLANE. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5536a1.htm?s_cid=mm5536a1_e#tab

Table of Contents Feed for the Digital Edition of Bariatric Times - June 2008

Bariatric Times - June 2008 Endoluminal Treatment Options for Morbid Obesity: Devices and Techniques for Natural Orifice Approaches The Multidisciplinary Approach to Weight Loss: Defining the Roles of the Necessary Providers Acute Bleeding after Gastric Bypass Editorial Message Contents ASMBS: 25 Years Editorial Board Surgical Site Infection In The Morbidly Obese Patient: A Review Consultant's Corner The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation Volume Matters Journal Watch Advertiser Index

Bariatric Times - June 2008

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