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bariatric surgery and diabetes remission: Sleeve gastrectomy or mini-gastric bypass?

World Journal of Gastroenterology 2013年第39期19卷 6590-6597页

作者： Marco Milone Matteo Nicola Dario Di Minno Maddalena Leongito Paola Maietta Paolo Bianco Caterina Taffuri Dario Gaudioso Roberta Lupoli Silvia Savastano Francesco Milone Mario Musella Department of Advanced Biomedical Science University of Naples "Federico Ⅱ"80131 NaplesItaly

AIM:To investigate the weight loss and glycemic control status[blood glucose,hemoglobin A1c(HbA1c)and hypoglycaemic treatment].METHODS:The primary risk factor for type 2 diabetes is obesity,and 90%of all patients with type 2 diabetes are overweight or obese.Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations,little is known about the difference among various weight loss surgical procedures on diabetes remission.Data from patients referred during a 3-year period(from January2009 to December 2011)to the University of Naples"FedericoⅡ"diagnosed with obesity and diabetes were retrieved from a prospective database.The patients were split into two groups according to the surgical intervention performed[sleeve gastrectomy(SG)and mini-gastric bypass(MGB)].Weight loss and glycemic control status(blood glucose,HbA1c and hypoglycaemic treatment)were evaluated.RESULTS:A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study.Of these,4 subjects were excluded because of surgical complications,7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up.Thirtyone obese patients were recruited for this study.A total of 15 subjects underwent SG(48.4%),and 16underwent MGB(51.6%).After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis,high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo(OR=0.366,95%CI:0.152-0.884).Using the same regression model,MGB showed a clear trend toward higher diabetes remission rates relative to SG(OR=3.780,95%CI:0.961-14.872).CONCLUSION:Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission,further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission.

关键词： bariatric surgery Sleeve Bypass Obesity and diabetes

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Role of abdominal drainage in bariatric surgery: Report of six cases

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World Journal of Clinical Cases 2019年第16期7卷 2336-2340页

作者： Yang Liu Meng-Yi Li Zhong-Tao Zhang Department of General Surgery Beijing Friendship Hospital Capital Medical University

BACKGROUND Abdominal drainage allows for timely detection of hemorrhage,but it cannot prevent hemorrhage.Whether routine abdominal drainage is needed during bariatric procedures remains controversial.Few reports describe the role of abdominal drainage in the diagnosis and treatment of abdominal hemorrhage in bariatric surgery.CASE SUMMARY Six cases of hemorrhage after bariatric surgery were described,including three cases with and three without abdominal drainage during the first surgery.The hemorrhage in five of the six cases was controlled by conservative treatment.Abdominal hemorrhage was found through the drainage tube on the day of the operation in the three patients with abdominal drainage during the first surgery.Emergency treatment was initiated,and their conditions gradually stabilized within 48 h.No patients required a reoperation.Abdominal hemorrhage was found later in the patients without abdominal drainage.Although the hemorrhage was controlled by conservative treatment in two cases (1 and 2),reoperation and percutaneous drainage were performed for abdominal infection and pelvic hemorrhage.An obsolete encapsulated effusion that may require treatment in the future was left in the abdominal cavity of a patient (Case 1).CONCLUSION The possibility of controlling abdominal hemorrhage after bariatric/metabolic surgery by conservative treatment is high.When hemorrhage occurs,abdominal drainage can reduce the probability of reoperation by reducing the formation of blood clots behind the stomach.

关键词： Abdominal drainage Morbid obesity bariatric surgery Hemorrhage Case report

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Research progress of bariatric embolization for treatment of obesity

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Chinese Medical Journal 2019年第7期132卷 880-882页

作者： Bin-Yan Zhong Pei-Cheng Li Cai-Fang Ni Department of Interventional Radiology The First Affiliated Hospital of Soochow UniversitySuzhouJiangsu 215006China

To the Editor:The prevalence of obesity,defined as body mass index(BMI)≥30 kg/m^2,is increasing worldwide and has been identified that obesity is a risk factor for several kinds of chronic diseases.[1]According to the severity of obesity,associated coexisting chronic diseases,and functional limitations,therapies for obesity include lifestyle intervention(eg,diet and exercise),pharmacotherapy,endoscopic bariatric therapies,bariatric surgery,and bariatric embolization(BAE).

关键词： bariatric embolization treatment obesity

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Considerations for bariatric surgery in patients with cirrhosis

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World Journal of Gastroenterology 2018年第28期24卷 3112-3119页

作者： George Boon-Bee Goh Philip R Schauer Arthur J McCullough Department of Gastroenterology and Hepatology Singapore General HospitalSingapore 169608Singapore Duke-NUS Graduate Medical School Singapore 169608Singapore bariatric and Metabolic Institute Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Cleveland ClinicClevelandOH 44195United States Department of Pathobiology Cleveland ClinicClevelandOH 44195United States

With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease(NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery. bariatric surgeons may encounter, either expectedly or unexpectedly, patients with non-alcoholic steatohepatitis(NASH) and NASH related cirrhosis more frequently. As such, the issues and considerations surrounding their medical care/surgery warrant careful deliberation to ensure the best outcomes. These considerations include severity of cirrhosis, liver synthetic function, portal hypertension and the impact of surgical factors. This review explores these considerations comprehensively and emphasizes the best approach to managing cirrhotic patients in the context of bariatric surgery.

关键词： Cirrhosis Portal hypertension Non-alcoholic fatty liver disease bariatric surgery Complications

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Achalasia after bariatric Roux-en-Y gastric bypass surgery reversal

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World Journal of Gastroenterology 2017年第37期23卷 6902-6906页

作者： Mouhanna Abu Ghanimeh Ayman Qasrawi Omar Abughanimeh Sakher Albadarin Wendell Clarkston Division of Gastroenterology Henry Ford Hospital Department of Internal Medicine University of Missouri-Kansas City Division of Gastr-oenterology Saint Luke’s Hospital of Kansas City

Achalasia is a rare esophageal motility disorder that is characterized by a loss of peristalsis in the distal esophagus and failure of lower esophageal sphincter relaxation. The risk of developing esophageal motility disorders, including achalasia, following bariatric surgery is controversial and differs based on the type of surgery. Most of the reported cases occurred with laparoscopic adjustable gastric banding. To our knowledge, there are only three reported cases of achalasia after Roux-en-Y gastric bypass and no reported cases after revision of the surgery. We present a case of a 70-year-old female who had a previous history of Roux-en-Y gastric bypass with revision. She presented with persistent nausea and regurgitation for one month. Esophagogastroduodenoscopy showed a dilated esophagus without strictures or stenosis. A barium study was performed after the endoscopy and was suggestive of achalasia. Those findings were confirmed by a manometry. The patient was referred for laparoscopic Heller's myotomy.

关键词：食管 bariatric 胃的乐队绕过外科 Achalasia Esophagogastroduodenoscopy Hellers 肌切开术活动性混乱

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Organization of future training in bariatric gastroenterology

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World Journal of Gastroenterology 2017年第35期23卷 6371-6378页

作者： Timothy R Koch Timothy R Shope Christopher J Gostout Center for Advanced Laparoscopic General and bariatric Surgery Med Star Washington Hospital Center and Georgetown University School of Medicine Division of Gastroenterology and Hepatology Mayo Clinic

A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the longterm impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a longterm approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees' prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicate

关键词： Obesity bariatrics bariatric surgery Intragastric balloon Endoscopic sleeve gastroplasty Nutrition Endoscopy Training

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Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas:Basic principles and recommendations

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World Journal of Gastroenterology 2023年第7期29卷 1173-1193页

作者： Victor Lira de Oliveira Alexandre Moraes Bestetti Roberto Paolo Trasolini Eduardo Guimaraes Hourneaux de Moura Diogo Turiani Hourneaux de Moura Serviço de Endoscopia Gastrointestinal Departamento de GastroenterologiaHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403010Brazil Division of Gastroenterology Hepatology and EndoscopyHarvard Medical SchoolBrigham and Women's HospitalBostonMA 021115United States

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery.They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat.These two related conditions must be distinguished and characterized to guide the appropriate treatment.Leak is defined as a transmural defect with communication between the intra and extraluminal compartments,while fistula is defined as an abnormal communication between two epithelialized surfaces.Traditionally,surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates.However,with the development of novel devices and techniques,endoscopic therapy plays an increasingly essential role in managing these conditions.Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas.Several endoscopic techniques are available with different mechanisms of action,including direct closure,covering/diverting or draining.The treatment should be individualized by considering the characteristics of both the patient and the defect.Although there is a lack of high-quality studies to provide standardized treatment algorithms,this narrative review aims to provide a summary of the current scientific evidence and,based on this data and our extensive experience,make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

关键词： Endoscopy Surgery bariatric Gastrointestinal Fistulas Leaks

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New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients

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World Journal of Diabetes 2019年第2期10卷 78-86页

作者： Ohad Guetta Alex Vakhrushev Oleg Dukhno Amnon Ovnat Gilbert Sebbag Department General Surgery B Soroka University Medical Center

BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015.Data was collected through digitized records.Any deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with T2DM.There were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM.Whether preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.

关键词： bariatric surgery Laparoscopic sleeve gastrectomy Type 2 diabetes Complications Morbidity Hemoglobin A1c Fasting plasma glucose Clavien-Dindo classification

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Laparoscopic sleeve gastrectomy:More than a restrictive bariatric surgery procedure?

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World Journal of Gastroenterology 2015年第41期21卷 11804-11814页

作者： David Benaiges Antonio Más-Lorenzo Albert Goday José M Ramon Juan J Chillarón Juan Pedro-Botet Juana A Flores-Le Roux Department of Endocrinology and Nutrition Hospital del Mar Department of Medicine Universitat Autònoma de Barcelona Institut Hospital del Mar d’Investigacions Mèdiques (IMIM) CiberOBN Instituto de Salud Carlos III Department of Gastrointestinal Surgery Hospital del Mar

Sleeve gastrectomy(SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications.

关键词： bariatric surgery Sleeve gastrectomy Severe obesit

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Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy

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World Journal of Gastroenterology 2013年第37期19卷 6188-6192页

作者： Ashish Shah Erica Boettcher Marianne Fahmy Thomas Savides Santiago Horgan Garth R Jacobsen Bryan J Sandler Michael Sedrak Denise Kalmaz Department of Gastroenterology University of California San Diego Department of Minimally Invasive Surgery University of California San Diego

AIM:To determine if esophageal capsule endoscopy(ECE)is an adequate diagnostic alternative to esophagogastroduodenoscopy(EGD)in pre-bariatric surgery patients.METHODS:We conducted a prospective pilot study to assess the diagnostic accuracy of ECE(PillCam ESO2,Given Imaging)vs conventional EGD in pre-bariatric surgery patients.Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled.All patients underwent ECE followed by standard EGD.Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings.The gold standard was the findings on EGD.RESULTS:Ten patients with an average body mass index of 50 kg/m2were enrolled and completed the study.ECE identified 11 of 14(79%)positive esophageal/gastroesophageal junction(GEJ)findings and 14of 17(82%)combined esophageal and gastric findings identified on EGD.Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD(P=0.64 for esophageal/GEJ and P=0.66 for combined esophageal and gastric findings respectively).Of the positive esophageal/GEJ findings,ECE failed to identify the following:hiatal hernia in two patients,mild esophagitis in two patients,and mild Schatzki ring in two patients.ECE was able to identify the entire esophagus in 100%,gastric cardia in0%,gastric body in 100%,gastric antrum in 70%,pylorus in 60%,and duodenum in 0%.CONCLUSION:There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients.

关键词： Capsule endoscopy bariatric Moderate sedation Esophagogastroduodenoscopy Esophageal capsule endoscopy

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