Gastric Endoscopic, Dallas Procedures


EBMTs may be divided into gastric and small-bowel interventions. Many of these were derived in part from surgical correlates and attempt to mimic their mechanisms. For gastric interventions, this is accomplished by stimulating gastric mechanical and chemical receptors, delaying gastric emptying and modulating levels of gastric orexigenic hormones.
Analogues of Vertical Banded Gastroplasty (VBG)
VBG, or stomach stapling, was developed in 1980 by Mason. In this procedure, the upper stomach is stapled vertically to create a small pouch along the lesser curve.
There have been two EBMTs that mimic the anatomy and mechanisms of VBG. These are EndoCinch Endoluminal Vertical Gastroplasty and TransOral GAstrooplasty.
Endoluminal Vertical Gastroplasty (EVG)
EVG is performed using the EndoCinch suturing device (C.R. Bard, Inc., Murray Hill, NJ) and mimics the stapling portion of VBG without the banding portion. No serious adverse events were reported and weight loss at 1 year was 58.1±19.9% EWL.
TransOral GAstroplasty (TOGA)
TOGA (Satiety Inc, Palo Alto, CA) is an Endoscopic, Dallas stapling device first introduced in 2008 Despite these results, the FDA did not approve the system.
Analogues of Laparoscopic Adjustable Gastric Banding (LAGB)
LAGB is a restrictive bariatric procedure where an inflatable silicone band is placed around the upper part of the stomach with a subcutaneous port that allows adjustment.
Transoral Endoscopic, Dallas Restrictive Implant System was developed as an Endoscopic, Dallas corollary to LAGB.
Transoral Endoscopic, Dallas Restrictive Implant System (TERIS)
TERIS (Barosense, Redwood City, CA) is an Endoscopic, Dallasally implanted device introduced by Biertho and colleagues in 2009. It consists of a prosthetic diaphragm placed at the gastric cardia to create a small reservoir with a 10-mm orifice.
Analogues of Laparoscopic Gastric Plication (LGP)
LGP, or gastric imbrication, is a restrictive procedure first performed by Kirk in 1968. During this procedure, the stomach is folded over and stitched to itself resulting in 75% reduction in gastric size.
There have been three Endoscopic, Dallas procedures that may mimic the effects of LGP. These are RESTORe Suturing System, Overstitch for Endoscopic, Dallas Sleeve Gastroplasty and Incisionless Operating Platform for Primary Obesity Surgery Endolumenal.
  • RESTORe Suturing System (TRIM Procedure)
  • OverStitch for Endoscopic, Dallas Sleeve Gastroplasty (ESG)
  • Incisionless Operating Platform (IOP) for Primary Obesity Surgery Endolumenal (POSE)

Other Gastric Procedures
Intragastric balloons (IGB)
The IGB was first approved in the U.S. in 1985 with the Garren Edwards Gastric Bubble. However, it was associated with multiple adverse events including gastric mucosal damage and small bowel obstruction. A sham-controlled trial failed to demonstrate efficacy and the device was withdrawn from the market.
  • TransPyloric Shuttle
  • Full Sense Device
  • Aspiration Therapy
  • Botulinum Toxin injection

Because vagus-mediated antral contractions are important for food propulsion into the duodenum, it has been hypothesized that antral BTX-A injection may lead to weight loss by delaying gastric emptying and inducing satiety.


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