Gastroscopic reduction of the stomach with the BaroSense ACE stapler in morbid obesity

Givan F Paulus, MD, M van Avesaat, MD, J M Conchillo, PhD, MD, A A Masclee, PhD, MD, N D Bouvy, PhD, MD

Maastricht University Medical Center

Bariatric surgery is the only long-term effective therapy for weight loss in morbidly obese patients and therefore has an increasing role in surgical practice. With the rising number of procedures, research and development of minimal invasive procedures also increases. Recently, our center started a gastroscopic method to reduce the volume of the stomach by creating plications.

The procedure starts with placing an endogastric tube to secure a safe entry route to the stomach. Through this tube the BaroSense Articulating Circular Endoscopic (ACE) stapler is introduced. With the ACE stapler, stomach tissue is acquired by vacuum and stapled to create a permanent plication (figure 1). Eight to ten plications are created, depending on the available space. Before and one month after the procedure patients came for a standardized test meal with breath sampling for gastric emptying (13C octoanoic acid breath test) and visual analogue scale (VAS) for hunger and satiety. Breath samples and VAS scores were obtained at several time points starting before and until four hours after breakfast (one sandwich with a fried egg). After four hours an ad libitum pasta meal was offered. Changes in weight, ad libitum caloric intake and gastric emptying were tested with the paired T-test, the VAS scores with repeated measures ANOVA and all are reported as mean ± SEM.

Ten patients were treated with the ACE stapler between July and October 2012. Baseline weight was 119,3±3,5 kg. All patients were discharged without complications and only reported a sore throat and stomach cramps until 2-3 days after the procedure as side effects. After three months, weight decreased to 106,2±3,8 kg, which equals a reduction in BMI from 39,6± 0,9 to 35,2± 0,9 (excess BMI loss is 30,1±3,1%). In the standardized meal test, one month after the procedure, no changes were found in gastric emptying (emptying half time 141,3±5,9 vs 138,7±12,3 minutes, p>0.05). AUC for satiety was significantly increased after the procedure (AUC 48,1±9,4 vs 68,8±8,9 p<0.02; figure 2), while ad libitum food intake significantly decreased from 842,8±45,9 to 441,8±100,1 kcal (p<0,01).

The preliminary results in this first group of patients are encouraging. The procedure is safe and is associated with quick recovery. In the first three months, weight loss is promising and comparable to other bariatric procedures. Increased feelings of satiety were observed and a decrease in ad libitum meal intake. Although the capacity of the stomach is reduced, gastric emptying after a standardized breakfast is not influenced. In the search for minimal invasive bariatric procedures, the BaroSense ACE stapling technique certainly has potential.

Session: Poster Presentation

Program Number: ETP031

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