Abstract Background and application Obesity remains a leading cause of global morbidity and mortality, yet most treatments are invasive, irreversible, or poorly tolerated. EMACS presents a novel, non-surgical alternative that leverages physiological gastric distension to activate satiety pathways without anatomical alteration. EMACS is a self-contained, untethered magnetic 90cc silicon covered round stent delivered and retrieved transorally. It interacts with a patient-operated, impact-safe external magnet, guided via a companion app, that generates targeted magnetic fields to move the implant and distend the stomach. This approach mimics the natural activation of vagal afferents and stretch-sensitive mechanoreceptors that trigger early satiety. Distension activates a cerebral network important in processing food stimuli and interacting with gut-secreted peptides. Neuroimaging has provided information regarding the vagal afferent pathways to visceral cortical areas and activation of neural areas associated with gastric distention. The mechanistic foundation builds on decades of research confirming that exaggerated gastric distension enhances neural satiety pathways via the vagus nerve and possibly gut peptide release (for example, GLP-1, PYY), inhibiting hunger and reducing caloric intake. This mechanistic strategy offers an alternative to static anatomical intervention, enabling intermittent activation of stretch receptors aligned with meal timing and behavioural reinforcement via AI app. Results Video-based modelling and cadaveric deployment of EMACS prototype demonstrates its practicality: the device shows precise manoeuvrability within the gastric lumen, reproducible positioning and atraumatic retrieval. The companion software prompts patients to initiate and end use, captures adherence data. Conclusion Ongoing preclinical studies will further validate safety, usability and metabolic impact for use alone or in combination with existing treatments.
Sedghi et al. (Thu,) studied this question.