Overview of the POSE Procedure
Primary Obesity Surgery Endoluminal, or POSE procedure, is an endoscopic incisionless weight loss procedure that reduces the size of the stomach and helps to diminish hunger cravings.
The POSE procedure is primarily designed for patients who want to lose between 25 and 60 or 70 pounds, rather than standard bariatric surgery patients who need to lose 100 pounds or more.
The procedure is performed entirely through the mouth and does not require any external cuts into the body. It is generally an outpatient procedure (about 1 hour), with most patients making a quick return to normal activities (only a few days to a week, depending on the individual).
POSE is currently considered investigational for weight loss and performed at only a few select locations around the United States. Advocates of the procedure say the POSE procedure may be an ideal solution for people with excess weight who have not had success with diet and exercise and who do not qualify or do not want to undergo a more extensive type of bariatric surgery.
How it Works
The POSE procedure is a type of weight loss surgery that restricts eating and reduces hunger by reducing the size and capacity of the stomach by folding and anchoring the stomach tissue.
The multiple folds of stomach tissue created by the POSE procedure effectively reduce the size and capacity of the stomach to limit food intake and diminish hunger cravings.
How is the POSE procedure performed?
The POSE procedure is performed using endoscopic "through the mouth" techniques on an outpatient basis under general anesthesia and lasts 30 to 45 minutes.
To perform POSE, doctors use the Incisionless Operating Platform (IOP), a specialized set of endoscopic surgery tools developed by USGI Medical for incisionless gastrointestinal procedures, and an endoscope (flexible tube with a small camera on the end) to visualize the stomach. The IOP and endoscope are passed through the mouth and into the stomach.
Once in the stomach, the IOP tools are used to grasp, fold, and fasten together sections of stomach tissue. The POSE procedure involves making multiple stomach folds and securing them with expandable suture anchors. The suturing technology was designed by USGI Medical researchers as a durable option for anchoring tissue in the stomach and GI tract.
The IOP device manufactured by USGI is also used to perform the ROSE (Restorative Obesity Surgery, Endoluminal) procedure, a revision for gastric bypass patients with weight regain. The ROSE procedure restores the size of the stoma and pouch to post-surgical dimensions.
The POSE procedure is very similar to the ROSE procedure, but on a stomach that has never been surgically altered.
What are the surgical advantages of the POSE procedure?
The POSE procedure is performed endoscopically (via the mouth) and does not require cuts or incisions through the abdomen to reach the stomach. This speeds healing time, minimizes surgical pain and discomfort, and leaves no visible scars.
It does not involve any cutting, removal, or rerouting of either the stomach or intestines as with gastric bypass surgery or sleeve gastrectomy and does not involve placing a medical implant into the body or need adjustments as with laparoscopic adjustable gastric banding.
Benefits of the POSE procedure include:
- No external cuts or incisions, leaves no visible scars
- Quick procedure (1 hour), usually performed on an outpatient basis
- Quick recovery time, resume normal activities within 2-3 days
- Overall risks much lower than with open or laparoscopic surgery
- May be reversible if necessary
Are you a candidate for the POSE Procedure?
The POSE procedure is primarily designed for patients with a BMI of 30 to 40; who have less than 100 pounds of excess weight to lose; who have made serious non-surgical weight loss attempts that have proved unsuccessful; and who are motivated and willing to make significant lifestyle changes in diet and exercise.
What is the expected recovery?
The majority of POSE patients are able to leave the hospital the same day that the procedure is performed. Those who have traveled from out of town for surgery can generally fly home the next afternoon.
How will it help with weight loss?
The POSE procedure can help patients in their weight loss efforts by controlling the amount of food that can be eaten at any one time and diminishing hunger sensations. Most patients who have undergone the POSE procedure report feeling satisfied with less food and less hungry between meals. Combined with diet and lifestyle changes, the POSE procedure is a surgical alternative that can help patients achieve meaningful weight loss.
What is the post-operative diet?
The first few days after the procedure will be limited to liquids, such as water, juice, milk, and broth. Normal foods will then be able to be gradually added back into the diet over a short period of time. Food toleration will vary among patients and usually improve over time.
The amount of food you are able to eat should be considerably reduced after the procedure. As with all weight loss procedures, it will be important to make healthy food choices in order to meet the body's nutritional needs and lose excess weight.
What is the cost and is it covered by insurance?
The POSE procedure is currently listed an investigational procedure and therefore not covered by insurance at this time. The cost of the POSE procedure is approximately $10,000.
If you do not have funds available, patient financing options may be available. Many healthcare providers accept payment through CareCredit, a company that offers special financing options for health, beauty, and wellness procedures to those who qualify.
How do I find a doctor for the POSE procedure?
The POSE procedure is considered investigational in the United States and outside of the eleven bariatric centers participating in the Essential Trial, it is performed at only a few select locations around the county.
The locations chosen to participate in the research study can be found on the clinical trials webpage (clinicaltrials.gov/ct2/show/NCT01958385). The principal investigator, Dr. Tom Lavin at the Crescent City Surgical Center and founder of Surgical Specialists of Louisiana, is one of the most experienced bariatric surgeons in the POSE procedure.
About the Clinical Trial
The POSE procedure is currently being studied in the United States in the ESSENTIAL Trial. Enrollment was completed in June 2014 with 377 patients. The study is ongoing, but not recruiting additional participants. The study completion date is December 2016.
The purpose of the clinical trial is to evaluate the safety and effectiveness of the POSE procedure as a weight loss treatment in obese patients.
Although the POSE procedure is not yet FDA-approved as a weight loss treatment for obesity, the specialized surgical tools used to perform the POSE procedure (USGI's Incisionless Operating Platform and g-Cath EZ Delivery Catheter with Snowshoe™ Suture Anchors) are approved by the FDA for tissue approximation in minimally invasive GI procedures.
Global Use of the POSE Procedure
While the POSE procedure is considered investigational in the United States, is has been widely used outside of the US with positive results. Thousands of patients have undergone the POSE procedure. It is usually performed in an outpatient setting and most of the patients are able to return to work without any bandages or signs of surgery within two to three days.
In one study in Spain, patients reported feeling full faster and less hungry between meals and lost up to 62% of excess weight (40 to 45 pounds on average) a year after the procedure.
(POSE is a registered trademark of USGI Medical, Inc., San Clemente, CA)