title: Endoscopic gastric volume reduction with a novel articulating plication device is safe and effective in the treatment of obesity (with video).
abstract: BACKGROUND
  Endoscopic volume reduction of the stomach may provide a minimally invasive alternative for surgical procedures in the treatment of obesity.
  
  
  OBJECTIVE
  To assess safety and preliminary effectiveness in the first human application of a novel endoscopic stapling technique.
  
  
  METHODS
  Prospective, observational, phase 1 study.
  
  
  METHODS
  Two university hospitals in The Netherlands.
  
  
  METHODS
  Patients with a body mass index (BMI) of 40 to 45 kg/m(2) or 30 to 39.9 kg/m(2) with obesity-related comorbidity.
  
  
  METHODS
  Gastric volume reduction with an endoscopic stapler.
  
  
  METHODS
  Primary outcome measure was the prevalence of serious or mild adverse events. Reduction of excess body weight after 12 months was assessed as a secondary outcome measure for effectiveness of the procedure.
  
  
  RESULTS
  Seventeen patients with a median BMI of 40.2 kg/m(2) (interquartile range [IQR] 37.6-42.8) underwent an endoscopic stapling procedure. Median procedure time was 123 minutes (IQR 95-129). No serious adverse events occurred. Adverse events were gastric pain (n = 7, range 1-3 days), sore throat (n = 4, 2-3 days), diarrhea (n = 4, 2-15 days), nausea (n = 3, 2-4 days), constipation (n = 4, 3-14 days), and vomiting (n = 3, 1-4 days). All adverse events were mild and resolved with conservative treatment within 15 days after surgery. The median percentage excess weight loss in the first year was 34.9% (IQR 17.8-46.6).
  
  
  CONCLUSIONS
  Limited number of patients.
  
  
  CONCLUSIONS
  This first human application of this endoscopic stapler demonstrates that the procedure is technically feasible and safe. One hundred sixty plications were created in 17 patients without significant problems. Weight loss after 1 year is promising, but long-term follow-up and randomized, controlled studies should evaluate whether this procedure is an effective and durable minimally invasive endoscopic treatment for obesity. (
  
  
  BACKGROUND
  NCT01429194.).
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Verlaan
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Givan F
authors.initials: GF
authors.lastname: Paulus
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Elisabeth M H
authors.initials: EM
authors.lastname: Mathus-Vliegen
authors.affiliation: Department of Nutrition and Dietetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Elisabeth A M L
authors.initials: EA
authors.lastname: Veldhuyzen
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: José M
authors.initials: JM
authors.lastname: Conchillo
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011446:Prospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling; D016896:Treatment Outcome; D015431:Weight Loss