1. 9J. Dargent, Innovative Technologies and Non-Invasive
Procedures in Bariatric Surgery,
DOI 10.1007/978-2-8178-0404-0_2, © Springer-Verlag France 2013
Benchmarking of Novel Technologies in Bariatric Surgery
By 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 % of
all potential candidates agreeing to proceed each year. We need something to offer
the other 99 %. Among the factors driving people away from bariatric surgery is its
invasiveness. The resurgence of bariatric surgery in the early 1990s with the intro-
duction of the laparoscopic approach and of adjustable gastric banding showed that
the less invasive the approach, the broader appeal it will have.
A new obesity procedure must be acceptable to the obese person and acceptable
to their healthcare provider. Each has different needs:
B
Acceptable to the obese patient Acceptable to their healthcare provider
Minimally invasive: Low upfront cost
Endoscopic or equivalent
Very low risk
Minimal side effects
Effective: Cost-efficient and cost-effective
Good weight loss Measure incremental cost-effectiveness ratio
Durable effect
Co-morbidity resolution
Adjustable Readily reproducible
Reversible Simple to deliver

2. 10 B
We need to benchmark any endoscopic procedure against the current best prac-
tice on either side of the invasiveness gradient. Endoscopic procedural approaches
to weight loss will generally fit between the relative impotence of best medical
therapy 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 the
latter. These can provide current best practice norms against which to compare. We
need options in between. They must be more effective than VLED. They must be
less 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? Will
patients accept it? What is the cost – in Euros, in time and effort?
Benchmark each procedure against the comparators by these criteria. Does it
measure up? Can it be reasonably expected to measure up in due course? If so, go
for it. Try it, measure it but be honest about it.
VLED LAGB
15 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 stay
Very low cost Low risk
Modest patient acceptability Upfront cost US$10–15 K

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