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metabolic surgery:present and future

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The Journal of Biomedical Research 2015年第2期29卷 91-92页

作者： Hui Liang Department of General surgery The First Affiliated Hospital with Nanjing Medical University

Several articles in this issue of the Journal cover a broad range of the new concepts of metabolic surgery, the mechanisms that leads to sustained metabolic syndrome remission, the new surgical procedures, and the per... 详细信息

关键词： metabolic surgery very than SG

Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus

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World Journal of Gastroenterology 2014年第39期20卷 14315-14328页

作者： Eng-Hong Pok Wei-Jei Lee Division of Upper GI surgery Department of Surgery University Malaya Medical Center University of Malaya Kuala Lumpur 50603 Malaysia Department of surgery Min-Sheng General Hospital National Taiwan University

Medical therapy for type 2 diabetes mellitus is ineffective in the long term due to the progressive nature of the disease, which requires increasing medication doses and polypharmacy. Conversely, bariatric surgery has emerged as a cost-effective strategy for obese diabetic individuals; it has low complication rates and results in durable weight loss, glycemic control and improvements in the quality of life, obesity-related co-morbidity and overall survival. The finding that glucose homeostasis can be achieved with a weight loss-independent mechanism immediately after bariatric surgery, especially gastric bypass, has led to the paradigm of metabolic surgery. However, the primary focus of metabolic surgery is the alteration of the physio-anatomy of the gastrointestinal tract to achieve glycemic control, metabolic control and cardio-metabolic risk reduction. To date, metabolic surgery is still not well defined, as it is used most frequently for less obese patients with poorly controlled diabetes. The mechanism of glycemic control is still incompletely understood. Published research findings on metabolic surgery are promising, but many aspects still need to be defined. This paper examines the proposed mechanism of diabetes remission, the efficacy of different types of metabolic procedures, the durability of glucose control, and the risks and complications associated with this procedure. We propose a tailored approach for the selection of the ideal metabolic procedure for different groups of patients, considering the indications and prognostic factors for diabetes remission.

关键词： metabolic surgery Gastrointestinal surgery Type-2 diabetes mellitus Glucolipotoxicity Efficacy Prognostic factor

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

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World Journal of Diabetes 2021年第10期12卷 1587-1621页

作者： Saptarshi Bhattacharya Sanjay Kalra Nitin Kapoor Rajiv Singla Deep Dutta Sameer Aggarwal Deepak Khandelwal Vineet Surana Atul Dhingra Viny Kantroo Sachin Chittawar Nilakshi Deka Vivek Bindal Puja Dutta Endocrinology Max Superspeciality HospitalNew Delhi 110092India Endocrinology Bharti HospitalKarnal 132001HaryanaIndia Endocrinology Christian Medical CollegeVellore 632004Tamil NaduIndia Endocrinology Kalpavriksh Super Speciality CenterNew Delhi 110075India Endocrinology CEDAR Superspecialty ClinicNew Delhi 110075India Endocrinology Apex Plus Superspeciality HospitalRohtak 124001HaryanaIndia Endocrinology Maharaja Agrasen HospitalNew Delhi 110026India Endocrinology Manipal HospitalsNew Delhi 110075India Endocrinology Gangaram Bansal Super Speciality HospitalSri Ganganagar 335001RajasthanIndia Respiratory Medicine&Critical Care Indraprastha Apollo HospitalsSarita ViharNew Delhi 110076India Endocrinology Gandhi Medical CollegeBhopal 462001Madhya PardeshIndia Endocrinology Apollo HospitalsGuwahati 781005AssamIndia Minimal Access Metabolic and Bariatric surgeryMax Superspeciality HospitalPatparganjNew Delhi 110092India Nutrition Max Superspeciality HospitalPatparganjNew Delhi 110092India

Diabetes mellitus(DM)and obesity are interrelated in a complex manner,and their coexistence predisposes patients to a plethora of medical *** surgery has evolved as a promising therapeutic option for both *** is recommended that patients,particularly those of Asian origin,maintain a lower body mass index threshold in the presence of uncontrolled ***,several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical *** Roux-en-Y gastric bypass(RYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used bariatric procedures *** bariatric benefits of RYGB and LSG are similar,but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM *** scoring systems have been formulated that are utilized to predict the chances of remission.A glycemic target of glycated hemoglobinmetabolic surgery.

关键词： Diabetes Obesity metabolic surgery Bariatric surgery Remission of diabetes

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery:A general perspective of current studies?

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World Journal of Diabetes 2021年第8期12卷 1312-1324页

作者： Gamze Akkus Tamer Tetiker Department of Internal Medicine Cukurova University Medical FacultyAdana 33170Turkey Department of Endocrinology Cukurova UniversityAdana 33170Turkey

BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus(T2DM).metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with *** are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM,but remission rates of T2DM after metabolic surgery can display great *** To discuss the most commonly used surgical options including vertical sleeve gastrectomy,adjustable gastric banding,Roux-en-Y gastric bypass,and biliopancreatic diversion with duodenal *** We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical *** In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patient with T2DM,but further studies are needed to clarify better the rate of diabetes *** In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patients with T2DM,but further studies are needed to clarify better the rate of diabetes remission.

关键词： metabolic surgery Type 2 diabetes mellitus Vertical sleeve gastrectomy Biliopancreatic diversion

Recent advances in bariatric/metabolic surgery:appraisal of clinical evidence

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The Journal of Biomedical Research 2015年第2期29卷 98-104页

作者： Wei-Jei Lee Abdullah Almulaifi Department of surgery Min-Sheng General HospitalNational Taiwan University

Obesity and associated type 2 diabetes mellitus（T2DM） are becoming a serious medical issue *** surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese *** data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2 DM *** review of recent developments in bariatric/metabolic surgery covers 4major fields.1） Improvement of safety：recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade *** safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now.2） New bariatric/metabolic surgery：laparoscopic sleeve gastrectomy（LSG） is becoming the leading bariatric surgery because of its simplicity and *** new procedures,such as gastric plication,banded plication,single anastomosis（mini） gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery.3）Mechanism of bariatric/metabolic surgery：Restriction is the most important mechanism for bariatric *** regain after bariatric surgery is usually associated with loss of *** studies demonstrated that gut hormone,microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2 DM ***,weight loss is still the cornerstone of T2 DM remission after metabolic surgery.4） Patient selection：patients who may benefit most from bariatric surgery was found to be patients with insulin *** Asian T2 DM patients,the indication of metabolic surgery has been set to those with not well2controlled（Hb A1 c.7.5%） disease and with their BMI.27.5 Kg/m.A novel diabetes surgical score,ABCD score,is a simple system for predicting the success of surgical therapy for T2 DM.

关键词： bariatric surgery metabolic surgery type 2 diabetes mellitus advances

Bile acids and metabolic surgery

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Liver Research 2021年第3期5卷 164-170页

作者： Hui Xue Luyao Huang Jui Tu Lili Ding Wendong Huang Shanghai Key Laboratory of Complex Prescriptions and MOE Key Laboratory for Standardization of Chinese Medicines Institute of Chinese Materia MedicaShanghai University of Traditional Chinese MedicineShanghaiChina Department of Diabetes Complications and Metabolism Institute of Diabetes and Metabolism Research CenterBeckman Research InstituteCity of Hope National Medical CenterDuarteCAUSA

The epidemic of obesity and its co-mortalities has reached an alarming level ***,metabolic surgeries,especially the Roux-en-Y gastric bypass and vertical sleeve gastrectomy,are the most effective and sustainable treatments for obesity,type 2 diabetes,non-alcoholic steatohepatitis,as well as other metabolic ***,the invasive nature of the surgeries limits their broad ap-plications to the general ***,developing alternative non-invasive approaches to mimic metabolic surgery is an important direction of the *** studies have identified several potential metabolic surgery-induced downstream endocrine mediators,among which bile acids are key candidate signaling *** acids are profoundly altered by metabolic surgery,which contributes to the metabolic effects of the *** this review,we focus on the most recent studies on the roles of bile acids and bile acid receptors farnesoid X receptor and Takeda G protein-coupled receptor 5 in mediating the metabolic effects of metabolic *** conclude that targeting bile acid pathways may be a promising pharmacological approach to mimic the beneficial effects of metabolic surgery.

关键词： metabolic surgery Obesity Type 2 diabetes(T2D) Non-alcoholic fatty liver disease(NAFLD) Bile acid Farnesoid X receptor(FXR) Takeda G protein-coupled receptor 5(TGR5)

Comparative effectiveness of medical treatment *** surgery for histologically proven non-alcoholic steatohepatitis and fibrosis:a matched network meta-analysis

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Hepatobiliary surgery and Nutrition 2022年第5期11卷 696-708,I0008-I0011页

作者： Adrian T.Billeter Beatrice Reiners Svenja E.Seide Pascal Probst Eva Kalkum Christian Rupp Beat P.Müller-Stich Department of General Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany Institute of Medical Biometry and Informatics University of HeidelbergHeidelbergGermany The Study Center of the German Surgical Society(SDGC) HeidelbergGermany Department of Gastroenterology and Hepatology University of HeidelbergHeidelbergGermany

Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related *** new drugs for NASH-treatment are currently *** study thus far directly compared surgical and non-surgical therapies for *** network meta-analysis compares for the first time the effectiveness of different therapies for NASH using a novel statistical ***:The study was conducted according to the PRISMA guidelines for network ***,CENTRAL and Web of Science were searched without restriction of time or language using a validated search *** investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were *** with liver cirrhosis were *** of bias was assessed with ROB-2 and ROBINS-I-tools.A novel method for population-adjusted indirect comparison to include and compare single-arm trials was *** outcomes were NASH-resolution and improvement of ***:Out of 7,913 studies,twelve randomized non-surgical studies and twelve non-randomized surgical trials were ***-resolution after non-surgical intervention was 29%[95%confidence interval(CI):23-40%]and 79%(95%CI:72-88%)after *** network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication[odds ratio(OR)=2.68;95%CI:1.44-4.97]while drug treatment was superior to placebo(OR=2.24;95%CI:1.55-3.24).surgery(OR=2.18;95%CI:1.34-3.56)and medication(OR=1.79;95%CI:1.39-2.31)were equally effective to treat fibrosis compared to placebo without difference between *** results did not change when only new drugs specifically developed for the treatment of NASH were ***:metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of *** d

关键词： Non-alcoholic fatty liver disease(NAFLD) non-alcoholic steatohepatitis(NASH) metabolic surgery fatty liver

The success of sleeve gastrectomy in the management of metabolic syndrome and obesity

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The Journal of Biomedical Research 2015年第2期29卷 93-97页

作者： Asim Shabbir Dallan Dargan Department of surgery National University HospitalNUHS Tower BlockLevel 8Singapore 119228

The rapid reversal of diabetes,hypertension,hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic *** gastrectomy,which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch,has seen an exponential rise in popularity as an effective lone laparoscopic bariatric *** excess weight loss,a low complication rate,and excellent food tolerance,combined with a short hospital stay,have made this the procedure of choice for patients and surgeons across the *** volume centres nurture the ongoing development of experienced and specialized teams,pathways and *** surgical outcomes allow minimization of metabolic syndrome,reducing cardiovascular and cerebrovascular risk.

关键词： metabolic surgery sleeve gastrectomy diabetes mellitus obesity

Laparoscopic revolution in bariatric surgery

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World Journal of Gastroenterology 2014年第41期20卷 15135-15143页

作者： Magnus Sundbom Department of Surgical Sciences Uppsala University

The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

关键词： Laparoscopy Bariatric surgery Minimal invasive surgery Gastric bypass Duodenal switch Gastric banding metabolic surgery