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GI Dynamics: In Metabolic Disease a Device Might Trump Drugs

Executive Summary

It's not often that a company in the medical device industry, where most new products offer incremental innovation, has a chance to change the world. Start-up GI Dynamics does, though. Shooting for a non-invasive device that would replicate some of the benefits of the invasive Roux-en-Y gastric bypass surgery in obesity, it discovered that an endoscopically delivered implant appears to be extremely effective in type 2 diabetes, as is the predicate gastric bypass. Simple and non-invasive, the technology is potentially disruptive by reversing the disease, not just managing its symptoms. (See also the sidebar to this article: "A Mechanistic Look at Diabetes Surgery: An Interview with Francesco Rubino." )

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ASMBS Highlights New Developments in Bariatric Surgery

A record-breaking attendance at 2010's meeting of the American Society for Metabolic and Bariatric Surgery marked the growing interest in new ways to address the issue of obesity. Currently, less than 1% of a potential US patient population of 15 million who might benefit from bariatric surgery actually undergo the procedure, and surgeons are scrambling to understand why and to identify new, less invasive approaches that might help them better penetrate this enormous patient pool.

Appetite for Obesity Devices Stays Strong

Numerous physiologic pathways lead to obesity; those related to hunger, satiety, the breakdown and absorption of nutrients, and the regulation of energy. Given the complexity of obesity, it's not surprising that diet and exercise aren't currently effective and that drugs have had only modest success. Bariatric surgery, on the other hand, which reduces the size of the stomach (and, in some versions, also reroutes part of the small intestine so that food bypasses it) is extremely successful. Many patients that have undergone the Roux-en-Y gastric bypass procedure have sustained losses of 50% of their excess weight out to ten years and beyond. Now companies with minimally invasive devices for the treatment of obesity hope to fill the therapy gap between dieting and invasive surgery. It's too early to claim victory, but start-ups and scientists are benefiting from a better understanding of why gastric bypass surgery works.

New Developments in Obesity Intervention

With soaring medical costs weighing heavily on the US economy, it's not surprising that obesity has become a target in the health care reform debate. Obesity is costly because it significantly increases the risk of many chronic diseases. Exercise, dieting and prescription drugs have had a limited effect in stemming the tide of obesity, leaving bariatric surgery and other interventional techniques as the primary treatment options for this potentially multi-billion dollar market. But device manufacturers have a challenge ahead of them--to develop more effective, safer, and less invasive obesity therapies that will not only result in long-term weight loss, but will also cut treatment costs and better manage comorbidities.

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