Power Blackout in the Nervus Vagus

30. April 2009
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If you always have considered bariatric surgeries rather martial you might get a bit more out of a new minimal invasive procedure. A kind of pacemaker was authorized in Europe which cripples the Nervus vagus in obese people.

Apart from a radical and consequent and therefore almost inhuman change of life style, bariatric surgey more or less was the only option for people with heavy obesity in order to really lose a considerable amount of weight. Although Germany was rather reluctant compared to other countries, the trend has been all too clear. About 2000 people got a gastric band paid by the public health insurances or a Y-Roux-Anastomosis. We can only guess how many patients paid themselves for such a surgery. Just in the US with its privately financed health system we are talking in 2006 only – now hold yourself – 260000 bariatric surgeries.

Surgery celebrates its successes. But the price is high.

The successes of obesity surgeries are indisputable. “There are several spectacular studies showing that the obesity surgeries normalize the metabolism, lower the indices of type-2 diabetes and even can improve the long-term survival,” emphasizes Professor Burkhard Göke at the Medizinischen Klinik II (Medical Clinic II) at the LMU Munich just recently during a congress in Berlin. According to him it is important though to tightly embed the patient in an internal – and even more important – a psychosomatic care. “The surgery itself is not enough, those patients need a life-long post-support”, says Göke.

And not only that: Bariatric surgeries are relatively invasive. The adjustable gastric band might be considered a rather small surgery. But the more effective Roux-Bypass changes the physiology of the digesting system sustainably and irreversibly. Does that have to be the case though? Not necessarily if you ask the company EnteroMedics. With its VBLOC („Vagal Blocking for Obesity Control“) it has developed a solution which electronically blocks the Nervus vagus which is significantly responsible for gastrointestinal motility and the feeling of hunger. We are talking about the so to speak neurophysiological variation of the gastric band, kind of a pacemaker against fattening. In Europe, EnteroMedics has now received the CE-mark authorization for the VBLOC. “VBLOC is an innovative form of therapy promising a significant loss of weight without having to make any compromises”, said Mark Knudson, head of the company on the occasion of the receipt of the certification.

Electric vagectomy with a time limit

The charm of the procedure lays in its rather gentle approach. The implantation of the Vagus-pacemaker electrodes is made laparoscopically. Also compared to other laparoscopic approaches in obesity surgery the intervention is rather small. But most important of all – there are no irreversible changes are made. The electric stimulation of the Nervus vagus is made by high frequent impulses paralyzing the Vagus and thus eventually reducing the feeling of hunger and the Peristalsis. Different from the surgical vagectomy, the pacemaker paralyzes the nerve only intermittently. It prevent that the compensation mechanism gets started which would render the initial effect of the vagotomy void.

The results of an initial study working with this approach were quite impressive. A total of 38 patients received the Vagus-pacemaker. After six months, the first follow-up showed an average loss of weight of 17.9 percent according to the company. For the second follow-up 12 months later, only 17 of the patients were available which might be an indication that this method does not help everyone. But nonetheless: Those remaining 17 patients had lost 28.1 percent of their weight and after 18 months – although only nine patients were checked – it was a full 37.6 percent. “We consider these results very encouraging. They show that a sustained loss of weight is possible without those undesirable effects other obesity therapies come along with”, says Knudson. The entrepreneur is aware of it that 38 patients don’t make a summer yet. But currently a large randomized-controlled study is on its way, first results should be available in the second half of this year.

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1 comment:

medico Omar Male
medico Omar Male

I like too much this procedure, I would like to know more about this
thanks
dr. male
mexico

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