Specialists at Brigham and Women’s Hospital are offering new techniques in endoluminal therapy and natural orifice transluminal endoscopic surgery (NOTES).
Advances in Endoluminal Therapy Recent advances in the field of endoscopy are providing novel therapy for patients. New devices are allowing endoscopists to perform endoluminal suturing. Brigham and Women’s Hospital is leading several trials of innovative endoluminal techniques in bariatric surgery, including:
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Randomized Evaluation of Endoscopic Suturing Transorally for Anastomotic Outlet Reduction (RESTORe) for Patients with Inadequate Weight Loss Following Roux-en-Y Gastric Bypass Surgery – Brigham and Women’s Hospital is the lead center for this multicenter, nationwide, double-blinded trial, which is currently open for patients who have undergone gastric bypass surgery and have experienced weight regain or inadequate weight loss following surgery. Patients who are six months post-primary Roux-en-Y gastric bypass (RYGB) with inadequate weight loss, BMI >30 and ² 50, and dilated gastrojejunal anastomosis may be eligible for this trial. Christopher C. Thompson, MD, MSc, Director of Developmental Endoscopy at Brigham and Women’s Hospital is the principal investigator, and David Lautz, MD, Director of Bariatric Surgery at Brigham and Women’s Hospital, is the blind assessor of this trial, which is designed to assess the effectiveness of reducing the size of the anastomotic outlet using a new transoral suturing device to help RYGB patients to lose additional weight;
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Transoral Gastric Volume Reduction as an Intervention for Weight Management (TRIM) – Brigham and Women’s Hospital is one of only two centers nationwide to offer this trial, which is designed for patients who have not previously undergone weight loss surgery. The trial will assess the effectiveness of a new reversible, transoral approach to stomach reduction. Patients with a BMI ³ 35 may be eligible for this trial.
Indications for Bariatric Endoscopy Referral
Advanced endoluminal therapy for weight loss may be appropriate for patients who have:
Additional Developments in Endoluminal Treatment
Additional endoluminal treatments include removal of gastric lesions such as gastrointestinal stromal tumors (GISTs). Other developments currently underway in this area include collaboration with industry in the refinement of devices that enable endoscopic suturing and development of novel weight loss therapy.
Advances in NOTES
Pioneering work by investigators at Brigham and Women’s Hospital is establishing the role of NOTES techniques in clinical practice. Part of a procedural continuum, NOTES presents the opportunity to perform procedures with less risk and fewer complications to patients.
A national leader in NOTES research and device development, Dr. Thompson has directed several key national and international medical educational activities in NOTES, including instructional courses through the American Society of Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Several protocols are now nearing clinical trial.
One study involves transluminal abdominal exploration for patients with pancreatic cancer and is led by minimally invasive surgeon Ali Tavakkolizadeh, MD. Currently, the outcome of pancreatic resection for patients with pancreatic head cancers is poor, with a five-year survival of 20 percent – due in large part to inaccurate staging of patients with pancreatic cancer. Despite improvements in radiological imaging and laparoscopy, there has been little improvement in the surgical outcomes. This trial is designed to better stage patients with pancreatic head cancers by evaluating the area behind the stomach (lesser sac) and determining the presence of metastatic disease prior to proceeding with Whipple surgical treatment. As the prognosis of patients with metastatic disease does not significantly improve following Whipple treatment, this explorative procedure prevents patients from undergoing unnecessary invasive surgical treatment that has not been shown to better the outcome in this subset of patients and may adversely affect their quality-of-life.
Other NOTES procedures in various stages of development by Brigham and Women’s Hospital investigators include:
Indications for NOTES Referral
NOTES is currently being evaluated for patients with:
Information and Referrals
For more information, or to refer a patient for NOTES or endoluminal therapy, please contact our Referral Coordinators at (617) 732-9894 or bwhteleservices@partners.org.
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