Endoscopy 2012; 44 - A03
DOI: 10.1055/s-0032-1329276

Gastric volume reduction created by the articulating circular endoscopic stapler for the treatment of obesity – preliminary safety results

T Verlaan 1, EMH Mathus-Vliegen 1, EAML Veldhuyzen 1, JH Eshuis 1, P Fockens 1
  • 1Adress available at: European Society of Gastrointestinal Endoscopy (ESGE), HG Editorial & Management Services, Mauerkircher Str. 29, 81679 Munich, Germany

Objective: Dietary and medical treatment of obesity often fail. Surgical treatment is successful but carries considerable morbidity. Endoscopic treatment could be an alternative with less morbidity. A minimally invasive technique was developed and studied on an animal model. We now present the preliminary results of the first human trial of a gastric volume reduction created by the Articulating Circular Endoscopic Stapler (ACE) for the treatment of obesity. The aim of this study is to evaluate safety in terms of adverse events.

Methods: Inclusion criteria consisted of a BMI of 40–45 kg/m or 30–39.9 kg/m plus obesity related co-morbidities, age 18–50 and ASA class I or II. Patients with prior oesophagogastric or bariatric surgery were excluded. Procedures were performed under general anaesthesia after intubation. A 20mm endogastric tube was placed, through which the ACE stapler was advanced. With the stapler a maximum of 10 plications were created in the fundus and antrum of the stomach to realize a gastric volume reduction.

Results: Between April 2012 and May 2012, 5 female patients (median age 37 years, range 28–49) with a BMI of 42kg/m (range 40.2–44.9) underwent an endoscopic gastric volume reduction using the ACE stapler. Median procedure time was 156 minutes (range 72–233). All patients were admitted for one night postoperatively. No patient was readmitted and no serious adverse events occurred. Adverse events were gastric pain (n = 3, range 2–3 days), constipation (n = 1, 14 days) and diarrhoea (n = 1, 21 days). All adverse events were mild and were treated conservatively.

Conclusions: Preliminary results of this study indicate that a minimally invasive gastric volume reduction created with the Articulating Circular Endoscopic stapler is a safe procedure. More studies are needed to evaluate whether this could be a safe and effective minimally invasive treatment alternative for obesity patients.