DDW 2009: Transoral Gastroplasty is Feasible, Safe, and Effective in Childhood Obesity

Martha Kerr

June 04, 2009

June 4, 2009 (Chicago, Illinois) — A minimally invasive transoral approach to gastroplasty resulted in an average loss of 61% of excess weight with no serious adverse events or complications in obese children, Venezuelan gastroenterologists announced here at Digestive Disease Week (DDW) 2009.

Results with transoral vertical gastroplasty in 21 adolescents between 13 and 17 years of age were presented by Roberto Fogel, MD, chief of the department of gastroenterology at the Hospital de Clinicas Caracas in Venezuela.

Dr. Fogel presented his preliminary findings last year at DDW 2008. He presented the 18-month follow-up results at this year's meeting.

The 18 girls and 3 boys had preprocedure weights of between 80 and157 kg and an average baseline body mass index (BMI) of 36.2 kg/m2. "These were highly selected children, and the girls were much better motivated than the boys," Dr. Fogel said. "They were severely overweight, but not morbidity obese."

He performed endoluminal vertical gastroplasty using a transoral approach to suture the anterior and posterior gastric walls together to reduce the volume or capacity of the stomach in order to induce weight loss. The procedure is performed under general anesthesia and subjects are discharged approximately 3 hours later. "At this point, it is about a 30-minute outpatient procedure," Dr. Fogel told meeting attendees.

Patients returned for follow-up at 1, 3, 6, 12, and 18 months postprocedure.

"We have had no adverse events or serious complications with any of the procedures," Dr. Fogel reported. "All patients lost weight and showed a significant reduction in their BMI," he said.

Eight patients have completed 18 months of follow-up, the Caracas surgeon said. In that group, excess weight loss averaged 61.5% (range, 45.7% to 77.3%) at 6 months and 58.8% (range, 41.3% to -76.3%) at 18 months.

Fifteen patients have completed 12 months of follow-up. In that group, excess weight loss averaged 67.3% (range, 51.7% to 82.9) at 6 months and 63.8% (range, 47.1% to 80.5%) at 12 months.

"Patients are maintaining their weight loss," Dr. Fogel told Medscape Gastroenterology during a briefing for reporters. "We are getting such good results partly because these patients are so highly selected. . . . And the procedure is completely reversible."

"Stapling procedures are not reversible. . . . Durability is more the issue here," moderator Robert H. Hawes, MD, professor of medicine at the Medical University of South Carolina in Charleston, pointed out.

"Weight loss is a complex issue. We are just beginning to unravel it. There appears to be a disconnect between weight loss and the comorbidities that accompany obesity," Dr. Hawes told Medscape Gastroenterology.

"There is no silver bullet. Not all procedures are for all patients. It requires a comprehensive bariatric center, with a multidisciplinary approach, because diet and exercise alone fail about 95% of the time."

"Evidence indicates that obese school-aged children are up to 6.5 times more likely to carry their disease into adulthood than their nonobese counterparts," Dr. Fogel added.

Dr. Fogel receives funding from Bard and Davol, which manufactures some of the devices used in his procedure. Dr. Hawes has disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2009: Abstract 1426. Presented June 2, 2009.


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