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Effects on physiologic measures of appetite from intragastric balloon and endoscopic sleeve gastroplasty: results of a prospective study

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Chinese Medical Journal 2022年第10期135卷 1234-1241页

作者： Babusai Rapaka Daniel B.Maselli Gontrand Lopez-Nava Inmaculada Bautista-Castano Reem Matar Veeravich Jaruvongvanich Eric J.Vargas Andrew C.Storm Andres Acosta Barham K.Abu Dayyeh Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905USA Madrid Sanchinarro University Hospital MadridSpain

Background: Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods: We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results: The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mLvs. 183.00 ± 217.13 mL,P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion: IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

关键词： Intragastric balloon Endoscopic sleeve gastroplasty Gastric emptying Gastric accommodation Obesity

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Transcatheter Closure vs.Surgical Ligation in Preterm Infants with Patent Ductus Arteriosus:A Systematic Review and Meta-Analysis

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Congenital Heart Disease 2023年第2期18卷 245-265页

作者： Rohan Suresh Daniel Georgia K.Schmidt Hayato Nakanishi Karen Smayra Mariah N.Mascara Dilip K.Vankayalapati reem H.matar Christian A.Than George Shiakos Ioannis Tzanavaros St George’s University of LondonLondonUK University of Nicosia Medical School University of NicosiaNicosia2417Cyprus Division of Gastroenterology and Hepatology Mayo ClinicRochester55905USA School of Biomedical Sciences The University of QueenslandSt LuciaBrisbane4072Australia Cardiac Innovation Center of Apollonion Private Hospital NicosiaCyprus

Background:Persistent patent ductus arteriosus(pPDA)is a common condition in preterm infants.This metaanalysis aimed to assess the safety and efficacy of transcatheter closure(TC)when compared to surgical ligation(SL)in preterm infants with pPDA.Methods:A literature search of Ovid Cochrane Library,Medline,Embase,Epub,Scopus,PMC Preprints,and ClinicalTrials.Gov was conducted from inception to May 06,2022.Eligible studies reported infants diagnosed with pPDA born at≤2000 g birth weight or at≤37 weeks’who underwent TC or SL as treatment.This review was registered in PROSPERO(CRD42022325944).Results:From 97 studies screened,8 studies met the eligibility criteria,with a total of 756 preterm infants undergoing either TC(n=366)or SL(n=390).Compared to TC,SL had higher mortality rates(OR=0.32,95%CI:0.16,0.66,I^(2)=0%).No difference was seen in post-procedural complication rate(OR=0.90,95%CI:0.18,4.44,I^(2)=79%),mean duration of post-procedural mechanical ventilation(MD=−2.21 days,95%CI:−4.88,0.47,I^(2)=60%),hospital stay length(MD=−8.30 days,95%CI:−17.03,0.44,I^(2)=0%)or neonatal intensive care unit stay length(MD=−3.50 days,95%CI:−10.27,3.27,I^(2)=0%).Conclusion:Our meta-analysis demonstrated TC as a viable alternative option in managing preterm infants with pPDA in the context of SL.Despite the promising trends demonstrated in this meta-analysis,further studies with larger sample size and controlled baseline characteristics are needed to evaluate the safety and efficacy of TC and SL for preterm infants with pPDA.

关键词： Patent ductus arteriosus transcatheter surgery preterm infants systematic review

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