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Gastrointestinal Physiological Changes and Their Relationship to Weight Loss Following the POSE Procedure

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Abstract

Background

Primary Obesity Surgery Endolumenal (POSE) is a novel bariatric endoscopic procedure that has been shown to reduce weight safely through 12 months. The study investigated potential mechanisms of weight loss following POSE.

Methods

Patients with class I–II obesity received transmural plications in the gastric fundus and distal gastric body. Patients were evaluated at baseline and at 2- and 6-month follow-up with gastric-emptying (GE) scintigraphy, a validated test of intake capacity (kcal) and plasma glucose homeostasis hormones/gastrointestinal peptides. Weight was recorded through 15 months. Mean data and 95 % CIs are reported. Regression modeling assessed variables that influenced total weight loss (%TWL) and excess weight loss (%EWL).

Results

POSE was performed on 18 patients (14 F/4 M); mean age 39 years (34–44), body mass index (BMI, kg/m2) 36 (95 % CI, 35; 37). At 15 months (n = 15), mean TWL was 19.1 ± 6.6 % (15.5; 22.8) and EWL was 63.7 ± 25.1 % (49.8; 77.6). At 2 and 6 months (n = 18), intake capacity decreased significantly from 901 (685; 1117) to 473 (345; 600) and 574 kcal (418; 730), respectively (p < 0.001). At 2 months, GE was delayed but returned to baseline levels at 6 months (n = 18). Glucose/insulin ratio improved (p < 0.05). Postprandial decrease in ghrelin was enhanced (p = 0.03) as well as postprandial increase in PYY (p = 0.001). The best model for EWL prediction 15 months after POSE (R 2: 66 %, p = 0.006) included pre-POSE BMI, post-POSE GE, and postprandial PYY increase.

Conclusions

The POSE procedure was followed by significant sustained weight loss and improved glucose homeostasis and satiation peptide responses. Weight loss following POSE may be mediated through changes in gastrointestinal neuro-endocrine physiology.

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Acknowledgments

We wish to thank Mónica Isart Rueda, director of Laboratory Services at Teknon; Javier Pavia for the assistance with gastric emptying analysis; and Maribel Sánchez for the nutritional support with patients during the study.

Conflict of Interest

Manuscript development was financially supported by USGI Medical, Inc., USA. A. Bronstone is a Scientific Research Writer and J. N. Buchwald is the Director and Chief Scientific Research Writer at Medwrite LLC, a CRO under contract with USGI.

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Authors and Affiliations

  1. Unidad de Endoscopia, Centro Médico Teknon, Barcelona, Catalonia, Spain

    J. C. Espinós, R. Turró, F. Mearin, A. Mata, H. Uchima & J. Turró

  2. CETIR Grup Médic Barcelona, Barcelona, Catalonia, Spain

    G. Moragas

  3. Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA

    A. Bronstone & J. N. Buchwald

  4. Neuro-Enteric Translational Science (NETS) Research Group, Institut Hospital del Mar d’Investigacions Mèdiques. IMIM-Parc de Salut Mar. PRBB, c/ Dr. Aiguader, 88, 08003, Barcelona, Catalonia, Spain

    S. Delgado-Aros

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  1. J. C. Espinós
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  2. R. Turró
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  3. G. Moragas
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  5. J. N. Buchwald
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Correspondence to S. Delgado-Aros.

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Espinós, J.C., Turró, R., Moragas, G. et al. Gastrointestinal Physiological Changes and Their Relationship to Weight Loss Following the POSE Procedure. OBES SURG 26, 1081–1089 (2016). https://doi.org/10.1007/s11695-015-1863-8

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  • DOI: https://doi.org/10.1007/s11695-015-1863-8

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