Weight Loss .... Without Surgery, Diet Or Exercise?
Posted Apr 03 2011 7:51am
Patients keep dreaming of that day. It probably hasn't come yet.
Gastric bypass for obese, Type 2 diabetes has gotten a lot of press in the last few years. We've seen a few cases in which complications after surgery made the patient deeply regret undergoing the procedure. We try to steer patients toward gastric banding if they are inclined to consider a "bariatric surgical resolution" to morbid obesity. Check out an explanation of both procedures here .
However, other approaches are being considered. For example, a 2-foot long gastrointestinal "sleeve" can be implanted, through the mouth, to line the upper portion of the small intestine just below the stomach. Such a device has been recently approved for use in parts of South America and Europe. By the way, three of our patients went to Mexico or Europe solely to have bariatric procedures performed. Medical or surgical procedures are often approved earlier in other countries. It would be our opinion that less litigious societies make it easier for that to happen, although there may be other issues.
Dr. Lee Kaplan of Harvard University Medical School is a consultant to GI Dynamics and has presented data suggesting the sleeve is, at least, as effective as gastric banding for weight loss.
GI Dynamics is planning a multi-center clinical trial that may include as many as 500 subjects. Full details are pending.
But, at at roughly $5,000, the EndoBarrier, considered an advanced investigational device in the United States, is not a permanent solution to diabetes, even for patients who respond well to it. Nor is it without risks of its own. It is designed to stay in the gut for no more than a year, after which physicians believe most patients will revert to their diabetic condition. And while it can be put in place in 25 minutes under sedation that keeps a patient conscious, it was found in one study presented this week to have slipped, become obstructed, or caused problems leading to its removal in more than one-in-three cases. Intestinal bleeding can result if it becomes dislodged.
The gastric sleeve "seems to capture some of the effect" by which gastric bypass surgery improves metabolic function in diabetics, said Kaplan. By lining a 2-foot portion of the intestine, it alters the complex mix of hormones secreted in the gut that affects appetite, digestion and metabolism.