Abstract
Endoluminal and transgastric procedures are evolving concepts that combine the skills and techniques of flexible endoscopy with minimally invasive surgery. Precisely how this technology and skill set will be applied in the field of general surgery is not yet known, but the treatment of obesity with an endoluminal or transgastric procedure holds great promise. As the demand for bariatric surgery increases, efforts will be directed toward developing less morbid and less costly treatment options that can provide substantial weight loss and resolution of comorbid conditions. Natural orifice bariatric procedures may include short-term weight loss in preparation for a definitive laparoscopic procedure, revisional procedures to reduce stoma or pouch size or repair fistulas, or primary therapy that provides durable weight loss. The latter application will undoubtedly appeal to patients and referring physicians if it can be performed as an outpatient procedure with significantly less morbidity than a laparoscopic procedure. Early preclinical and clinical work has been published in this area, but many technical obstacles must be overcome before a primary endoluminal or transgastric bariatric procedure can be offered. This article reviews the endoluminal and transgastric technology currently available, the endoluminal procedures currently performed, and the future of these technologies with respect to bariatric surgery.
Similar content being viewed by others
References
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and metaanalysis. JAMA 292: 1724–1737
Nguyen NT, Root J, Zainabadi K, Sabio A, Chalifoux S, Stevens CM, Mavandadi S, Longoria M, Wilson SE (2005) Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 140: 1198–1202
Hawes R (2006) ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. Gastrointest Endosc 63: 199–203
Kadirkamanathan SS, Evans DF, Gong F, Yazaki E, Scott M, Swain CP (1996) Antireflux operations at flexible endoscopy using endoluminal stitching techniques: an experimental study. Gastrointest Endosc 44: 133–143
Chen YK, Raijmann I, Ben-Menachem T, Starpoli AA, Liu J, Pazwash H, Weiland S, Shahrier M, Fortajada E, Saltzman JR, Carr-Locke DL (2005) Long-term outcomes of endoluminal gastroplication: a U.S. multicenter trial. Gastrointest Endosc 61: 659–667
Corley DA, Katz P, Wo JM, Stefan A, Patti M, Rothstein R, Edmundowicz S, Kline M, Mason R, Wolfe MM (2003) Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 125: 668–676
Deviere J, Costamagna G, Neuhaus H, Voderholzer W, Louis H, Tringali A, Marchese M, Fiedler T, Darb-Esfahani P, Schumacher B (2005) Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial. Gastroenterology 128: 532–540
Doldi SB, Micheletto G, Perrini MN, Rapetti R,(2004) Intragastric balloon: another option for treatment of obesity and morbid obesity. Hepatogastroenterology 51: 294–297
Spaulding L (2003) Treatment of dilated gastrojejunostomy with sclerotherapy. Obesi Surg 13: 254–257
European Patent Office. Retrieved October 2005 at www.european-patent-office.org
Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the supersuper obese patient. Obes Surg 13: 861–864
Cottam D, Mattar S, Sharma S, Thodiyil P, Bonomani G, Holover S, Sebastian J, Ramanathan R, Eid G, Schauer P (2006) Laparoscopic sleeve gastrectomy as an initial weight loss procedure for high risk patients with morbid obesity. Surg Endosc 20:859–863
Almogy G, Crookes PF, Anthone GJ (2004) Longitudinal gastrectomy as a treatment for the high-risk superobese patient. Obes Surg 14: 492–497
Sallet JA, Marchesini JC, Ribeiro MR, Pizani CE, Kamoto K, Sallet PC (2004) Utilization of the intragastric balloon (BIB) in preoperative preparation for superobese patients with high surgical risk. Presented at the 21st Annual Meeting of American Society for Bariatric Surgery p 69
Busetto L, Segato G, De Luca M, Bortolozzi E, MacCari T, Magon A, Inelmen EM, Favretti F, Enzi G (2004) Preoperative weight loss by intragastric balloon in superobese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg 14: 671–676
Livingston EH (2005) Complications of bariatric surgery. Surg Clin North Am 85: 853–868, vii
Thompson CC (2005) Per-oral endoscopic reduction of dilated gastrojejunal anastomosis following Roux-en-Y gastric bypass: a possible new option for patients with weight regain. SOARD 1: 223
Schweitzer M (2004) Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Surg Tech A 14: 223–226
Catalano MJ, George S, Thomas M, Geenen JE, Chua T (2004) Weight gain following bariatric surgery secondary to staple line disruption and stomal dilation: endotherapy using sodium morrhuate to induce stomal stenosis prevents need for surgical revision. Gastrointest Endosc 59: 149
Papavramidis ST, Eleftheriadis EE, Papavramidis TS, Kotzampassi KE, Gamvros OG (2004) Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 59: 296–300
U.S. surgical procedure volumes (2005) MedTech Insight 7: 136
Roman S, Napoleon B, Mion F, Bory RM, Guyot P, D’Orazio H, Benchetrit S (2004) Intragastric balloon for “nonmorbid” obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg 14: 539–544
Mathus-Vliegen EM, Tytgat GN (2005) 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 61: 19–27
Kelleher B, Stone C, Burns M, Gaskill H (2003) The butterfly procedure for endoluminal treatment of obesity. Gastrointest Endosc 57: AB186
Swain CP, Park P-O, Savides T, Kelleher B, Stone C, Burns M (2003) In vivo evaluation of the butterfly endoluminal gastroplasty procedure for obesity. Gastrointest Endosc 57: AB83
Fogel R, De La Fuente R, Bonilla Y (2005) Endoscopic vertical gastroplasty: a novel technique for treatment of obesity: a preliminary report. Gastrointest Endosc 61: AB106
Kantsevoy S, Jagannath S, Niiyama H, Chung S, Cotton P, Gostout C, Hawes R, Pasricha P, Magee C, Vaughn C, Barlow D, Shimonaka H, Kalloo A (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62: 287–292
Park A, Adrales G, McKinlay R, Knapp C (2004) A novel anastomotic device in a porcine model. Am Surg 70: 767–773
Swanstrom L, Kozarek R, Pasricha P, Gross S, Birkett D, Park PO, Saadat V, Ewers R, Swain P (2005) Development of a new access device for transgastric surgery. J Gastrointest Surg 9: 1129–1137
MacFadyen BV Jr, Cuschieri A (2005) Endoluminal surgery. Surg Endosc 19: 1–3
O’Brien PE, Brown WA, Smith A, McMurrick PJ, Stephens M (1999) Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 86: 113–118
Scopinaro N, Gianetta E, Adami GF, Friedman D, Traverso E, Marinari GM, Cuneo S, Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V (1996) Biliopancreatic diversion for obesity at eighteen years. Surgery 119: 261–268
Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y, 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10: 233–239
Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232: 515–529
Shikora SA, Storch K (2005) Implantable gastric stimulation for the treatment of severe obesity: the American experience. SOARD 1: 334–342
Weiner R, Gutberlet H, Bockhorn H (1999) Preparation of extremely obese patients for laparoscopic gastric banding by gastric-balloon therapy. Obes Surg 9: 261–264
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schauer, P., Chand, B. & Brethauer, S. New applications for endoscopy: the emerging field of endoluminal and transgastric bariatric surgery. Surg Endosc 21, 347–356 (2007). https://doi.org/10.1007/s00464-006-9008-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-006-9008-8