The management of obesity is an evolving field of medicine with new modalities of treatment being introduced and the old ones undergoing modifications. Some of the demerits of bariatric surgeries are the invasiveness of the procedures, the non-reversibility (except for gastric banding) and series of attendant complications.
Bariatric surgery also alters the natural anatomy of the gastrointestinal tract by either reducing the size of the stomach or reconstructing the small intestine. These are also associated with one form of complication or the other.
AspireAssist is a non-invasive, reversible, FDA approved weight loss treatment device that is associated with fewer complications. The placement of the device can be done on an outpatient basis under conscious sedation as against general anesthesia for bariatric surgeries.
AspireAssist is an aspiration therapy system that is made up of a tube (A-tube or gastrostomy tube) that is inserted into the stomach by an endoscopic procedure, a skin port that is connected to the outer end of the A-tube, a connector, the companion, the reservoir and the drain tube.
- The part of the A-tube that is within the stomach has holes that allow aspiration of the stomach content.
- The skin port has a valve that prevents a gastric leak. The valve is normally in a closed position and only opened when the patient is ready for aspiration.
- The connector is responsible for making a connection with the skin port and opening the skin port valve during aspiration. It can only connect to the port 115 times after which it locks, and aspiration becomes impossible. When this happens, the patient will have to return to his physician to replace the connector. This is a safety device that prevents excessive and long-term use without medical supervision.
- The companion is the siphon that controls the flow of aspirate from the stomach and also infusing water from the reservoir into the stomach.
- The reservoir is a water bottle of about 650 ml capacity. It contains water that is infused into the abdomen to allow aspiration.
- The drain tube is the pathway of the aspirated stomach contents into the toilet.
What is AspireAssist?
The AspireAssist helps remove part of the ingested food from the stomach before the food enters the small intestine where absorption is expected to take place. About 30% of the ingested food can be aspirated. Aspiration is carried out after 30 minutes of food ingestion.
The aspiration is done by flushing the remnants of food particles in the A-tube into the stomach through the infusion of clean water from the reservoir. About 150mls of fluid can be infused at a time. This is then followed by aspiration which is achieved by lowering the level of the companion. The entire procedure is repeated until the aspirate no longer contains food particles.
The process should last for about 15minutes and often done in the restroom where the aspirate is emptied directly into the toilet. It must be stressed that this treatment modality is used in conjunction with dietary adjustment and exercise and should be done under strict medical supervision. Patients are advised to eat slowly and chew the food thoroughly to facilitate drainage.
Noren and Forssell recorded a reduction of BMI from an average of 39.8kgm-2 to 32.1kgm-2 and a percentage excess weight loss of 54.4% after one year of AspireAssist therapy in a group of 25 obese patients. The percentage excess weight loss after 2years rose to 61.5%. They also observed an improvement in the quality of life of these patients and no serious adverse events was recorded. Diabetic patients had a reduction in the value of glycated hemoglobin (HbA1C), and some were able to discontinue their anti-diabetic drugs.
Expected Weight Loss With AspireAssist
Eleven participants had AspireAssist therapy in addition to lifestyle modification while seven members had lifestyle change alone in the study conducted by Sullivan et al. AspireAsses participants had a mean percentage excess weight loss of 49% as opposed to 14.9% in the other group after one year. At the end of the second year, the percentage excess weight loss has risen to 54.4% in the participants who had aspiration therapy. No adverse event was noted.
In conclusion, AspireAssist is a less invasive therapy for obesity with fewer side effects (pain, stoma irritation, and infection) when compared to bariatric surgeries but almost similar weight loss outcome.
