Is Primary Obesity Surgery Endoluminal (POSE) an effective technique?
Posted in Pictures on 25 April 2017
Henry Cordova (Gastroenterology Department)
Ana Otero (Gastrointestinal surgery specialist) Hospital Clínic, Barcelona – Spain
In this procedure, the stomach is plicated at several locations of the fundus and the antrum, using specific sutures. These mechanically and physiologically plicated areas restrict the contact of food with the total surface of the stomach. The antrum folds modify its shape and cause slower gastric emptying, which increases the satiating effect.
We present the case of a 55-year-old female patient with no known medical allergies, with a history of minor thalassemia and no surgical history. The patient had presented with a BMI of 42 kg/m2. She underwent a POSE procedure with an initial weight loss of 12 kilos. Later she regained weight. She came to our office to undergo bariatric surgery 8 months later with a BMI of 39.
During preoperative testing, a gastroscopy and an upper gastrointestinal series were carried out; there was no evidence of reflux with a small hiatal hernia. The stomach demonstrated good motility and emptying, and the fold pattern was normal.
In the gastroscopy a small-sized hiatal hernia with no associated lesions was found. At the level of the major fundus-body-antrum curvature, multiple endoscopic suture threads, 2 of which were ulcerated (one at the antrum level and another at the fundus level), were identified .
Currently the patient is waiting to undergo bariatric surgery. We can conclude that, based on what is published in the literature, the POSE procedure is a safe and feasible procedure, but well-designed, randomized, controlled studies are necessary to determine short- and long-term efficacy.
The POSE is indicated in obese or overweight patients who are not candidates for bariatric surgery, and who intend to implement changes in their lifestyle but need permanent assistance to improve satiety.
It is possible that we may find ourselves treating more and more patients, on whom treatment of this type has failed, and who need a definitive solution. In any event, a careful, precise technique is recommended since, as in any revision surgery, there may be a higher percentage of complications in these patients.