The Emerging Field of Endoluminal and Transgastric Bariatric Surgery

  • Philip R. Schauer
  • Bipan Chand
  • Stacy A. Brethauer


Gastrointestinal endoluminal technology is emerging as the next major revolution in minimally invasive surgery. A similar trend is already well underway in vascular surgery with the widespread endoluminal vascular therapy. The endoluminal approach to bariatric surgery will have numerous advantages. These techniques will potentially be performed as outpatient procedures without the need for skin incisions or general anesthesia and they may reduce the risk, discomfort, and cost of bariatric procedures. Innovative devices have been developed and Food and Drug Administration (FDA) approved for the treatment of gastroesophageal reflux disease (GERD), and they may be adapted as, or lead to, new devices that can be used for weight loss procedures. This chapter reviews endoluminal technologies currently in development, preliminary clinical and preclinical data describing their use in bariatric applications, and the future of endoluminal bariatric surgery.


Bariatric Surgery Gastric Bypass Sleeve Gastrectomy Intragastric Balloon BioEnterics Intragastric Balloon 
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  1. 1.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–1737.CrossRefPubMedGoogle Scholar
  2. 2.
    Nguyen NT, Root J, Zainabadi K, et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 2005;140:1198–1202.CrossRefPubMedGoogle Scholar
  3. 3.
    Hawes R. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. Gastrointest Endosc 2006;63:199–203.CrossRefGoogle Scholar
  4. 4.
    Kadirkamanathan SS, Evans DF, Gong F, Yazaki E, Scott M, Swain CP. Antireflux operations at flexible endoscopy using endoluminal stitching techniques: an experimental study. Gastrointest Endosc 1996;44:133–143.CrossRefPubMedGoogle Scholar
  5. 5.
    Chen YK, Raijmann I, Ben-Menachem T, et al. Long-term outcomes of endoluminal gastroplication: a U.S. multicenter trial. Gastrointest Endosc 2005;61:659–667.CrossRefPubMedGoogle Scholar
  6. 6.
    Corley DA, Katz P, Wo JM, et al. Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial. Gastroenterology 2003; 125:668–676.CrossRefPubMedGoogle Scholar
  7. 7.
    Deviere J, Costamagna G, Neuhaus H, et al. Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial. Gastroenterology 2005;128:532–540.CrossRefPubMedGoogle Scholar
  8. 8.
    Doldi SB, Micheletto G, Perrini MN, Rapetti R. Intragastric balloon: another option for treatment of obesity and morbid obesity. Hepatogastroenterology 2004;51:294–297.PubMedGoogle Scholar
  9. 9.
    Spaulding L. Treatment of dilated gastrojejunostomy with sclerotherapy. Obes Surg 2003;13:254–257.CrossRefPubMedGoogle Scholar
  10. 10.
    European Patent Office. Accessed October 2005.Google Scholar
  11. 11.
    Regan JP, Inabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13:861–864.CrossRefPubMedGoogle Scholar
  12. 12.
    Cottam D, Mattar S, Sharma S, et al. Sleeve gastrectomy as an initial weight loss procedure for high risk patients with morbid obesity. Surg Endosc 2006;20:859–863.CrossRefPubMedGoogle Scholar
  13. 13.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg 2004;14:492–497.CrossRefPubMedGoogle Scholar
  14. 14.
    Sallet JA, Marchesini JC, Ribeiro MR, Pizani CE, Kamoto K, Sallet PC. Utilization of the intragastric balloon (BIB) in pre-operative preparation for super obese patients with high surgical risk. Presented at the 21st Annual Meeting of American Society for Bariatric Surgery, 2004:P69.Google Scholar
  15. 15.
    Busetto L, Segato G, De Luca M, et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg 2004;14:671–676.CrossRefPubMedGoogle Scholar
  16. 16.
    Livingston EH. Complications of bariatric surgery. Surg Clin North Am 2005;85:853–868, vii.CrossRefPubMedGoogle Scholar
  17. 17.
    Thompson CC. Per-oral endoscopic reduction of dilated gastrojejunal anastomosis following Roux-en-Y gastric bypass: a possible new option for patients with weight regain. SOARD 2005;1:223.Google Scholar
  18. 18.
    Schweitzer M. Endoscopic intraluminal suture plication of the gastric pouch and stoma in postoperative Roux-en-Y gastric bypass patients. J Laparoendosc Adv Surg Tech A 2004;14:223–226.CrossRefPubMedGoogle Scholar
  19. 19.
    Catalano MJ, George S, Thomas M, Geenen JE, Chua T. Weight gain following bariatric surgery secondary to staple line disruption and stomal dilation: endotherapy using sodium morrhuate to induce stomal stenosis prevents need for surgical revision. Gastrointest Endosc 2004;59: P149.CrossRefGoogle Scholar
  20. 20.
    Papavramidis ST, Eleftheriadis EE, Papavramidis TS, Kotzampassi KE, Gamvros OG. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 2004;59:296–300.CrossRefPubMedGoogle Scholar
  21. 21.
    Roman S, Napoleon B, Mion F, et al. Intragastric balloon for “non-morbid” obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg 2004;14:539–544.CrossRefPubMedGoogle Scholar
  22. 22.
    U.S. Surgical procedure volumes. MedTech Insight 2005;7: 136.Google Scholar
  23. 23.
    Mathus-Vliegen EM, Tytgat GN Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc 2005;61:19–27.CrossRefPubMedGoogle Scholar
  24. 24.
    Kelleher B, Stone C, Burns M, Gaskill H. The butterfly procedure for endoluminal treatment of obesity. Gastrointest Endosc 2003;57:AB186Google Scholar
  25. 25.
    Swain CP, Park P-O, Savides T, Kelleher B, Stone C, Burns M. In vivo evaluation of the butterfly endoluminal gastroplasty procedure for obesity. Gastrointest Endosc 2003; 57:AB83.Google Scholar
  26. 26.
    Fogel R, De La Fuente R, Bonilla Y. Endoscopic vertical gastroplasty: a novel technique for treatment of obesity: a preliminary report Gastrointest Endosc 2005;61:AB106.Google Scholar
  27. 27.
    Kantsevoy S, Jagannath S, Niiyama H, et al. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 2005;62:287–292.CrossRefPubMedGoogle Scholar
  28. 28.
    Park A, Adrales G, McKinlay R, Knapp C. A novel anastomotic device in a porcine model. Am Surg 2004;70:767–773.PubMedGoogle Scholar
  29. 29.
    Swanstrom L, Kozarek R, Pasricha P, et al. Development of a new access device for transgastric surgery Surg 2005;9: 1129–1137.Google Scholar
  30. 30.
    MacFadyen BV Jr, Cuschieri A. Endoluminal surgery. Surg Endosc 2005;19:1–3.CrossRefPubMedGoogle Scholar
  31. 31.
    O’Brien PE, Brown WA, Smith A, McMurrick PJ, Stephens M. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 1999;86(1):113–118.CrossRefPubMedGoogle Scholar
  32. 32.
    Scopinaro N, Gianetta E, Adami GF, Friedman D, Traverso E, Marinari GM, Cuneo S, Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V. Biliopancreatic diversion for obesity at eighteen years. Surgery 1996;119(3):261–268.CrossRefPubMedGoogle Scholar
  33. 33.
    Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10(3):233–239.CrossRefPubMedGoogle Scholar
  34. 34.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232(4):515–529.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Shikora SA, Storch K, Investigational team, 2004 ABS Consensus Conference. Implantable gastric stimulation for the treatment of severe obesity: the American experience. Surg Obes Relat Dis 2005;1(3):334–342.CrossRefPubMedGoogle Scholar
  36. 36.
    Weiner R, Gutberlet H, Bockhorn H. Preparation of extremely obese patients for laparoscopic gastric banding by gastric-balloon therapy. Obes Surg 1999;9:261–264.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Philip R. Schauer
    • 1
    • 2
  • Bipan Chand
    • 3
  • Stacy A. Brethauer
    • 4
  1. 1.Lerner College of MedicineUSA
  2. 2.Advanced Laparoscopic and Bariatric Surgery, Bariatric and Metabolic InstituteThe Cleveland Clinic FoundationClevelandUSA
  3. 3.Department of Bariatric and Metabolic InstituteThe Cleveland Clinic FoundationClevelandUSA
  4. 4.Advanced Laparoscopic and Bariatric Surgery, Department of General SurgeryThe Cleveland Clinic FoundationClevelandUSA

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