Intragastric Stimulation [Intragastric Stimulation] |
Is there a future for gastric electrical stimulation for obesity treatment?
Some years ago (2000-2004), a promising large scale trial took place in Europe and in the US. A gastric pacemaker (Intra-gastric Stimulation or IGS), which is a simple, mini-invasive and elegant operation, was proposed to obese patients. Please refer to the chapters ('digestive surgery') dealing with this operation, technical details and initial results.
Unfortunately, results did not match the expectations. For instance, a randomized multi-center study took place in the USA in 2003 and failed to demonstrate a difference in terms of weight-loss between patients with the device 'on' and those 'off'. The most important company making this device (MEDTRONIC) decided then to stop clinical trials, while continuing animal research. Although this look grim, some news could bring hope:
- Some hypothesis are still being tested and could turn worthwile: weight-loss physiological mechanisms, particularly with regards to neuro-mediators and digestive hormones, the action of some gastric nerves etc. Active research is carried on with important changes ahead in the understanding of related issues, such as the factors of diabetes mellitus.
- There are ongoing trials with a stimulation device that differs from the typical pacemaker (so called TANTALUS system).This device delivers a selective stimulation during the meals only, thanks to an automatic detection of food intake.
- The VBLOC system applies solely to the main gasric nerves (vagus nerves). It had been demonstrated before that a standard bariatric operation such as a vertical banded gastroplasty could have a better efficacy in terms of weight-loss if a vagotomy (division and section of the vagus nerves) was performed during the same procedure. The VBLOC system claims to obtain the following effects : alteration of gastric compliance and contractions (hence of the gastric emptying), decrease of pancreatic secretions. Yet preliminary series have reported an excess weight-loss at 6 months of 'only' 14%.
The bottomline is that some experiments are on the way, as well as interesting prospects. Yet it is certainly premature to acknowledge the principle of long-term gastric stimulation for the treatment of obesity. |
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