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Tidbits@bariatricsupermarket.com
PROMISING NEW TECHNOLOGIES IN BARIATRICS
In a recent article in Bariatric Times (a peer-reviewed newsletter) Dr. Shikora discussed emerging technologies for bariatric and metabolic surgeries. Here is a summary of what the article discussed.
As noted in the article, keep in mind as you read this, that although all these procedures sound very exciting and promising, currently none of these new technologies have been adequately studied to warrant introduction into practice. Only time will tell which procedures will be deemed worthy to use.
INTRAGASTRIC BALLOONS
Weight loss achieved by placing a balloon into the stomach to occupy space and decrease the capacity of the stomach. This was first introduced in 1980 but was short-lived due to poor weight loss and the development of serious complications. Recently, gastric balloons have resurfaced. Studies have shown achieved 25-35% excess weight loss with few complications. It is not currently FDA-approved in the US but there are several other balloons available worldwide.
MECHANICAL GASTRIC BANDS
LAP Banding is one of the most popular bariatric surgical procedures in the world. Currently band adjustments require needle punctures for the instillation of saline in to the band. This procedure can be painful, lead to bleeding and infections. The adjustment of the band can also be prone to inaccuracy. In the future, LAP bands may contain a “watch” motor that can easily be adjusted by radio frequency.
NATURAL ORIFICE SURGERY
This type of surgery refers to operating via natural openings such as the mouth, anus or vagina. This would allow surgery without incisions, postoperative pain and scars. This may be used to place LAP bands, and perform surgeries like the vertical sleeve gastrectomy and Roux-en-Y gastric bypass. To date, there are reports of cholecystectomies being preformed vaginally. But better data from a greater number of patients with longer follow-up is needed to prove that natural orifice surgeries are truly safe and efficacious.
ENDOSCOPIC GASTROINTESTINAL SLEEVES
Unlike the current Sleeve Gastrectomy being performed, this procedure would not involve any cutting or removal of the stomach. The device is a soft, 60 cm sleeve that is deployed with an endoscope. The device is anchored into the stomach and extended down into the small intestine. Small studies that have been done with diabetic subjects, showed a 23.6% excess weight loss with discontinuation of hypoglycemic medications. It is currently not known, however, how long this sleeve can be safely left in the gastrointestinal tract. The mechanism of action is also not yet determined.
NEUROMODULATION
This uses an electrical pulse generator (similar to a heart pacemaker) to deliver patterned electrical impulse to a target in the gastrointestinal tract. The target could be the stomach, the intestine, etc. The impulse can be used to stimulate or enhance the normal electrical activity or block it. Several animal studies have shown that this could result in a reduction of food intake and weight loss. However, the exact mechanism of action has not yet been determined. The human trials that have been conducted involved two gastric stimulation systems that were implanted into the wall of the stomach. Unfortunately, not all subjects responded , making this technology not yet consistently effective.
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