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The human kind becomes heavier every day and this excess weight is progressively increasing.1 More than 58% of the United States adult population is presently overweight (BMI > 25 kg/m2).2 In addition, 4.7% (14–16 million) of American people are morbidly obese (BMI > 40 kg/m2).3 The consequence of this pandemic is the increase in comorbidities4,5 and premature death6,7 in this group. These individuals suffer from a wide variety of obesity-related diseases and integrate the second largest group of avoidable deaths, coming after smokers (>300,000 annually).3 The cost of this obese population reaches approximately US$70 billion a year.8 Overweight/obesity prevalence worldwide is estimated around 1.7 billion people,9 what leads to more than 2.5 million deaths a year.10


Many ways of treatment are available for obesity, with variable efficacy: diets, appetite suppressor drugs, and surgery.2 For the patients considered morbidly obese (BMI > 40 kg/m2), the US National Institutes of Health concluded that obesity surgery is the most adequate therapeutic option.11 Several studies have shown dramatic improvement in obesity-related comorbidities in patients submitted to diverse surgical treatments (restrictive, malabsorptive, or combined) after weight loss.12 Throughout the last 50 years, with the development of adequate techniques and instruments, surgical treatment has evolved into a safe and efficient treatment. In addition, the emerging of minimally invasive surgery such as laparoscopy has increased the safety and popularity of these procedures. Nevertheless, in spite of all technical and technological advances, every procedure may lead to short-term postoperatory complications and long-term nutritional and gastrointestinal consequences.13


Less than 1% of the obese patients that fulfill the criteria for surgical treatment actually have access to it, however. While many potential candidates have their operations denied by health insurance companies, lack of knowledge about the efficacy of the specific method and other reasons, a great number of individuals will avoid surgery because of the fear of the possible complications and long-term consequences of the procedures performed to date.12


The implantable gastric stimulation (IGS), usually referred as the gastric pacemaker, comes as a new concept for the treatment of severe obesity. Unlike other ways of bariatric surgery, it involves minimal manipulation of the normal gastrointestinal tract anatomy, and is feasible by laparoscopy. These features minimize the risks of postoperatory complications and the development of late nutritional and gastrointestinal disturbances; it is even a possibility for the patients not eligible for invasive procedures for presenting with BMI < 35 kg/m2.13


Gastric Motility and Emptying


Motility is one of the major functions and characteristics of the gastrointestinal tract, without which the progression of food, its digestion, and absorption would be impaired. In order to perform this task adequately, the stomach needs to generate coordinated contractions (peristalsis) to propel nutrients to regions of maximum absorption in a regular rate. Thus, coordinated gastric contractions are ...

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