Another weight loss procedure which seems to have caught the headlines in the last couple of weeks has been given the name POSE (Primary Obesity Surgery, Endolumenal). In essence it allows the stomach to be made smaller – from the inside - without the need for surgery.
The procedure is performed under light sedation and involves passing a flexible tube (endoscope) through the mouth and into the stomach. The physician then uses special tools to grasp the lining of the stomach and place sutures (stitches) which create multiple folds in the stomach wall. The effect is to reduce the volume of the stomach so that the patient has to eat smaller quantities of food. If the procedure works, it has enormous potential to become a safe, simple, non-surgical treatment for weight loss which could be applied on a mass scale.
The problem is that no one has the faintest idea as to whether POSE will work or not. There are no published data on the procedure because it is currently little more than an experimental technique which has yet to be evaluated. In fact, POSE is just one of several endoscopic procedures under development which could compliment existing surgical options. However, until the appropriate clinical trials have been done, there is really no place for undue optimism. The technical problems are substantial and there are several reasons for thinking that the technique will not turn out to be as effective as existing surgical options. For example, gastric bypass – as well as reducing the size of the stomach – causes profound changes in gut hormones which cause a substantial reduction in appetite. It is very unlikely that placing a few stitches in the stomach wall would have a similar effect.
So, whilst we eagerly await the dawn of the endoscopic weight loss era, for now we’ll stick to the procedures for which we have excellent scientific evidence; gastric banding, gastric bypass and sleeve gastrectomy.
Dr David Ashton
13th July 2010