Gastric peroral endoscopic myo-neurotomy as less-invasive bariatric surgery in porcine models: an experimental study

Obesity is a global health problem, and less-invasive treatments are warranted. We developed a novel endoscopic intervention named peroral endoscopic myo-neurotomy (POEM-N) that is performed at the greater curvature of the gastric antrum as a bariatric/metabolic procedure and assessed its feasibility using porcine models.

Six live pigs were divided into 3 groups of 2: POEM-N with a high-fat diet (HFD) (POEM-N group); sham procedure with HFD (HF-control group); and sham procedure with normal diet (N-control group). All pigs were fed the diets for 2 weeks, underwent POEM-N or sham procedure, and were observed for 2 weeks after the procedure. The primary outcome was the safety and feasibility of POEM-N. Adverse events and histology of the area after POEM-N were evaluated to assess the procedure's safety and feasibility. Secondary outcomes were changes in body weight and glycolipid levels.

There was no severe worsening of vital signs during or after the POEM-N procedure. All pigs were well and food intake was good, with no delayed adverse events. Excessive storage of dietary residue, deformity of the gastric antrum, and fold concentration were observed after POEM-N, as expected. Histologic examination revealed hypertrophic regeneration of Auerbach's plexus, which regulates gastric peristalsis, in both POEM-N pigs. After the procedure, HFD-induced weight gain in the POEM-N pigs slowed, and the increase in serum and liver cholesterol levels was suppressed.

We applied POEM-N as a bariatric/metabolic procedure and showed its safety and feasibility using porcine models.