The vagus nerve as a target for bariatric and metabolic interventions: is there a future?

Scott Shikora, MD FACS. Professor of Surgery, Harvard Medical School, Director of the Center for Metabolic and Bariatric Surgery, Brigham and Women’s Hospital, Boston (Massachusetts, USA) reviews the physiology of the vagal nerve and explains how its neuromodulation may be an alternative to metabolic and bariatric surgery.

In this interesting lecture, Dr. Shikora explains the differences between neuromodulation and neuroblocking, and how incidental findings in patients with epilepsy lead to the hypothesis that neuroblocking of the vagal nerve may be a useful tool for weight control. Also, the current literature data on vagal nerve neuromodulation is thoroughly reviewed.

Some questions are still unanswered, such as: what is the real mechanism of action? How can patients be selected? Where should the neuromodulator be placed: upper vagus, lower vagus...? And what are the optimal device parameters?

Preliminary studies have suggested that reversible, programmable, vagal nerve blocking can safely achieve durable weight loss and metabolic benefits. It should be considered an option in patients not interested in or unable to undergo conventional bariatric surgical procedures.