SAFETY PROFILE OF THE POSE PROCEDURE

Aims:

Bariatric surgery, diet and lifestyle modifications, and non-exogenous drugs, have not managed to stop obesity worldwide expansion. Several bariatric endoscopic techniques emerge as safe and cost-effective promising alternatives. Our aim was to evaluate the security of the POSE (Primary Obesity Surgery Endolumenal) procedure.

Methods:

Prospective registry of intraoperative incidents, and adverse effects in a consecutive cohort of 518 obese patients (BMI 30 – 44.9) subjected to POSE method within a multidisciplinary program of lifestyle changes. Interventions were carried out by two endoscopists between June-2012 and June-2017. All patients signed the consent informed. Interventions were performed under general anesthesia, antibiotics, and CO2, inserting an ultrathin gastroscope in the incisionless operating platform (IOP), performing 12 – 18 transmural plications in fundus and distal body, in an inpatient basis. Intraoperative incidents, symptomatology, and adverse effects were described.

Results:

The procedure could be performed in 515 patients (99.4%), failing to pass the IOP through the esophagus in 3. Average surgical time: 25 minutes. Minor events: anesthetic mild complications: 2%; intraoperative submucosal bruising: 24.8%, without clinical impact; mucosal snagging with IOP or forceps were infrequent, and 100% solvable. In 5 we treated hemorrhagic points. Symptomatology: most patients had mild to moderate epigastric pain lasting 24 – 72 hours, requiring opioids in 3.5%; slight cervical pain: 62%; chest pain: 4.8%; low fever: 1.5%; postoperative vomiting: 5%, Major events: 2 gastric bleedings, one within 24 hours, resolved with adrenaline/clips. Another after 3 weeks in context of NSAIDs due to gout in a thrombocytopenia-HIV patient, requiring transfusions. There was an asymptomatic pneumoperitoneum. Up to 97% of patients were discharged in < 24 hours.

Conclusions:

The POSE method is safe and feasible in a short surgical time. Its commonest symptom is mild epigastric pain, being its biggest drawback is assymptomatic mural bruises production. Only three major complications were registered.