Interventional gastroenterology

Bridging the gap between diet advice and surgery

Thursday, 20 Jul 2017


Medical devices that can be delivered laparoscopically to help achieve weight loss have probably been overlooked as a tool in the management of obesity in Australia.

While bariatric surgery has been ‘hugely successful’ in treating obesity, there is also a growing need for less invasive options, according to a comprehensive review of gastrointestinal devices for weight loss.

Co-author Professor John Dixon told the limbic that while some devices had been around for many years, there had been relatively poor uptake except for adjustable gastric bands and intragastric balloons.

“The adjustable gastric band sets a standard that other devices would have to come up to. It is safe, simple, works well if you learn how to adjust it and results in long-term weight loss.”

He said balloons had a similar success rate of about 14-15% weight loss to very low calorie diets. Given balloons only remain in for about six months, an important part of the strategy was managing their removal and maintaining the weight loss.

“Gastrointestinal devices are another useful tool but no single tool is a panacea. Combinations of therapies, like adding in drug treatment to suppress appetite are very useful.”

Professor Dixon, head of clinical obesity research at the Baker Heart and Diabetes Institute, said there was still some mystery surrounding the way the gut and brain interact to regulate energy.

“Sucking the residual contents from the stomach via gastric emptying systems doesn’t remove many calories but does increase satiety,” he said.

Other devices either approved or under active investigation for weight loss included electrical stimulation systems, endoluminal bypass liners, endoluminal gastric plication, duodenal mucosal resurfacing and magnetic anastomosis.

Professor Dixon said with no weight loss drugs on the PBS and little access to bariatric surgery in the public health system, there was a real need for other options including gastrointestinal devices.

“Only 1 in 20 people can stick to a low dietary intake, exercise regularly and maintain significant weight loss. But nutritional support and exercise can synergise with other tools such as drugs, devices and surgery.”

He said there was a lack of clinical capacity for obesity management in Australia with the health care system failing to adapt to the times. There was also an urgent need for advocacy.

“Obese people don’t advocate for themselves. They think like other people do and blame themselves.”

 

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