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Old 02-02-2009, 09:48 AM   #1
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Default Gastric 'condoms' could help obese avoid surgery

GASTRIC surgery is a last resort for people who are dangerously obese. But there may soon be a gentler option in the shape of a removable device inserted into the gut though the mouth.

The EndoBarrier, developed by GI Dynamics of Lexington, Massachusetts, is an impermeable sleeve that lines the first 60 centimetres of the small intestine. In animal experiments and preliminary human trials, it reduces weight and rapidly brings type II diabetes under control.

Given the rising tide of obesity across the developed world, new treatments are a matter of priority. In the US alone, more than 15 million adults meet the criteria for gastric surgery because they have a body mass index of more than 40, or a BMI of 35 plus a complication such as diabetes.

While the operations do cause dramatic and sustained weight loss, their high cost and concerns about the risk of dying on the operating table mean only a fraction of those who might benefit go on to have the surgery. According to the American Society for Metabolic and Bariatric Surgery, around 220,000 people in the US had gastric surgery for weight loss in 2008.

GI Dynamics is not the only company working on alternatives (see "Wired for weight loss"), but its approach is appealing for its simplicity and low cost. The device, enclosed in a capsule, is inserted via the mouth using an endoscope. Once in place below the base of the stomach, the capsule releases a small ball that with the help of a catheter pulls a flexible sleeve made of the slippery polymer PTFE through the intestine. The ball is jettisoned and the sleeve fixed in place by releasing a spiked attachment made from the shape-memory metal alloy nitinol (see diagram).

The entire process takes less than half an hour, and the EndoBarrier can also be removed in less than 10 minutes by tugging on a drawstring to collapse the attachment device and pull out the spikes. The EndoBarrier is then pulled back out though the mouth.

At the Massachusetts General Hospital in Boston, a team led by gastroenterologist Lee Kaplan has shown that a miniature version of the sleeve causes weight loss in rats equivalent to a popular form of gastric surgery in humans, where food intake is restricted by an adjustable band placed around the top of the stomach (Obesity, vol 12, p 2585).

"We aren't doing anything to the stomach, so the patient can still eat normally," says Stuart Randle, president of GI Dynamics, who adds that some patients given gastric bands find ways to fulfil their cravings for more calories. "They can do a lot of creative things - basically putting food into blenders," he says.

There is also a video that goes with this article here:

According to the video the sleeve can be left in place for a couple of months. It works by reducing the amounts of calories and stubstances that would normally be absorbed by the small intestine.
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Old 02-02-2009, 09:54 AM   #2
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avoid, condoms, gastric, obese, surgery

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