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Abstract

We agree with Dr Hasler that more research is needed before this novel method of intestinal electrical stimulation (IES) can be applied for treating patients with obesity. Indeed, a number of studies have been performed in our laboratory related to the issues/concerns raised by Dr Hasler: (1) Increased fecal fat losses. Recently, a preliminary clinical study was performed in healthy volunteers with intestinal electrical stimulation performed using a duodenal feeding tube attached with ring electrodes. Lipid was perfused directly into the duodenum via the feeding tube and feces were collected during the 24-hour period in the control and stimulation session. A significant increase in fecal fat losses was noted (Gastroenterology 2005;128:abstract [in press]). (2) Weight reduction. A short-term study was performed in rats to investigate the effect of IES on weight loss. IES was performed 2 hours daily for 4 weeks in a cross-over design. A significant weight loss and reduction in food intake was noted between periods of sham stimulation and real IES. (3) Multi-pair electrodes. We compared the effects of IES on small intestinal transit between 2-channel stimulation and 3-channel stimulation and found no significant difference. In a canine model, single channel intestinal electrical stimulation 10 cm beyond the pylorus was found to be equally effective in altering intestinal motility measured at various locations from stimulation site to 2 meters distal to the stimulation site. These data seem to suggest that one-channel stimulation may be sufficient for IES. (4) Possible increased gastrointestinal symptoms. It is possible that IES may increase gastrointestinal symptoms such as early satiety, fullness, bloating, and diarrhea. Some of these dyspeptic symptoms may be beneficial to weight loss and may force the patient to alter his/her eating habits. However, a compromise must be made between the efficacy of the therapy and any unwanted side effects. This may be possible by careful selection of stimulation parameters. More research is required to optimize stimulation parameters. In addition to its effect on fat absorption, IES has also been found to exert inhibitory effects on gastric motility. IES reduces gastric tone, inhibits antral contractions in the fed state, delays gastric emptying, and reduces food intake (Neurogastroenterol Motil 2002;14:114, 2002;14:456). These data suggest that IES may also have a restrictive effect on food intake, in addition to its malabsorptive effects. Intestinal electrical stimulation: A possible treatment for morbid obesity?GastroenterologyVol. 128Issue 5PreviewSun Y, Chen J (Transneuronix Research and Veterans Research Foundation, Oklahoma City, Oklahoma). Intestinal electric stimulation decreases fat absorption in rats: therapeutic potential for obesity. Obes Res 2004;12:1235–1242. Full-Text PDF