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Interview: Jerome Dargent

New technologies in bariatric surgery

Dr Jerome Dargent is the chairman of the International Symposium on Non-Invasive Bariatric Techniques, held in Lyon, France. Based on his experience with non-invasive techniques, he has written a book listing 40 new and developing bariatric technologies, to be released before this year's conference. We talked to Jerome about his book, ‘Innovative Technologies and Non-Invasive Procedures in Bariatric Surgery’, as well as his upcoming conference, to be held on April 26-27.

The cover to Jerome Dargent's new book

Why did you decide to write the book?  

This book is a natural continuation of the meeting on new technologies in the bariatric field we organise each year, particularly minimally invasive technologies using natural orifices.

I started to write the book just before our second meeting, in April 2012. Participants have expressed the need for a directory covering as much as possible these novelties.

The important challenge was to provide relevant and updated information in a field that is constantly evolving. Therefore, readers will have to forgive inaccuracies, or obsolete data – which should be corrected in the next edition.

Are you aware of any similar books covering the same topic?

None to my knowledge, although many bariatric books have a more or less prominent chapter dedicated to new operations, etc, and brochures have been edited regarding particular operations (e.g. SILS operations).

Are there other authors?

Many fellow physicians have contributed to this book, many if not most after giving outstanding talks during the meetings. The main contributor has been Giovanni Dapri, but for personal reasons he did not wish to have his name mentioned.

Recent abstracts from the literature and other meetings have been helpful, as well as updated information from innovative companies. Companies and physicians share information during the sessions of the meeting, thus maintaining a workshop spirit and a casual atmosphere, which hopefully will reflect in the book!

What content do you have in the book for each device? Does it just offer information, or do you include critiques or commentary?

It varies a lot according to the type of device and/or operation. Sometimes full abstracts are available, sometimes just oral presentations and brochures from companies.

On the other hand, operations and devices are mentioned that are not currently available, or that obviously represent a wrong path. Nevertheless, most of these are relevant in the sense that the approach could be attempted again, or will be – for example, the TOGA endo-stapler. As always in medicine, we also have a lot to learn from our failures, like Botox injections in the stomach!

Are there any limitations to the type of device featured? Do you cover endoscopic devices, for example?

Endoscopic devices are definitely the most innovative and may represent the real future of the bariatric field. Besides, smaller innovations are also instrumental, like motorised staplers and robotic needle-holders. We also cover new operations that have raised controversies, like gastric plication or ileal transposition, and and transversal issues, like ethics, benchmarking, and anaesthesiology.

Does it only cover devices that are already in the market, or devices that are in development as well?

Both, but some devices in development have not been disclosed yet. Technically, companies that come to the meeting have at least some information to be released, even if they cannot deliver results and experts. This technological and scientific data is useful for physicians and companies alike.

What do you hope clinicians will be able to gain from your book?

I hope that they will be updated on new stuff, since most of the bariatric community is aware of the necessity of significant evolution. Besides, it should provide them with clues, ideas for new directions, or let them pick up trials they want to be part of, etc.

When you got in touch with us, you posed several questions that need to be answered about new bariatric devices: what is the cost of innovation? Can companies that make these expensive devices wait for final approval before getting some return on investment? On the other hand, do we have enough data when a device is launched? Do we have to question the ethics of the trials that are being conducted? – Are these questions answered in your book?

Not exactly, because these issues will be a primary focus of the forthcoming Non-Inva meeting and have not been addressed yet; they will be definitely dealt with in the next edition – a summary will be edited quite soon after the meeting.

Did you enjoy the process of writing the book?

Yes! But not always, because I was constantly assuming that part of the information was going to become obsolete before being edited! 

What can we look forward to at Non-Inva this year? Are there any particular highlights that you're looking forward to?

Issues such as economics versus ethics, and of course new devices, for instance Barosense and Obalon, as well as promising updates on already successful technologies, like Endobarrier. 

Who helped you organise the conference this year?

Karl "Charlie" Miller, like in 2012, just after his always-successful March Austrian meeting in Saafelden.

How do you decide what goes on to the programme?

The problem is to stay sharp on what is going on, both with unexpected disappointments and surprising novelties. Then of course you have to convince companies, big and small ones alike, to come, send representatives, and finance a bit.

This is the third year that you've put on this conference – how has it developed? What has changed, and what has stayed the same, since you started organising the conference?

Unless surprises arise, the outline of the conference will stay the same, and again we expect 100-130 people, most of them being key opinion leaders. We imagined doing training sessions with new devices, but it was complicated to set up and we had to admit that most devices were not really ready for that yet. So once again we will keep the low profile of a research forum.

Is there any particular theme to the programme this year, or area of surgery which researchers seem to be particularly interested in?

I would put it (subjectively) like this: gastric plication, endoscopic plication, and new balloons are coming up; SILS procedures are going down. We’re still waiting for further data on the Endo-barrier and neuromulation.