Transoral Stapling Benefits the Morbidly Obese

A new stapling device that is guided into the stomach endoscopically may help morbidly obese patients for whom non-surgical attempts at weight loss, such as diet and exercise, have failed.

Researchers from Washington University (St. Louis, MO, USA) conducted a pilot study of 12 patients with a history of morbid obesity for at least two and one-half years who underwent transoral gastroplasty (TOGa). All participants were eligible for bariatric surgery according to the U.S. National Institutes of Health (NIH) guidelines, i.e., a body mass index (BMI) higher than 40 or higher than 35 for patients with one or more co-morbidities. Of the 12 participants, 10 were female. The average age was 43, and the average BMI was 44.

After undergoing the procedure under general anesthesia, patients were put on a liquid diet and asked to begin an exercise program. No serious adverse events were reported during or after the procedure. However, minor adverse events included vomiting, posterior pharyngeal pain, temporomandibular joint dysfunction, and post prandial fullness. Each of these was experienced by one participant, and all the events were transient. All patients had significant weight loss at one month of follow-up, with an average weight loss of about 8 kg. The results were reported at the American College of Gastroenterology meeting, held in October 2006 in Las Vegas (NV, USA).

The TOGa transoral stapling device was developed by Satiety Incorporated (Redwood City, CA, USA). The device grabs opposite sides of the stomach lining, holds them together, and inserts a line of staples to partition and shrink the active portion of the stomach down to the size of a golf ball. The procedure takes 30 minutes, and the company claims it will reduce costs of bariatric surgery by 75%.

"Carefully designed long-term randomized controlled studies will be required to demonstrate the efficacy of this device for the treatment of morbid obesity,” said lead author Steven Edmundowciz, M.D. "Although the technique is certainly less invasive than other forms of bariatric surgery, it is not clear that it would be less expensive. We hope that it will be, but we have no idea where the prices will go.”



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