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Gastric pacing : will it be the new thing in weight loss surgery?

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    Richard Coleman considers reports of a new weight loss treatment, known as ‘gastric pacing’, the reported benefits and risks and the growing use of the procedure within the UK.

    By Richard Coleman

In my role as a Clinical Negligence Solicitor, I have particular expertise and interest in cases involving weight loss surgery.  I follow developments in this area with interest and have, in particular, been following reports of a new procedure, known as ‘gastric pacing’.

What are the most common types of weight loss surgery at present?

There are currently two main surgical procedures for weight loss approved for use in the NHS by The National Institute for Health and Care Excellence (NICE), who are the UK government’s healthcare advisory body: (a) adjustable gastric bands (“bands”) and (b) gastric bypasses (“bypasses”).

Each procedure is not without its reported risks however.  Bands commonly slip or erode into the stomach, need regular adjustments and are prone to infection.  A slipped band is a medical emergency and if not removed quickly will lead to stomach necrosis, sepsis and even death.  Bypasses have a risk of a leak from one of the join sites that can also lead very quickly to sepsis and can be fatal if not acted upon quickly.  Furthermore malnutrition from a lack of absorption of vitamins and minerals is common leading to fatigue, poor skin, hair and nails as well as diarrhoea because less water is also absorbed back into the body.

With this in mind clinicians are continually trying to find other ways of ensuring weight loss that have less ongoing risks.

Implantable gastric simulators / gastric pacing

One such initiative I have been reading about is the implantable gastric stimulator (“IGS”), which comprises two wires or electrodes that are implanted into the wall of the stomach in a laparoscopic (keyhole) operation. These are attached to a small battery powered simulator that is inserted beneath the skin in the subcutaneous tissues to the side of the abdomen. The stimulator sends out programmed electrical impulses to the electrode in the stomach wall, in much the same way as a heart pacemaker works.

At present the precise way in which this device works is not really known, but it is believed that the impulses stimulate the stomach to send nerve and/or biochemical messages to the brain to bring about a feeling of “fullness” or satiety.  By artificially inducing satiety, people with this device should stop or reduce the amount of food and liquids they consume and thereby consume fewer calories, resulting in significant, long-term, weight loss. Each device is programmed individually based on the level of stimulation needed to control that person’s appetite.

Results of trials of gastric pacing in the US and Europe

Early trials in the US were reported to have mixed results with relatively poor long term weight loss, however more recent European studies have reported up to 80% weight loss following implantation of the device with up to 60% of patients losing more than 10% of their body weight over a 2-year follow-up period.

Insertion of the IGS device is associated at present with fewer serious side effects although there does appear to be a reported increase in reflux/heartburn which is not only uncomfortable but can lead to long term conditions such as Barrett’s oesophagus (which is a pre-cancerous condition).  Furthermore the longevity of the batteries in the pacemaker is not yet known and each time the batteries need replacing this will involve further (albeit minor) surgery.

The growing use of gastric pacing in the UK

As the IGS device is not yet approved by NICE, it is not readily provided on the NHS. Nevertheless a growing number of surgeons are offering this procedure where they have been able to obtain special funding or offer it to private patients.

As with any form of weight loss surgery it is vital to ensure that your surgeon has appropriate experience of the procedure and also fully explains both the benefits and risks. I have acted for a number of patients who have had either an unsuitable procedure performed on them for their particular needs, or the right procedure but performed poorly.  When innovative surgery is contemplated getting the right surgeon and the right information is even more important.

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