Adolescent Bariatric Surgery Can be Safely Performed With Minimally Invasive Techniques

Martha Kerr

May 26, 2008

May 26, 2008 (San Diego, California) – A per oral, minimally invasive approach to bariatric surgery appears to be a safe, virtually painless approach to weight loss in highly selected morbidly obese adolescents, early results presented here at Digestive Disease Week 2008 indicate.

Preliminary results show that endoluminal vertical gastroscopy (EVG) is safe, but before the technique can be considered truly feasible, longer follow-up is needed, Dr. Roberto Fogel, MD, chief of the department of gastroenterology at the Hospital de Clinicas Caracas, in Venezuela, cautioned when he presented the preliminary results.

In EVG, the surgeon sutures the anterior and posterior walls of the stomach together to reduce the volume of the stomach.

The pilot study involved 10 girls and 2 boys between the ages of 14 and 17 years. At baseline, average body mass index (BMI) was 38.1 kg/m2 (±7.7) and average baseline weight range was 80 kg to 158 kg.

Dr. Fogel performed the procedure using general anesthesia. It took approximately 40 minutes to complete. Patients were ambulatory and discharged home an hour afterward. Patients reported minimal pain and there was no scarring. There were no procedural complications, he announced.

Postoperative follow-up assessments were conducted at 1, 3 and 6 months. The primary outcome measure was excess weight loss, with calculations based on the 50th percentile for adolescent growth.

"All patients lost weight," Dr. Fogel reported, with a mean weight loss of 17.9% (± 5.9%) at 1 month, 38.6% (± 16.3%) at 3 months, and 62.2% (± 15.0%) at 6 months. "The incredible thing is that patients have gone to almost 80% of excess weight loss. Our patients just do not feel hungry," he commented.

Six months after per oral bariatric surgery, mean BMI was 27.8 kg/m2 (± 5.8).

"This degree of weight loss is phenomenal," session moderator Mark DeLegge, MD, professor of medicine in the Digestive Disease Center of the Medical University of South Carolina, in Charleston, commented after Dr. Fogel's presentation.

"We'll have to see if patients can maintain this weight loss. A lot of adults are starting to regain the weight they lost after surgery," Dr. DeLegge said. "The problem is not the technique and not the [procedure], but the patient."

Dr. Fogel cautioned that "these patients were highly selected.... Patients have to realize that they need to change their lives," with diet and exercise as well as surgery. As with adults who undergo bariatric surgery, the stomach can get stretched out again, and younger patients seem to have stomachs that can stretch more than adults."

Dr. Fogel has disclosed no relevant financial relationships. Dr. DeLegge is a consultant for Nestle Home Care Products, but has no financial conflicts with the devices or techniques used in Dr. Fogel's study.

Digestive Disease Week (DDW) 2008: Abstract 243. Presented May 19, 2008.

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