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Leo K. Cheng - One of the best experts on this subject based on the ideXlab platform.

  • supervised machine learning segmentation and quantification of Gastric Pacemaker cells
    International Conference of the IEEE Engineering in Medicine and Biology Society, 2020
    Co-Authors: Sue Ann Mah, Recep Avci, Jeanmarie Vanderwinden, Leo K. Cheng
    Abstract:

    Interstitial Cells of Cajal (ICC) are specialized Pacemaker cells that generate and actively propagate electrophysiological events called slow waves. Slow waves regulate the motility of the gastrointestinal tract necessary for digesting food. Degradation in the ICC network structure has been qualitatively associated to several gastrointestinal motility disorders. ICC network structure can be obtained using confocal microscopy, but the current limitations in imaging and segmentation techniques have hindered an accurate representation of the networks. In this study, supervised machine learning techniques were applied to extract the ICC networks from 3D confocal microscopy images. The results showed that the Fast Random Forest classification method using Trainable WEKA Segmentation outperformed the Decision Table and Naive Bayes classification methods in sensitivity, accuracy, and F-measure. Using the Fast Random Forest classifier, 12 Gastric antrum tissue blocks were segmented and variations in ICC network thickness, density and process width were quantified for the myenteric plexus ICC network (the primary Pacemakers). Our findings demonstrated regional variation in ICC network density and thickness along the circumferential and longitudinal axis of the mouse antrum. An inverse relationship was observed in the distal and proximal antrum for density (proximal: 9.8±4.0% vs distal: 7.6±4.6%) and thickness (proximal: 15±3 μm vs distal: 24±10 μm). Limited variation in ICC process width was observed throughout the antrum (5±1 μm).Clinical Relevance— Detailed quantification of regional ICC structural properties will provide insights into the relationship between ICC structure, slow waves and resultant gut motility. This will improve techniques for the diagnosis and treatment of functional GI motility disorders.

  • design of a closed loop Gastric Pacemaker for modulating dysrhythmic conduction patterns via extracellular potentials
    International Conference of the IEEE Engineering in Medicine and Biology Society, 2020
    Co-Authors: Luman Wang, Leo K. Cheng, Avinash Malik, Partha S Roop, Nira Paskaranandavadivel
    Abstract:

    A potential treatment option for chronic and severe motility disorders such as gastroparesis is the implantation of a Gastric Electrical Stimulator (GES), which is designed to modulate the bio-electric slow waves. However, the effectiveness of current GESs remains uncertain since they do not work in a closed-loop by sensing, processing, and modulating the dysrhythmic patterns. This work presents the design of a GES model working in closed-loop with the network of the Interstitial Cells of Cajal (ICC). A pre-existing two-dimensional ICC network is enhanced by proposing an extracellular potential generation model, which can precisely capture the timing behaviour of slow wave propagation pattern of the simulated ICC network. The GES senses the extracellular potential, detects bradyGastric patterns and finally modulates the activity to ensure normal conduction. The GES is designed to be practical for ease of validation and implementation.

  • EMBC - Supervised Machine Learning Segmentation and Quantification of Gastric Pacemaker Cells
    Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Inte, 2020
    Co-Authors: Sue Ann Mah, Recep Avci, Jeanmarie Vanderwinden, Leo K. Cheng
    Abstract:

    Interstitial Cells of Cajal (ICC) are specialized Pacemaker cells that generate and actively propagate electrophysiological events called slow waves. Slow waves regulate the motility of the gastrointestinal tract necessary for digesting food. Degradation in the ICC network structure has been qualitatively associated to several gastrointestinal motility disorders. ICC network structure can be obtained using confocal microscopy, but the current limitations in imaging and segmentation techniques have hindered an accurate representation of the networks. In this study, supervised machine learning techniques were applied to extract the ICC networks from 3D confocal microscopy images. The results showed that the Fast Random Forest classification method using Trainable WEKA Segmentation outperformed the Decision Table and Naive Bayes classification methods in sensitivity, accuracy, and F-measure. Using the Fast Random Forest classifier, 12 Gastric antrum tissue blocks were segmented and variations in ICC network thickness, density and process width were quantified for the myenteric plexus ICC network (the primary Pacemakers). Our findings demonstrated regional variation in ICC network density and thickness along the circumferential and longitudinal axis of the mouse antrum. An inverse relationship was observed in the distal and proximal antrum for density (proximal: 9.8±4.0% vs distal: 7.6±4.6%) and thickness (proximal: 15±3 μm vs distal: 24±10 μm). Limited variation in ICC process width was observed throughout the antrum (5±1 μm).Clinical Relevance— Detailed quantification of regional ICC structural properties will provide insights into the relationship between ICC structure, slow waves and resultant gut motility. This will improve techniques for the diagnosis and treatment of functional GI motility disorders.

  • EMBC - Design of a closed-loop Gastric Pacemaker for modulating dysrhythmic conduction patterns via extracellular potentials.
    Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Inte, 2020
    Co-Authors: Luman Wang, Leo K. Cheng, Avinash Malik, Partha S Roop, Nira Paskaranandavadivel
    Abstract:

    A potential treatment option for chronic and severe motility disorders such as gastroparesis is the implantation of a Gastric Electrical Stimulator (GES), which is designed to modulate the bio-electric slow waves. However, the effectiveness of current GESs remains uncertain since they do not work in a closed-loop by sensing, processing, and modulating the dysrhythmic patterns. This work presents the design of a GES model working in closed-loop with the network of the Interstitial Cells of Cajal (ICC). A pre-existing two-dimensional ICC network is enhanced by proposing an extracellular potential generation model, which can precisely capture the timing behaviour of slow wave propagation pattern of the simulated ICC network. The GES senses the extracellular potential, detects bradyGastric patterns and finally modulates the activity to ensure normal conduction. The GES is designed to be practical for ease of validation and implementation.

  • Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping
    Obesity Surgery, 2017
    Co-Authors: Rachel Berry, Leo K. Cheng, Peng Du, Niranchan Paskaranandavadivel, Timothy R. Angeli, Terence Mayne, Grant Beban, Gregory O’grady
    Abstract:

    Background Laparoscopic sleeve gastrectomy (LSG) is increasingly being applied to treat obesity. LSG includes excision of the normal Gastric Pacemaker, which could induce electrical dysrhythmias impacting on post-operative symptoms and recovery, but these implications have not been adequately investigated. This study aimed to define the effects of LSG on Gastric slow-wave pacemaking using laparoscopic high-resolution (HR) electrical mapping. Methods Laparoscopic HR mapping was performed before and after LSG using flexible printed circuit arrays (64–96 electrodes; 8–12 cm^2; n  = 8 patients) deployed through a 12 mm trocar and positioned on the Gastric serosa. An additional patient with chronic reflux, nausea, and dysmotility 6 months after LSG also underwent Gastric mapping while undergoing conversion to Gastric bypass. Slow-wave activity was quantified by propagation pattern, frequency, velocity, and amplitude. Results Baseline activity showed exclusively normal propagation. Acutely after LSG, all patients developed either a distal unifocal ectopic Pacemaker with retrograde propagation (50%) or bioelectrical quiescence (50%). Propagation velocity was abnormally rapid after LSG (12.5 ± 0.8 vs baseline 3.8 ± 0.8 mm s^−1; p  = 0.01), whereas frequency and amplitude were unchanged (2.7 ± 0.3 vs 2.8 ± 0.3 cpm, p  = 0.7; 1.7 ± 0.2 vs 1.6 ± 0.6 mV, p  = 0.7). In the patient with chronic dysmotility after LSG, mapping also revealed a stable antral ectopic Pacemaker with retrograde rapid propagation (12.6 ± 4.8 mm s^−1). Conclusion Resection of the Gastric Pacemaker during LSG acutely resulted in aberrant distal ectopic pacemaking or bioelectrical quiescence. Ectopic pacemaking can persist long after LSG, inducing chronic dysmotility. The clinical and therapeutic significance of these findings now require further investigation.

Richard W. Mccallum - One of the best experts on this subject based on the ideXlab platform.

  • Two-channel Gastric pacing with a novel implantable Gastric Pacemaker accelerates glucagon-induced delayed Gastric emptying in dogs
    American journal of surgery, 2008
    Co-Authors: Robert A. Ross, Richard W. Mccallum, Jiande Chen
    Abstract:

    Abstract Background The aim of the current study was to investigate the efficacy of 2-channel Gastric electrical stimulation (GES) with a custom-made implantable Pacemaker on delayed Gastric emptying and Gastric dysryhthmia induced by glucagon in dogs. Methods Six dogs were studied in 4 randomized session (saline, glucagon, glucagon with single-channel or 2-channel GES). GES was applied via the first pair of electrodes for single-channel GES or the first and third pairs of electrodes for 2-channel GES. Gastric emptying was assessed for 90 minutes and Gastric slow waves were recorded at the same time. Results Both single-channel and 2-channel GES improved Gastric dysryhthmia ( P Conclusion Two-channel GES with a novel implantable Pacemaker is more efficient and effective than single-channel GES in improving delayed Gastric emptying induced by glucagon. This implantable multipoint Pacemaker may provide a new option for treatment of Gastric motility disorders.

  • The Role of Hope in the Psychological Adjustment of Gastropareutic Patients Receiving the Gastric Pacemaker: A Longitudinal Study
    Journal of Clinical Psychology in Medical Settings, 2006
    Co-Authors: Stacy C. Parenteau, Irene Sarosiek, Sheryle Gallant, Richard W. Mccallum
    Abstract:

    Hope, depressive symptoms, anxiety, and physical quality of life (QOL) were assessed in three subgroups of patients receiving the Gastric Pacemaker. Patients ( n = 22) completed questionnaires prior to Pacemaker implantation and at 3 and 6 months post-surgery. The idiopathic subgroup reported a significantly greater degree of hope and less anxiety at 6-month follow-up, compared to the diabetes patients. The idiopathic patients also reported significantly less anxiety at 6 months than the postsurgical patients. Across all subgroups, there was an increase in hope and physical QOL, and decrease in depressive symptoms and anxiety, from baseline levels. There was a significant negative relationship between hope and both depressive symptoms and anxiety at baseline and 3- and 6-month follow-up. Presurgical hope level did not significantly predict depressive symptoms or anxiety after implantation. This study provides evidence that the Pacemaker improves the physical and psychological health of gastropareutic patients; hope appears to play a role in the psychological adjustment of these patients.

  • The treatment of gastroparesis in the age of the Gastric Pacemaker: a review.
    MedGenMed : Medscape general medicine, 2003
    Co-Authors: Daniel C. Buckles, Jameson Forster, Richard W. Mccallum
    Abstract:

    Gastroparesis is a chronic disabling condition of impaired Gastric motility that results in decreased quality of life. Currently available medical therapy consists of prokinetic medication combined with antiemetic therapy, dietary modifications, and nutritional supplementation. Many patients continue to have a suboptimal clinical response despite maximal use of these modalities. Instead of surgery, which involves irreversible stomach-modifying procedures, Gastric electrical stimulation (GES) with a high-frequency/low-energy stimulus was approved by the US Food and Drug Administration (FDA) and can now be used in this setting. This approach has been shown to decrease symptom frequency and severity, reduce hospitalizations and medical costs, and improve quality of life. Occurrence of complications with this device are uncommon (< 5% of patients). Preliminary studies of new Gastric stimulators that restore Gastric contractility are promising, but additional investigation is needed. This article reviews the pathophysiology and epidemiology of gastroparesis and the role of conventional medical therapies, and discusses GES therapy with respect to its mechanisms of action, appropriate application, results and benefits, and future directions.

  • Hope as a predictor of anxiety and depressive symptoms in patients receiving the Gastric Pacemaker for gastroparesis: a longitudinal study
    The American Journal of Gastroenterology, 2003
    Co-Authors: Stacy C. Parenteau, Irene Sarosiek, Sheryle Gallant, Richard W. Mccallum
    Abstract:

    Hope as a predictor of anxiety and depressive symptoms in patients receiving the Gastric Pacemaker for gastroparesis: a longitudinal study

  • EUS guidance in Gastric Pacemaker implantation
    Gastrointestinal endoscopy, 2002
    Co-Authors: Gottumukkala S. Raju, Jameson Forster, Irene Sarosiek, Stanton J. Rosenthal, Zhiyue Lin, Richard W. Mccallum
    Abstract:

    Background: EUS provides excellent imaging of the Gastric wall. The utility of EUS imaging in guiding the placement of a Gastric Pacemaker was investigated. Methods: Fourteen patients underwent Gastric Pacemaker implantation for refractory gastroparesis at laparotomy. Placement of the lead into the muscle layer of the antrum of the stomach was imaged by intraoperative surface ultrasonography in the first 8 patients and by EUS in the subsequent 6 patients. Results: Surface US examination of the lead placement revealed reverberation artifacts. The images were uniformly unsatisfactory and the position of the lead in the Gastric wall could not be visualized in any patient. In contrast, the lead was clearly and easily identified by EUS as a bright linear echo in the Gastric wall. This was observed uniformly in all of the patients evaluated by EUS. Compared with surface US, EUS provided better images of the Gastric lead placement as well as less abdominal distension and thus easier closure of the incision. Conclusions: EUS is useful in confirming the accurate placement of Pacemaker leads within the muscular coat of the stomach.

Eri Nakamura - One of the best experts on this subject based on the ideXlab platform.

  • Factors modifying the frequency of spontaneous activity in Gastric muscle.
    The Journal of Physiology, 2006
    Co-Authors: Hikaru Suzuki, Yoshihiko Kito, Hikaru Hashitani, Eri Nakamura
    Abstract:

    The cellular mechanisms that determine the frequency of spontaneous activity were investigated in Gastric smooth muscles isolated from the guinea-pig. Intact antral muscle generated slow waves periodically; the interval between slow waves was decreased exponentially by depolarization of the membrane to reach a steady interval value of about 7 s. Isolated circular muscle bundles produced slow potentials spontaneously or were evoked by depolarizing current stimuli. Evoked slow potentials appeared in an all-or-none fashion, with a refractory period of ∼2–3 s. Low concentrations of chemicals that modify intracellular signalling revealed that the refractory period was causally related to the activity of protein kinase C (PKC). Activation of PKC increased and inhibition of PKC activity decreased the frequency of slow potentials. Chemicals that inhibit mitochondrial functions reduced the frequency of slow waves. Inhibition of internal Ca2+-store activity decreased the amplitude, but not the frequency of slow potentials, suggesting that the amplitude is causally related to Ca2+ release from the internal store. The results suggest that changes in [Ca2+]i caused by the activity of mitochondria may play a key role in determining the frequency of spontaneous activity in Gastric Pacemaker cells.

  • Factors modifying the frequency of spontaneous activity in Gastric muscle.
    The Journal of physiology, 2006
    Co-Authors: H Suzuki, Hikaru Hashitani, Y Kito, Eri Nakamura
    Abstract:

    The cellular mechanisms that determine the frequency of spontaneous activity were investigated in Gastric smooth muscles isolated from the guinea-pig. Intact antral muscle generated slow waves periodically; the interval between slow waves was decreased exponentially by depolarization of the membrane to reach a steady interval value of about 7 s. Isolated circular muscle bundles produced slow potentials spontaneously or were evoked by depolarizing current stimuli. Evoked slow potentials appeared in an all-or-none fashion, with a refractory period of approximately 2-3 s. Low concentrations of chemicals that modify intracellular signalling revealed that the refractory period was causally related to the activity of protein kinase C (PKC). Activation of PKC increased and inhibition of PKC activity decreased the frequency of slow potentials. Chemicals that inhibit mitochondrial functions reduced the frequency of slow waves. Inhibition of internal Ca(2+)-store activity decreased the amplitude, but not the frequency of slow potentials, suggesting that the amplitude is causally related to Ca(2+) release from the internal store. The results suggest that changes in [Ca(2+)](i) caused by the activity of mitochondria may play a key role in determining the frequency of spontaneous activity in Gastric Pacemaker cells.

Gregory O'grady - One of the best experts on this subject based on the ideXlab platform.

  • Design and application of a novel Gastric Pacemaker
    2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2017
    Co-Authors: Saeed Alighaleh, Leo K. Cheng, Timothy R. Angeli, Shameer Sathar, Gregory O'grady, Niranchan Paskaranandavadivel
    Abstract:

    Omnipresent bioelectrical events known as slow waves are responsible for coordinating motility in the gastrointestinal tract. Functional motility diseases, such as gastroparesis, are associated with slow wave dysrhythmias. Electrical stimulation is a potential therapy to correct abnormal slow wave patterns. We present the design and application of a new Gastric Pacemaker. Real-time changes to the stimulation parameters such as period, amplitude and pulse width were applied using a graphical user interface, which communicated with the microcontroller to deliver the stimulus. The new Pacemaker allows the voltage, delivered current and resistance between pacing electrodes to be continuously monitored. The pacing device was applied experimentally and was able to modulate and entrain Gastric slow wave activity. After the onset of pacing, the direction of slow wave propagation was altered. Furthermore, the mean velocity and amplitude of slow wave activity increased from 4.7±1.5 to 5.4±1.3 mm/s, and from 1.1±1.1 to 1.7±0.9 mV, respectively. A simplified bidomain electrical model was used to simulate the recorded stimulus artifact. The model illustrated a new approach to evaluate if the stimulus has been delivered to the Gastric tissue. The new pacing device and model will be used to investigate the mechanisms that allow pacing to entrain slow wave activity.

  • Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping.
    Obesity surgery, 2017
    Co-Authors: Rachel Berry, Leo K. Cheng, Niranchan Paskaranandavadivel, Timothy R. Angeli, Grant Beban, Terence P. Mayne, Gregory O'grady
    Abstract:

    Background Laparoscopic sleeve gastrectomy (LSG) is increasingly being applied to treat obesity. LSG includes excision of the normal Gastric Pacemaker, which could induce electrical dysrhythmias impacting on post-operative symptoms and recovery, but these implications have not been adequately investigated. This study aimed to define the effects of LSG on Gastric slow-wave pacemaking using laparoscopic high-resolution (HR) electrical mapping.

  • EMBC - Design and application of a novel Gastric Pacemaker
    Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Inte, 2017
    Co-Authors: Saeed Alighaleh, Leo K. Cheng, Timothy R. Angeli, Shameer Sathar, Gregory O'grady, Niranchan Paskaranandavadivel
    Abstract:

    Omnipresent bioelectrical events known as slow waves are responsible for coordinating motility in the gastrointestinal tract. Functional motility diseases, such as gastroparesis, are associated with slow wave dysrhythmias. Electrical stimulation is a potential therapy to correct abnormal slow wave patterns. We present the design and application of a new Gastric Pacemaker. Real-time changes to the stimulation parameters such as period, amplitude and pulse width were applied using a graphical user interface, which communicated with the microcontroller to deliver the stimulus. The new Pacemaker allows the voltage, delivered current and resistance between pacing electrodes to be continuously monitored. The pacing device was applied experimentally and was able to modulate and entrain Gastric slow wave activity. After the onset of pacing, the direction of slow wave propagation was altered. Furthermore, the mean velocity and amplitude of slow wave activity increased from 4.7±1.5 to 5.4±1.3 mm/s, and from 1.1±1.1 to 1.7±0.9 mV, respectively. A simplified bidomain electrical model was used to simulate the recorded stimulus artifact. The model illustrated a new approach to evaluate if the stimulus has been delivered to the Gastric tissue. The new pacing device and model will be used to investigate the mechanisms that allow pacing to entrain slow wave activity.

  • The analysis of human Gastric Pacemaker activity
    The Journal of physiology, 2012
    Co-Authors: Gregory O'grady, Andrew J. Pullan, Leo K. Cheng
    Abstract:

    In their recent paper ‘Analysis of Pacemaker activity in the human stomach’, Sanders, Ward and colleagues challenge several fundamental concepts of human Gastric slow wave activity Rhee et al. 2011. The authors make the following claims, based on intracellular recordings from isolated Gastric tissue strips: (1) The normal human Gastric slow wave frequency ranges from approximately 5–8 cycles per minute (cpm), instead of the established 3 cpm; (2) There is no intrinsic interstitial cells of Cajal (ICC) frequency gradient in the human stomach; (3) Slow wave activity occurs in the Gastric fundus; (4) The established clinical diagnostic norms for tachygastria and bradygastria are inaccurate; and (5) All past human Gastric extracellular recordings are invalidated by movement artifacts.

R. A. Mazure - One of the best experts on this subject based on the ideXlab platform.

  • TÉCNICAS MÍNIMAMENTE INVASIVAS EMERGENTES EN EL TRATAMIENTO DE LA OBESIDAD
    Nutricion hospitalaria, 2012
    Co-Authors: Emilia Cancer, V. Abilés, Jimena Abilés, M. A. Martínez Olmos, Irene Bretón, N. Pelaez, V. Álvarez, Jesús M. Culebras, R. A. Mazure
    Abstract:

    Introduction: Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intraGastric balloon. Objective: To review the minimally invasive techniques described in the last years for the treatment of obesity. Material and method: It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. Result: Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intraGastric balloon, the intraGastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the Gastric Pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. Discussion: With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications.

  • Técnicas mínimamente invasivas emergentes en el tratamiento de la obesidad Minimally invasive emergent techniques in obesity treatment
    Sociedad Española de Nutrición Parenteral y Enteral, 2012
    Co-Authors: Emilia Cancer, V. Abilés, Jimena Abilés, Irene Bretón, N. Pelaez, V. Álvarez, Jesús M. Culebras, M. Martínez A. Olmos, R. A. Mazure
    Abstract:

    Introducción: La obesidad es una enfermedad crónica para la que se investigan hoy múltiples caminos terapéuticos. Uno de ellos es el conjunto de técnicas poco agresivas que se han sumado al balón intragástrico. Objetivo: Revisar las técnicas mínimamente invasivas descritas en los últimos años para el tratamiento de la obesidad. Material y método: Se procede a revisar toda la bibliografía asequible a través de los buscadores habituales, además de la información obtenida de las casas comerciales. Se clasifican en restrictivas y malabsortivas, y las primeras en restricción mecánica o funcional. Resultado: Entre las técnicas emergentes clasificadas como restrictivas mecánicas incluimos el balón intragástrico ajustable, la prótesis intragástrica, la gastroplastia vertical endoluminal y la gastroplastia transoral. Para obtener una restricción funcional, tenemos el marcapaso gástrico y la toxina botulínica. Y por último, se describe el by-pass duodenoyeyunal endoluminal que sería una técnica malabsortiva. Discusión: Con menos de 10 años de existencia, parece que las técnicas descritas compensan su menor eficacia frente a las técnicas quirúrgicas, con la ausencia de modificaciones sustanciales en la anatomía del tubo digestivo. Ninguna de estas técnicas está exenta de riesgos y complicaciones. Conclusión: Tal como ya manifestó la SAGES en 2009, estas técnicas parecen tener un futuro prometedor, pero la escasez de datos actuales no nos permiten aún confirmar su utilidad en el tratamiento de la obesidad.Introduction: Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intraGastric balloon. Objective: To review the minimally invasive techniques described in the last years for the treatment of obesity. Material and method: It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. Result: Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intraGastric balloon, the intraGastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the Gastric Pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. Discussion: With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications