Dr Ashton - Jan 2010 - Comment on EndoBarrier™

There has been a lot in the press and media recently about a new anti-obesity device called the EndoBarrier™.  Essentially this is a very thin sleeve which is passed through the mouth and is then anchored in the stomach and small intestine.  It provides a barrier or a lining between the contents of the intestine and the bowel wall, which means that food – and therefore calories – cannot be absorbed.  And of course fewer calories, means weight loss.  Obesity “experts” are already talking about a 15-minute cure for obesity and how much money this device will save the NHS. 

As is so often the case with new developments in weight loss, the claims and the hype far exceed the available evidence.  The fact is that we know very little about how effective and how safe the EndoBarrier™ actually is, because there have been very few properly conducted trials.  The most recent study was a randomized trial involving just 30 patients, 26 of whom had the sleeve successfully implanted.  Although subjects lost weight, all (100%) experienced at least one adverse event, especially abdominal pain and nausea.  Four devices had to be removed because of obstruction or because the sleeve became dislodged. 

So although it looks promising, we are at a very preliminary stage in the development of this technology and there are many unanswered questions.  Before the EndoBarrier™ can be regarded as a safe and effective intervention, we will need to see more convincing results from longer term studies.  A major hurdle is that the device has to be removed after 3 months.  That being the case, experience suggests that patients will almost invariably replace any weight they may lose.  This is exactly what happens in patients who have the gastric balloon; whilst they lose weight initially, as soon as the device is removed, they quickly replace any weight they may have lost. 

So the message for now is we will not be offering the EndoBarrier™ until we are satisfied that it is a safe, effective and durable treatment.

Dr David Ashton MD PhD
Medical Director