Elliot R Goodman, MD  
Male, 56
New York, NY

Specialties: Upper GI Pathology

Interests: Digestive Health, Weight Management
Beth Israel Medical Center
212 844 8838
New York, NY
All Journal Entries Journals
Previous | Next

Endoscopic incision free bariatric surgery – offering weight loss without the risks of major abdominal surgery

May 17, 2010 - 30 comments



bariatric surgery




weight loss surgery


Weight Loss


Losing weight


Primary Obesity Surgery



INTRODUCING POSE (Primary Obesity Surgery, Endoluminal)

POSE is a type of restrictive surgery that reduces the stomach’s capacity through the use of a flexible tube that is inserted into the mouth to reach the stomach. Because POSE is an incision-free procedure, it offers several benefits including reduced risk of infection, shorter recovery periods, and no visible scarring. Though long-term results are not yet available, doctors believe POSE will be an effective surgical option for patients who need to lose between 50 and 100 pounds.

Incision free weight loss surgery is performed under general anesthesia entirely through the patient’s mouth without any external incisions into the body. In addition to the absence of visible scars, this technique results in fewer complications, less trauma, and shorter recovery time. The procedure uses a flexible tube with multiple channels for surgical instruments. The surgeon advances the tube and a small endoscope – a video camera so that the surgeon can view the operative site on a nearby video monitor – through the patient’s mouth, into the stomach. The surgeon then inserts the surgical tools through the channels of the tube to grasp the stomach tissue and create suture folds in the stomach to reduce its volume capacity in the case of the POSE procedure.

POSE is still very new and so long term results are as yet unavailable. However, if the promise of the incision free surgical procedure of reduced complications and faster recovery times holds true, incision free surgery could significantly expand the number of patients who are able to undergo weight loss surgery.

POSE will soon be available in the UK. To find out if it might be right for you, contact Dr Elliot Goodman (Centre for Endoscopic Surgery, Nuffield Leeds Hospital) @ 0800 0988 435.

Post a Comment
751951 tn?1406632863
by PastorDan, May 18, 2010
Lost my second wife to complications from Roux-en-Y surgery just over a year ago.  She was a high risk candidate to start with; we knew that going in.  It will be interesting to see how this procedure pans out statistically in comparison to the other, more historically documented methods.

Avatar universal
by erincas, May 18, 2010
PastorDan, I am sorry for your loss. My mother had internal hemorrhaging from the same surgery but luckily they caught in time.

As an obese person, this sounds very promising but getting the insurance companies to cover this procedure is a different story.

I look forward to hearing more about POSE and its success.

Thank you for sharing this.


Avatar universal
by Sallyanne555, May 22, 2010
I wonder if it will ever be possible for people who have had a Nissen fundoplication to safely have a roux-en-Y?  I canceled mine at MGH that was scheduled in 2005 because the surgeon scared me about the very increased risks.

1140722 tn?1266352679
by Elliot R Goodman, MDBlank, May 22, 2010
Possible but risky
don't blame u for cancelling in 2005

Avatar universal
by budf, Jun 01, 2010
I am just starting down the path of exploring surgical weight-loss options after having had a Nissen almost 10 years ago.  Dr. Goodman, I see your response on roux-en-Y...what about Lap-Band and/or POSE?

1140722 tn?1266352679
by Elliot R Goodman, MDBlank, Jun 01, 2010
Lap band and POSE would not be a good idea given prior Nissen
Perhaps a duodenal switch/biliopancreatic diversion - would avoid operating on top of stomach now wrapped around esophagus

Avatar universal
by MsArin, Jun 18, 2010
Dr. Goodman,

How soon before POSE will be available in the UK?  I am still trying to understand why ROSE would receive FDA approval in the US but not POSE...


1140722 tn?1266352679
by Elliot R Goodman, MDBlank, Jun 20, 2010
I can offer you POSE now in our new endoscopic surgery clinic in Barcelona, Spain
We have yet to start the programme in the UK
The total cost in Barcelona will be 5500GBP - a discount price since the procedure is so new
All pre and postop visits will be in my Central London office
POSE is not FDA approved but ROSE is because the device used is only fully labelled for the "repair of gastric tissues"
Hence it can be used to revise prior gastric bypass surgery e.g. for patients with dilated gastric pouches
The FDA is MUCH more conservative than its counterparts in the EU and in the UK
Hence the slow introduction of many new drugs and devices into the USA
Please call 0800 0988 435 for more info about POSE
Dr Goodman

Avatar universal
by jan17347, Jul 18, 2010
I have read an article on POSE in newspaper,and this does sound more appealing than the Gastric bypass of which i am put off having due to complications, and wonder if you could tell me when it would be coming to the UK?
Would there be any conditions/restrictions to having the surgery?
Also would the pre and postop visits still be in Central London office? Or could /would these be done in Leeds/Manchester?

Many thanks

1140722 tn?1266352679
by Elliot R Goodman, MDBlank, Jul 18, 2010
Hi Jan
We are beginning to roll out a POSE programme in which all pre and postoperative office visits would be in England (Leeds or London) but the actual 2 hour operation would be in Spain (Barcelona) where I am working with another US based surgeon and a group of Spanish gastroenterologists
Our programme will also include counselling by a dietician and behavioral therapist
It is targeted at patients 50-75lbs (20-30kgs) above their ideal weight who have tried diets without success BUT who are well motivated and can follow a strict postoperative diet for the first 6-8 weeks after surgery
The introductory price for the procedure will be 5500GBP (for the first 2 months of the programme)
Please call me @ 0800 0988 435 for more info
Dr Goodman

1140722 tn?1266352679
by Elliot R Goodman, MDBlank, Jul 20, 2010
New article in Sunday Express (UK) on POSE

Sunday July 18,2010
By Lucy Johnston BRITISH surgeons are set to carry out a revolutionary incision-less obesity operation.

The treatment is so straightforward patients can have the procedure in the morning and be back at work next day.

Most obesity surgery patients require several days in hospital, costing the NHS thousands of pounds.

The new operation is performed through the mouth so it does not leave a scar. Patients are given a general anaesthetic then a tube is fed into the stomach. A camera and cutting and sewing tools are then fed through the tube.

The stomach is reduced by half and the operation is over within half an hour. Doctors claim patients lose about a third of their body weight within six months. Conventional operations to treat obesity involve keyhole surgery and at least five incisions into the abdomen to fit a silicone “lap band” around the stomach. Another option is a gastric bypass, using stapling to reduce the size of the gut.

Patients normally spend several nights in hospital and then have to take up to two weeks off work to recover.

There is a fairly low complication rate for the lap band. But the death rate for gastric bypass surgery is as high as one in 100, putting some obese people off treatment. The new operation, which has already been carried out 500 times in the United States, has had no major drawbacks.

Adam Power, of Elemental Healthcare, which is bringing the operation to the UK, said: “This will be an operation that you don’t have to tell anyone you’re having if you don’t want to.

“You could even slip off for the day and have it done without a partner or family knowing. There are no marks on the body as in other forms of obesity surgery, so the only person who would know would be the patient.

“The most common complaint from patients is not about the procedure itself but little niggles such as pain from where the needle went in for the anaesthetic.”

Mr Power’s company is introducing the operation to several private hospitals in the UK over the next few weeks and the first operations are due to take place on the South Coast before the end of the month.

Called POSE – Primary Obesity Surgery, Endoscopic – the operation is unlikely to be available on the NHS as it is designed for treating only the moderately obese.

Guidelines from the National Institute for Clinical Excellence and Health only allow for surgery if patients have a BMI of more than 40 and a medical condition such as diabetes.

Mr Power said: “Ideally you would want to treat the obese before they become really large.”

Mr Power, who has sent two UK ­surgeons to the US to learn the new operation, believes it will become extremely popular.

For more info on this procedure in the UK - call 0800 0988 435

Avatar universal
by ANorris, Aug 06, 2010
Hi, can this be done with Gastric Plication Surgery?  That is the one where they use stiches to make your stomach smaller and shape it like a bananna so you be full on much less food.  Similar to Gastric Sleeve, but without staples and no partial stomach removal. Anyone please email me at ***@****  I want to have Plication done, but it sounds much better if they only need to go through the mouth vs. laprospocially.

Avatar universal
by Shaana, Aug 09, 2010
Dear Dr Goodman

It was really good chatting with you today about the POSE procedure.  I'd just like to enquire as to comparative weight loss surgery data, 1 yr post op via the POSE procedure versus other forms of weight loss surgery?

I look forward to your email slide share regarding POSE and hope to chat again soon.

S Rafiq

Avatar universal
by danu25, Aug 23, 2010
My sister had the POSE 2 weeks ago and has already lost 12 pounds.  She did miss a week of work, due to some pain and feeling icky.  Now she is doing great. She does not get hungry and has no cravings. She can only eat 1/2 a bowl of soup. If she eats the whole bowl she becomes uncomfortably full.

My surgey is on 31 Aug 10 and I cannot wait.

Avatar universal
by ANorris, Oct 28, 2010
Hi Dr. Goodman, I was set to have Plication surgery where they fold it over, but polyps were found.  They are none cancerous at this point, and my gastric level is <10 so is low. I am going to have a colonscopy and make sure there are no problems.  I don't want lapbad.  Really wanted Plication but at this point I am nervous about sewing up part of my stomach and not being accessable to an endoscope  if there are issues down the road.  With your Pose procedure is the entire stomach view able through endoscope? Are their any articles I can read about statics of success on this?  If stomach stretches over time, can it be redone?  Can it be reversed?  Is there a special diet required before or after this? Danu25, Please let us know yours and your sisters progress!  Any testimonials or further experiences would be great!

Avatar universal
by mimi24999, Oct 30, 2010
well this  sound great if it  woulb be done in us i live in houston tx and had the gastric sleeve surgery done 2007 wen i was 350lbs at age 20 and did loose weight got to 195lbs soo happy but  months later got married and 2009 got pregnant gained alot of weight back now im 270lbs and  so unhappy i feel so frustrated cuz i cant loose the weight do to my obsessive craving for chocolate and coca cola i dont know wat to do ne more this new procedure sounds great if i just had the money for it but have no money and my husband lost his job soo ugh i dont know

Avatar universal
by jno6904, Feb 14, 2011
It's not clear how the surgery is done? Is the stomach sutured smaller?

Avatar universal
by mushyfi, Mar 03, 2011
I have recently contacted by local surgeon regarding the Gastric Band and have been told I can get this procedure.  However, my main concern was after the 2 year period as I was advised that the NHS will not cover non emergency treatment and a simple band adjustment costs approximately £100 a visit.

Does the POSE require any treatment after the initial adjustment period or can you carry on as normal?

What is the cost now for this procedure?

Avatar universal
by JessicaForester, Jul 04, 2011
After 6 months of offering stem cell therapy in combination with the venous angioplasty liberation procedure, patients of CCSVI Clinic have reported excellent health outcomes. Ms. Kasma Gianopoulos of Athens Greece, who was diagnosed with the Relapsing/Remitting form of MS in 1997 called the combination of treatments a “cure”. “I feel I am completely cured” says Ms. Gianopoulos, “my symptoms have disappeared and I have a recovery of many functions, notably my balance and my muscle strength is all coming (back). Even after six months, I feel like there are good changes happening almost every day. Before, my biggest fear was that the changes wouldn’t (hold). I don’t even worry about having a relapse anymore. I’m looking forward to a normal life with my family. I think I would call that a miracle.”
Other recent MS patients who have had Autologous Stem Cell Transplantation (ASCT), or stem cell therapy have posted videos and comments on YouTube. www.youtube.com/watch?v=jFQr2eqm3Cg.
Dr. Avneesh Gupte, the Neurosurgeon at Noble Hospital performing the procedure has been encouraged by results in Cerebral Palsy patients as well. “We are fortunate to be able to offer the treatment because not every hospital is able to perform these types of transplants. You must have the specialized medical equipment and specially trained doctors and nurses”.  With regard to MS patients, “We are cautious, but nevertheless excited by what patients are telling us. Suffice to say that the few patients who have had the therapy through us are noticing recovery of neuro deficits beyond what the venous angioplasty only should account for”.
Dr. Unmesh of Noble continues: “These are early days and certainly all evidence that the combination of liberation and stem cell therapies working together at this point is anecdotal. However I am not aware of other medical facilities in the world that offer the synthesis of both to MS patients on an approved basis and it is indeed a rare opportunity for MS patients to take advantage of a treatment that is quite possibly unique in the world”.
Autologous stem cell transplantation is a procedure by which blood-forming stem cells are removed, and later injected back into the patient. All stem cells are taken from the patient themselves and cultured for later injection. In the case of a bone marrow transplant, the HSC are typically removed from the Pelvis through a large needle that can reach into the bone. The technique is referred to as a bone marrow harvest and is performed under a general anesthesia. The incidence of patients experiencing rejection is rare due to the donor and recipient being the same individual.This remains the only approved method of the SCT therapy.

Avatar universal
by Delacey70, Sep 01, 2011
Very Interesting ...I am due to see my surgeon next week regarding weight loss surgery to discuss which method is best for me. I have the funding in place from the NHS. Is this new proceedure an option for me yet? I live in Bradford UK

Avatar universal
by n1911, May 28, 2012
i had RNY done in 2009 (110kilos) and am about 5'4 and am currently weigh 69kg, my lowest weight post op was 53 kilos and am desperate to get back to 57kilos, will power/sugar addict, have been metaphorically screaming at my NHS team for about a year or so as weight has been sneaking back. They see me as a success story, I don't want to put weight back on and am wondering if you know what I could do to make stomach more restricted. Am currently waiting for CBT, but have been looking into POSE/ROSE procedures.

Please advise.

Avatar universal
by missy2598, Jun 18, 2012
Had the gastric bypass 10 years ago gained back 50 pounds because my hypothyroid won't let me diet.I'm looking to do it again but with the POSE  procedure.Can I use my medical insurance to pay for this procedure?

Avatar universal
by bukol98, Nov 30, 2012
Dr. goodman, i'm in new york, i'm interested in this P.O.S.E. procedure.......... i'm 46 now 5'7 220 lbs.  when i was on my 20's i used to weigh 130 lbs. very active, teach and compete in martal arts up to now in senior division, i'd like to regain my old weight or at least cut about 40-50 lbs. from my present weight to reduce pressure on my knees and feet..... question: how much will the procedure cost, how long recovery time... a respond is appreciated thank you..........e-mail... ***@****

Avatar universal
by mercesb85, Mar 27, 2013
Dr. goodman, i'm in London(but i come from from Spain), i'm interested in this P.O.S.E. surgery.......... i'm 28, i'm 1.64 mtrs and 105kilos.  i've be trying ieverything during all my life,  from 8 to 17 i was fat, how be a fat girl in my high school was strange was very cruel, and i decided tray to stop eatting, but after that my heart stopped with 21 years old and i decided eat againg, and since 24 years old untill now iḿ with the same weight, i've tryed loose again, but was very difficult, now, iḿ very tired to continuous, near to go down in my life, without any kind of life because i don't want to see nobody...  i'd like to be a normal person and do normal things, like normal activities people normal used to do.....i'm ready for this one "surgery POSE" could you help me? and my questions are the same lik BUKOL98: how much will the procedure cost, how long recovery time... a respond is appreciated thank you.........

Avatar universal
by tonacious1, May 01, 2013
Hi Dr. Goodman, I am really interested in the P.O.S.E. procedure. I have been diagnosed as morbidly obese since the age of 10. I am now 48 and am recovering from a cerebral aneurysm. I have been very interested in having bariatric surgery since the 1980's. Unfortunately, as a result of my aneurysm, I had a VP shunt placed. I have been told that I am no longer a candidate for surgery due to the high infection risk. I am curious to know if I would be a candidate for this procedure?

Avatar universal
by johndf04, Feb 06, 2014
I had endoscopic nissan about 20 years ago. Since then I have inquired about gastric bypass surgery but was told by my pcp that I may not qualify for bariatric surgery since I had this procedure. Is this true?

Avatar universal
by moz2014, Aug 27, 2014
Dear Dr. Goodman.great article and comments from your side.
I would like to inquire about the Pose since I am almost 25 kgs overweight. I have always been choppy but now fat with 88 kg by 160cm. Please email me moz.***@****
Thank you

Avatar universal
by Certifiedangel, Sep 23, 2015
Dear Dr. Goodman, I am the mother of a 27 year old  Developmentally Delayed Beautiful Daughter, her Diagnosis is Hydrocephalus, and Cerebral Palsy.  Randi is her name. For the past 71/2 years, Randi lived in Group homes, funded by the state of Georgia. During this time, Randi had a Shunt Revision 4 years ago that left her paralyzed, until her next revision, 11/2 which all use came back!  yet during the 3 years of no use of any limbs she spent in a Nursing Home,  and was put on extremely too many unnecessary medications, one being Depakote... that caused excessive weight gain. my question to you is, with her having SPASTIC QUADRAPLEGIC CEREBRAL PSALSY, and HYDROCEPHALUS, Can she be considered for POSE? Due to being OBEISE with CP She can not even begin to get the quality of life back, of Independent Living, she is so use to. Randi was able to crawl, and get around the house this way, including get herself in and out of the bathtub, bathing herself, then dressing herself. she could also put herself on and off the commode, and stand at the bathroom sink, to brush her teeth, wash her face, ect. All the things we see as everyday living skills, and take for GRANTED, is her independence of living what she calls a NORMAL LIFE< has been robbed by being 60 plus pounds over weight.  Randi is living back at home with me, and my goal is to seek out and find a way that would be successful for her weight loss to regain her independence. PLEASE give me your honest expert opinion on this matter. I live everyday Concerned about her Quality of Life... Physical Therapy is so Vital in her life, yet excessive weight on her 4foot 10.5 inch body at 161.5 pounds, makes even P.T. extremely difficult.  I PRAY YOU ARE THE ANSWER TO OUR PRAYERS!  Waiting on a response... Sincerely, Michelle Stoner

Avatar universal
by Certifiedangel, Sep 23, 2015
Dr. Goodman, Would POSE be an option for a 27 yr. old female with diagnosis of Hydrocephalus, W/ Chronic Headaches, and Cerebral Palsy, who is 4'10.5" @ 161.5 pounds? I pray you are the answer  to a Mothers Prayer for her Developmentally Delayed Daughter. (weight gain was caused from Medication side effect, she is no longer taking)

Avatar universal
by jhonjadercara, Jul 13, 2017
I’ve lost 5 kilos in my first week. It's my 10th day and I have included salad with some protein (eg. egg/ lean chicken) as you suggested. After 4 years of trying, the fat is finally coming off. It truly feels like magic!  http://loseweight2weeks.com/new-eating-for-your-eye-color-weight-loss-diet/

Post a Comment