title: Endoscopic cervical bariatric surgery: follow-up study in a porcine model.
abstract: BACKGROUND
  The realisation of bariatric surgery has to date modified the digestive process solely through procedures within the abdominal cavity. However, endocrine surgeons have recently demonstrated the feasibility of a minimally invasive approach to the neck. In this study, we explored the feasibility, safety and weight progression of a bariatric procedure performed at the neck.
  
  
  METHODS
  Eleven 40-50 kg Yorkshire pigs underwent endoscopic placement of an adjustable band to the cervical esophagus (ECB). Weight was monitored at postoperative days 15, 30, and after 7 weeks; weight progression was compared with an identical group of pigs who underwent a sham procedure. At autopsy, the surgical site was evaluated in a microscopic and macroscopic manner.
  
  
  RESULTS
  Mean operating time was 66 +/- 5.76 min. All pigs tolerated the procedure well, except one subject that experienced food intolerance. The ECB group experienced significantly slower weight gain than the sham group (P = 0.005). Proper location of the band and absence of microscopic lesions at the esophageal wall were confirmed at autopsy and pathological examination.
  
  
  CONCLUSIONS
  Bariatric surgery at the neck is feasible and produces effects on weight reduction. Further refinements and longer observation periods are required to propose this procedure as safe and effective alternative in humans.
authors.affiliation: Foregut and Obesity Pathophysiology Study Center, Department of Surgery, University of Naples II, via Pansini, Naples, Italy. gdg@doctor.com
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.forename: Federico
authors.initials: F
authors.lastname: Cuenca-Abente
authors.forename: Laurent
authors.initials: L
authors.lastname: Biertho
authors.forename: Anne
authors.initials: A
authors.lastname: Waage
authors.forename: Barbara
authors.initials: B
authors.lastname: Faife
authors.forename: Federica
authors.initials: F
authors.lastname: del Genio
authors.forename: Camilo
authors.initials: C
authors.lastname: Boza
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Alberto
authors.initials: A
authors.lastname: Del Genio
mesh_terms: D000818:Animals; D004724:Endoscopy; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D009092:Mucous Membrane / Q000473:pathology; D009333:Neck; D013552:Swine; D015431:Weight Loss