Although weight loss surgery has traditionally been considered the treatment of last resort for severe obesity, new treatments and safer techniques are making surgical intervention a potentially suitable option for a greater amount of overweight individuals. As we start a new year, it is a good time to review some of the innovative procedures that are promising to make a big change in the way we treat obesity and the related disease of type 2 diabetes.
One of the most notable new surgical approaches is the use of endoscopic methods, referred to as natural orifice translumenal endoscopic surgery (NOTES). This surgical technique accesses the body through a natural opening, such as the mouth to reach the stomach, thus avoiding the need for incisions. Procedures such as StomaphyX and ROSE for gastric bypass revision have already been approved by the FDA, while several primary procedures are currently undergoing clinical trials. Three of the most promising are TOGA, EndoBarrier, and POSE.
TOGA
TOGA, or trans-oral gastroplasty, is an incision-free treatment developed by Satiety, Inc. The TOGA procedure creates a sleeve in the stomach to limit the amount of food that can be eaten and give the feeling of fullness after a small meal. Clinical trials started in July 2008 with an estimated primary completion date of October 2010. Special medical instruments (set of flexible staplers) are introduced into the stomach via the mouth for gastric stapling. Study results to date have been positive.
EndoBarrier
The EndoBarrier by GI Dynamics is a non-surgical therapy to treat type 2 diabetes and obesity. The product is an intestinal liner that acts as a barrier between food and a portion of the small intestine where digestion occurs. It is placed endoscopically (via the mouth) and does not require surgical incisions, does not alter the anatomy, and is typically removed after six months. The EndoBarrier is currently undergoing clinical trials in the United States, but preliminary results have shown benefits similar to those achieved with gastric bypass surgery. It received the European CE mark of approval for use in Europe in December 2009.
POSE
POSE (Primary Obesity Surgery, Endolumenal) is performed using a special set of endoscopic surgery tools manufactured by USGI known as the EndoSurgical Operating System (EOS) and a flexible endoscope that is used to visualize the stomach. This is the same system that is used to perform the ROSE (Restorative Obesity Surgery, Endoluminal) procedure, a revision for gastric bypass patients with weight regain. The POSE is currently being evaluated in clinical trials.
These innovative procedures are not only promising a safer bariatric option, but will potentially be able to help those who do not qualify for gastric bypass surgery or laparoscopic adjustable gastric banding based on current National of Institutes of Health (NIH) patient criteria for bariatric surgery.
As more and more people suffer from obesity and related medical problems, it is encouraging to see that the medical field is developing treatments that will improve the health, longevity, and quality of life of many overweight and diabetic individuals.
Would like more information of TOGA surgery and where it is being done in Florida.