Lexa W Lee

April 23, 2007

April 23, 2007 (Las Vegas) — Early results of a new transoral restrictive procedure for the treatment of morbid obesity show promise and may offer lower morbidity than current methods, according to a study presented at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.

The TOGA System (Satiety, Inc), a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch (similar to other restrictive pouches) along the lesser curve of the stomach. Coauthor Stephen Scott, MD an associate professor of surgery at the University of Missouri, commented, "The instruments are simple to use and don't take much time to learn. The procedure is adjustable and reversible."

The study was conducted by 2 centers, the University of Missouri in Columbia and Washington University in St. Louis. A total of 21 patients ranging in age from 22 to 57 years were enrolled. The patients' body mass index ranged from 35 to 53 kg/m2. After stapling, patients were kept overnight for observation and underwent a barium upper gastrointestinal series the next morning. They also followed a liquid diet for a month and were asked to start an exercise program. Follow-up was completed at 1 week and at 1, 3, and 6 months.<

There were no complications; all but 2 instances of procedure-related adverse effects (nausea, vomiting, pain, dysphagia, pharyngitis) resolved within 5 days and none were serious. The most recent follow-up visits (endoscopy at 3 or 6 months) showed persistent full or partial stapled sleeves in all patients. Weight loss averaged 17.5 lb at 1 month and 24.7 lb at 3 months after treatment (excessive weight loss [EWL], 14.9% and 20.5% at the respective time points). At 6 months, average weight loss was 31.1 lb and EWL was 24.9% for 6 patients followed up so far.

According to Dr. Scott, "Gaps between staple lines [negatively] affected weight loss. The gaps were dependent on stomach anatomy. As we gained more experience with the instruments and the procedure, we made adjustments, and weight loss increased."

Natan Zundel, MD, a bariatric surgeon in North Miami Beach, Florida, who was not involved in the study, commented, "This is a very innovative study because they were doing it through a scope. The variations in stomach anatomy created implications in how they performed the surgery; those variations have nothing to do with a patient's general anatomy."

Dr. Scott reports a financial relationship with Satiety, Inc. Dr. Zundel reports financial relationships with Ethicon and Inamed.

SAGES 2007 Annual Scientific Session: Abstract S003. Presented April 20, 2007


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.