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Endoscopic sleeve gastroplasty in class Ⅲ obesity:Efficacy, safety, and durability outcomes in 404 consecutive patients

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World Journal of Gastrointestinal Endoscopy 2023年第6期15卷 469-479页

作者： Daniel Barry Maselli Anna Carolina Hoff Ashley Kucera Emily Weaver Laura Sebring Lori Gooch Kathleen Walton Daniel Lee Taylor Cratty Selena Beal Srikar Nanduri Kendall Rease Christina S Gainey Laura Eaton Brian Coan Christopher E McGowan Department of Endobariatrics True You Weight LossCaryNC 27513United States bariatric Endoscopy Angioskope ClinicSão Josédos Campos 12243-680São PauloBrazil Gastroenterology and Hepatology University of North Carolina SystemChapel HillNC 27599United States UltaMed Corporation UltaMed CorporationFort LauderdaleFL 33308United States

BACKGROUND Endoscopic sleeve gastroplasty(ESG) is an effective therapy for class Ⅰ-Ⅱ obesity, but there are knowledge gaps in the published literature about its implementation in patients with class Ⅲ obesity [body mass index(BMI) ≥ 40 kg/m2].AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class Ⅲ obesity.METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss(TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss(EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.RESULTS 404 consecutive patients(78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type Ⅱ diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization(0.2% serious adverse event rate).CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class Ⅲ obesity, with improvement in comorbiditie

关键词： Endoscopic sleeve gastroplasty Obesity bariatric Endobariatrics Class III obesity Comorbidities

Ménage-à-trois of bariatric surgery,bile acids and the gut microbiome

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World Journal of Diabetes 2015年第3期6卷 367-370页

作者： Rajendra Raghow Department of Veterans Affairs Medical Center Department of Pharmacology University of Tennessee Health Science Center

bariatric surgeries have emerged as highly effective treatments for obesity associated type-2 diabetes mellitus.Evidently,the desired therapeutic endpoints such as rates of weight loss,lower levels of glycated hemoglobin and remission of diabetes are achieved more rapidly and last longer following bariatric surgery,as opposed to drug therapies alone.In light of these findings,it has been suspected that in addition to causing weight loss dependent glucose intolerance,bariatric surgery induces other physiological changes that contribute to the alleviation of diabetes.However,the putative post-surgical neuro-hormonal pathways that underpin the therapeutic benefits of bariatric surgery remain undefined.In a recent report,Ryan and colleagues shed new light on the potential mechanisms that determine the salutary effects of bariatric surgery in mice.The authors demonstrated that the improved glucose tolerance and weight loss in mice after vertical sleeve gastrectomy(VSG) surgery were likely to be caused by post-surgical changes in circulating bile acids and farnesoid-X receptor(FXR) signaling,both of which were also mechanistically linked to changes in the microbial ecology of the gut.The authors arrived at this conclusion from a comparison of genome-wide,metabolic consequences of VSG surgery in obese wild type(WT) and FXR knockout mice.Gene expression in the distal small intestines of WT and FXR knockout mice revealed that the pathways regulating bile acid composition,nutrient metabolism and anti-oxidant defense were differentially altered by VSG surgery in WT and FXR-/-mice.Based on these data Ryan et al,hypothesized that bile acid homeostasis and FXR signaling were mechanistically linked to the gut microbiota that played a role in modulating post-surgical changes in total body mass and glucose tolerance.The authors' data provide a plausible explanation for putative weight loss-independent benefits of bariatric surgery and its relationship with metabolism of bile acids.

关键词： Vertical sleeve gastrectomy Bile acids Farnesoid-X-receptor Type-2 diabetes mellitus Gutmicrobiome bariatric surgery

Endoscopic management of bariatric complications: A review and update

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World Journal of Gastrointestinal Endoscopy 2015年第5期7卷 518-523页

作者： Caolan Walsh Shahzeer Karmali Department of Surgery Dalhousie University Centre for the Advancement of Minimally Invasive Surgery Royal Alexandra Hospital

With over a third of Americans being considered obese, bariatric procedures have now become the most performed operation be general surgeons in the United States. The most common operations are the Laparoscopic Roux-en-Y Gastric Bypass, the Laparoscopic Sleeve Gastrectomy, and the Laparoscopic Adjustable Gastric Band. With over 340000 bariatric procedures preformed worldwide in 2011, the absolute number of complications related to these operations is also increasing. Complications, although few, can be life threatening. One of the most dreaded acute complication is the anastomotic/staple line leak. If left undiagnosed or untreated they can lead to sepsis, multi organ failure, and death. Smaller or contained leaks can develop into fistulas. Although most patients with an acute anastomotic leak return to the operating room, there has been a trend to manage the stable patient with an endoscopic stent. They offer an advantage by creating a barrier between enteric content and the leak, and will allow the patients to resume enteral feeding much earlier. Fistulas are a complex and chronic complication with high morbidity and mortality. Postoperative bleeding although rare may also be treated locally with endoscopy. Stenosis is a more frequent late complication and is best-managed with endoscopic therapy. Stents may not heal every fistula or stenosis, however they may prevent certain patients the need for additional revisional surgery.

关键词： bariatric surgery bariatric complications Endoscopic treatment Sleeve gastrectomy Roux-en-Ygastric bypass Anastomotic leak Self-expanding metalstent

Medical management of patients after bariatric surgery: Principles and guidelines

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World Journal of Gastrointestinal Surgery 2014年第11期6卷 220-228页

作者： Abd Elrazek Mohammad Ali Abd Elrazek Abduh Elsayed Mohamed Elbanna Shymaa E Bilasy Department of Gatsroenterology and Hepatology Al-Azhar Faculty of Medicine Al-Azhar University Asiut brach Asuit 721572 Egypt Department of General Laparoscopic and Bariatric Surgery-Head of Bariatric unit (D)-Al Husain university Hospital Al Azhar University Darrasa-Cairo 16789 Egypt Department of Biochemistry Faculty of PharmacySuez Canal University Ismailia 41522Egypt

Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

关键词： Obesity bariatric surgery Postoperative care Body-mass index El banna

Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

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World Journal of Diabetes 2013年第5期4卷 202-209页

作者： Sarah E Messiah Gabriela Lopez-Mitnik Deborah Winegar Bintu Sherif Kristopher L Arheart Kirk W Reichard Marc P Michalsky Steven E Lipshultz Tracie L Miller Alan S Livingstone Nestor de la Cruz-Muoz Division of Pediatric Clinical Research Department of PediatricsDepartment of Public Health SciencesUniversity of Miami Leonard M Miller School of MedicineMiami Division of Pediatric Clinical Research Department of PediatricsDepartment of Public Health SciencesDivision of BiostatisticsUniversity of Miami Leonard M Miller School of MedicineMiami Surgical Review Corporation Department of Surgery Nemours Alfred I.DuPont Hospital for Children Department of Pediatric Surgery Nationwide Children's Hospital The Ohio State University College of Medicine Department of Surgery University of Miami Leonard M Miller School of Medicine

AIM:To investigate whether or not bariatric surgeryweight outcomes vary by ethnicity in a large,nationally representative sample of adolescents.METHODS:The bariatric Outcomes Longitudinal Database was used for analysis and contains data on surgeries performed on adolescents from 2004 to 2010from 423 surgeons at 360 facilities across the United States Adolescents(n=827)between 11 and 19 years old who underwent either gastric bypass or adjustable gastric banding surgery were included in the analysis.Outcome measures included changes in anthropometric measurements[weight(kg)and body mass index]from baseline to 3(n=739),6(n=512),and 12(n=247)mo after surgery.RESULTS:A year after patients underwent either gastric bypass(51%)or adjustable gastric banding(49%)surgery,mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg,being34.3 kg(95%CI:30.0-38.5 kg)for Hispanics,33.8 kg(95%CI:27.3-40.3 kg)for non-Hispanic blacks,and32.8 kg(95%CI:30.9-34.7 kg)for non-Hispanic whites.No overall pairwise group comparisons were significant,indicating that no ethnic group had better weight loss outcomes than did another.CONCLUSION:bariatric surgery substantially reduces the weight of severely obese adolescents at 1 year post-procedure with little variation by ethnicity and/or gender.These results suggest that bariatric surgery is a safe and reasonable treatment for all severely obese adolescents with the appropriate indications.

关键词： bariatric surgery Gastric bypass surgery Adjustable gastric band surgery Adolescents Severe obesity Ethnicity Weight loss

Endoscopic sleeve gastroplasty: From whence we came and where we are going

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World Journal of Gastrointestinal Endoscopy 2019年第5期11卷 322-328页

作者： Diogo Turiani Hourneaux de Moura Eduardo Guimar?es Hourneaux de Moura Christopher C Thompson Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical School Department of Endoscopy of Clinics Hospital of S?o Paulo University

The most effective and durable treatment for obesity is bariatric surgery.However,less than 2% of eligible patients who fulfill the criteria for bariatric surgery undergo the procedure. As a result,there is a drive to develop less invasive therapies to combat obesity. Endoscopic bariatric therapies(EBT) for weight loss are important since they are more effective than pharmacological treatments and lifestyle changes and present lower adverse event rates compared to bariatric surgery. Endoscopic sleeve gastroplasty(ESG) is a minimally invasive EBT that involves remodeling of the greater curvature. ESG demonstrated favorable outcomes in several centers,with up to 20.9% total body weight loss and 60.4% excess weight loss(EWL) on 2-year follow-up,with a low rate of severe adverse events(SAE). As such,it could be considered safe and effective in light of ASGE/ASMBS thresholds of > 25% EWL and ≤ 5% SAE,although there are no comparative trials to support this. Additionally,ESG showed improvement in diabetes mellitus type 2,hypertension,and other obesity-related comorbidities. As this procedure continues to develop there are several areas that can be addressed to improve outcomes,including device improvements,technique standardization,patient selection,personalized medicine,combination therapies,and training standardization. In this editorial we discuss the origins of the ESG,current data,and future developments.

关键词： Endoscopy Surgery bariatric Obesity Overweight Comorbidities Gastroplasty Sleeve Endoscopic sleeve gastroplasty Editorial

Routine surveillance endoscopy before and after sleeve gastrectomy?

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World Journal of Gastrointestinal Endoscopy 2019年第1期11卷 1-4页

作者： Radwan Kassir Rani Kassir Bénédicte Deparseval Sarah Bekkar Chloé Serayssol Olivier Favre Pierre-Philippe Garnier Department of bariatric Surgery CHU Félix Guyon Department of Gastroenterology CHU Félix Guyon

There is no consensus when it comes to the necessity of an oeso-gastroduodenal fibroscopy(OGDF) before and after bariatric surgery. Many reports expressed the preoccupations about a gastroesophagal reflux disease(an acute risk of Barrett's esophagus) and its consequences after a sleeve gastrectomy(SG) and the risk of leaving a premalignant lesion in an excluded stomach after a Roux-en-Y gastric bypass. The International Federation for the Surgery of Obesity and Metabolic Disorders recommends a surveillance endoscopy, routinely after a SG. After review of the literature, we set out the arguments in favor of performing a systematic preoperative and post-operative OGDF.

关键词： bariatric Surgery Endoscopy Sleeve gastrectomy Surveillance Oesogastroduodenal fibroscopy Novo Barrett's esophagus Gastroesophagal reflux

Current status of intragastric balloon for obesity treatment

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World Journal of Gastroenterology 2016年第24期22卷 5495-5504页

作者： Seung Han Kim Hoon Jai Chun Hyuk Soon Choi Eun Sun Kim Bora Keum Yoon Tae Jeen Division of Gastroenterology and Hepatology Department of Internal Medicine Institute of Gastrointestinal Medical Instrument Research Korea University College of Medicine

Endoscopic bariatric therapy may be a useful alternative to pharmacological treatment for obesity, and it provides greater efficacy with lower risks than do conventional surgical procedures. Among the various endoscopic treatments for obesity, the intragastric balloon is associated with significant efficacy in body weight reduction and relief of comorbid disease symptoms. Anatomically, this treatment is based on gastric space-occupying effects that increase the feeling of satiety and may also affect gut neuroendocrine signaling. The simplicity of the intragastric balloon procedure may account for its widespread role in obesity treatment and its applicability to various degrees of obesity. However, advances in device properties and procedural techniques are still needed in order to improve its safety and cost-effectiveness. Furthermore, verification of the physiological outcomes of intragastric balloon treatment and the clinical predictive factors for treatment responses should be considered. In this article, we discuss the types, efficacy, safety, and future directions of intragastric balloon treatment.

关键词： Intragastric balloon Obesity bariatric Metabolic Endoscopy

Laparoscopic gastric bypass vs sleeve gastrectomy in obese Korean patients

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World Journal of Gastroenterology 2015年第44期21卷 12612-12619页

作者： Ji Yeon Park Yong Jin Kim Department of Surgery Soonchunhyang University Seoul Hospital Department of Surgery National Cancer Center Goyang-si

AIM: To compare the mid-term outcomes of lapa-roscopic sleeve gastrectomy(LSG) and laparoscopic Roux-en-Y gastric bypass(LRYGB) in obese Korean patients. METHODS: All consecutive patients who underwent either LSG or LRYGB with primary to treat morbid obesity between January 2011 and December 2012 were retrospectively reviewed. Patients with a body mass index(BMI) ≥ 30 kg/m2 with inadequately controlled obesity-related comorbidities(e.g., diabetes, obstructive sleep apnea, hypertension, or obesityrelated arthropathy) or BMI ≥ 35 kg/m2 were considered for bariatric surgery according to the International Federation for the Surgery of Obesity-Asia Pacific Chapter Consensus statements in 2011. The decision regarding the procedure type was made on an individual basis following extensive discussion with the patient about the specific risks associated with each procedure. All operative procedures were performed laparoscopically by a single surgeon experienced in upper gastrointestinal surgeries. Baseline demographics, perioperative surgical outcomes, and postoperative anthropometric data from a prospectively established database were thoroughly reviewed and compared between the two surgical approaches.RESULTS: One hundred four patients underwent LSG, and 236 underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than that of the LRYGB group(38.6 kg/m2 vs 37.2 kg/m2, P = 0.024). Patients with diabetes were more prevalent in the LRYGB group(18.3% vs 35.6%, P = 0.001). Operating time and hospital stay were significantly shorter in the LSG group compared with the LRYGB group(100 min vs 130 min, P < 0.001; 1 d vs 2 d, P = 0.003), but the incidence of perioperative complications was similar between the groups(P = 0.351). The mean percentage of excess weight loss(%EWL) was 71.2% for LRYGB, while it was 63.5% for LSG, at mean follow-up periods of 18.0 and 21.0 mo, respectively(P = 0.073). The %EWL at 1, 3, 6, 12, 18, 24, and 36 mo was equivalentbetween the groups. Four patients required surgical revision aft

关键词： Morbid obesity bariatric surgery Rouxen-Y gastric