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9J. Dargent, Innovative Technologies and Non-InvasiveProcedures in Bariatric Surgery,DOI 10.1007/978-2-8178-0404-0_2, © Sp...
10 BWe need to benchmark any endoscopic procedure against the current best prac-tice on either side of the invasiveness gr...
http://www.springer.com/978-2-8178-0403-3
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Innovative technologies and non invasive procedures in bariatric surgery

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Innovative technologies and non invasive procedures in bariatric surgery

  1. 1. 9J. Dargent, Innovative Technologies and Non-InvasiveProcedures in Bariatric Surgery,DOI 10.1007/978-2-8178-0404-0_2, © Springer-Verlag France 2013Benchmarking of Novel Technologies in Bariatric SurgeryBy Paul O’Brien: Melbourne, Australia, Centre for Obesity Research and Education(CORE), Monash University, Melbourne, Australia.There is a huge unmet need for acceptable, effective treatments for obesity.Bariatric surgery is effective but it is largely unacceptable with only around 1 % ofall potential candidates agreeing to proceed each year. We need something to offerthe other 99 %. Among the factors driving people away from bariatric surgery is itsinvasiveness. The resurgence of bariatric surgery in the early 1990s with the intro-duction of the laparoscopic approach and of adjustable gastric banding showed thatthe less invasive the approach, the broader appeal it will have.A new obesity procedure must be acceptable to the obese person and acceptableto their healthcare provider. Each has different needs:BAcceptable to the obese patient Acceptable to their healthcare providerMinimally invasive: Low upfront costEndoscopic or equivalentVery low riskMinimal side effectsEffective: Cost-efficient and cost-effectiveGood weight loss Measure incremental cost-effectiveness ratioDurable effectCo-morbidity resolutionAdjustable Readily reproducibleReversible Simple to deliver
  2. 2. 10 BWe need to benchmark any endoscopic procedure against the current best prac-tice on either side of the invasiveness gradient. Endoscopic procedural approachesto weight loss will generally fit between the relative impotence of best medicaltherapy and the fear of major bariatric surgery. Very low energy diets (VLED) rep-resent the most effective of the former and LAGB represents the least fearful of thelatter. These can provide current best practice norms against which to compare. Weneed options in between. They must be more effective than VLED. They must beless invasive and yet equally effective as LAGB.Reasonable expectations for the comparators are as follows:For each candidate procedure we must ask: Is it safe? Is it feasible generally?Does it work? – What weight loss? What health benefit? Is the effect durable? Willpatients accept it? What is the cost – in Euros, in time and effort?Benchmark each procedure against the comparators by these criteria. Does itmeasure up? Can it be reasonably expected to measure up in due course? If so, gofor it. Try it, measure it but be honest about it.VLED LAGB15 kg weight loss in 3 months 30 kg weight loss over long term (>10 years)Short term only Less than 1 h procedure time,No procedure at all Outpatient – Less than 3 h length of stayVery low cost Low riskModest patient acceptability Upfront cost US$10–15 K
  3. 3. http://www.springer.com/978-2-8178-0403-3

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