1. Hospital stay: Rarely does a patient go to an out-patient surgery center.
2. Top Surgeons: Those are the same surgeons who may charge up to $20,000 for the same surgery (think Priceline.com®)
3. Recourse: A rarely mentioned benefit of having surgery in the US is the checks and balances that are instituted. We complain about the legal system, however, if you have surgery abroad, any surgery, and just about anywhere else, you have very limited options. In the USA, we hold our surgeons and hospitals responsible (THIS IS THE BIGGEST REASON TO NOT GO OUSIDE OF THE USA).

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The dramatic effects of the removable device on blood glucose levels in this animal model suggest an important role for the duodenum (the first part of the small intestine) and jejunum (the central part of the small intestine) in the regulation of this metabolic function. GI Dynamics is developing an endoluminal sleeve, known as the EndoBarrier™ Gastrointestinal Liner, and is currently in late-stage clinical trials.

The study authors were recognized by the Obesity Society with The Obesity Awards for Outstanding Journal Research which recognizes exemplary research in basic, clinical, or population manuscripts published in the journal Obesity. This award was presented during a plenary session at the Obesity Society's 2008 Annual Meeting on October 3-7 in Phoenix, AZ.

"We believe the weight loss and normalization of blood glucose levels observed in this study reflect the physiological effects of preventing contact between ingested food and the duodenum, thereby mimicking the effects of gastric bypass surgery. These animal data further support the potential role of endoscopic duodenal exclusion as a new treatment option for patients suffering from obesity and other metabolic conditions and may offer a valuable alternative to more invasive surgical approaches," said Lee M. Kaplan, M.D., Ph.D., associate professor of medicine at Harvard Medical School, director of the Weight Center at Massachusetts General Hospital, and a co-author of the study.

To evaluate the effect of the EndoBarrier on body weight, the obese and diabetic rats were randomized into two groups; the first group received the device in the duodenum and the second group underwent a sham operation (control group). After seven weeks, the device treated rats weighed an average of 20% (p<0.001) less than those in the sham treatment group, and the difference in the two groups continued through the end of the 16-week follow up period demonstrating that treatment with the EndoBarrier resulted in sustained weight loss over time.

Caloric intake and percentage of calories absorbed by the gastro-intestinal tracts of both groups of rats were also evaluated. Treatment with the EndoBarrier resulted in a 28% (p<0.05) reduction in daily caloric intake. There was no difference in calories absorbed between the two groups, indicating that malabsorption is not a significant contributor to the weight loss. The study also found that the device prevented acute weight gain in lean, obesity-prone rats.

In addition, this study showed that treatment with the EndoBarrier substantially decreased fasting blood glucose (p<0.001) and insulin levels (p<0.02) compared to the sham treatment group, and improved oral glucose tolerance, as evidenced by a 40% decrease in the area under the curve analysis of glucose excursion. Improved peripheral insulin sensitivity was confirmed by calculation of the homeostasis model assessment of insulin resistance (HOMA-IR).

"The sustained weight loss and reduction in blood glucose levels seen in the rats treated with the EndoBarrier underscores what we've seen to date in our human clinical trials," said Stuart A. Randle, chief executive officer of GI Dynamics. "We recently announced new data from a clinical trial indicating that the EndoBarrier is a safe, noninvasive device with excellent short-term weight loss results in severely obese patients and the patients in this trial also experienced reductions in blood glucose levels. We look forward to conducting additional trials to further evaluate the device and are pleased to share these findings."

In September 2008, GI Dynamics announced data from a multi-center, randomized clinical trial of 37 patients - 26 received the EndoBarrier Gastrointestinal Liner and 11 were in the diet control group. The EndoBarrier was implanted for 12 weeks and some of these patients were allowed to continue for an additional 12 weeks. Four patients continued beyond the initial 12 weeks. Results from this recent trial indicate that the EndoBarrier may be a safe, noninvasive device with excellent short-term weight loss results in severely obese patients. These data showed that patients treated with the EndoBarrier lost on average, triple the weight of their diet control group. At three months, EndoBarrier patients experienced a mean excess weight loss of 19.0% versus 6.9% (p<0.001) in the diet control group. In the eight patients with type 2 diabetes, all improved dramatically during the study period as evidenced by the decrease in blood glucose levels and a reduction in diabetic medication. The mean procedure time was 33 minutes for device implants and 15 minutes for device explants. There were no procedure related adverse events.

Online copies of the article can be found at:
Obesity: " An Endoluminal Sleeve Induces Substantial Weight Loss and Normalizes Glucose Homeostasis in Rats with Diet-Induced Obesity," by Aguirre et al., http://www.nature.com (subscription required) --Source: Medical News Today
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A body mass index (BMI) above 40 - most often means about 100 pounds overweight for men and about 80 pounds for women - indicates that a person is severely obese and therefore is a possible candidate for the lap band or stomach stapling surgery (if you have comorbidities your BMI can be less and you would still be a candidate). New less invasive weight loss surgery procedures use laparoscopic (lap) tools and provide new alternatives to stomach stapling operations.

The number of stomach stapling or lap band type operations has nearly tripled since 1997 to 63,100 last year. The Lap Band and the gastric stimulator (once FDA approved) may be available to patients with BMI's from 25 and up based on their doctors recommendation. The Lap Band is reversible if necessary making the lap band a good initial weight loss solution to consider. Gastric Bypass Surgery or stomach stapling may also be an option for people with a BMI between 35 and 40 who suffer from life-threatening problems...Learn more>>

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