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bariatric surgery in old age:a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

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The Journal of Biomedical Research 2015年第2期29卷 118-124页

作者： Chih-Kun Huang Amit Garg Hsin-Chih Kuao Po-Chih Chang Ming-Che Hsin bariatric & metabolic International(B.M.I) surgery Centre E-Da Hospital Department of Health Management I-Shou University

bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly *** aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass（LRYGB） and sleeve gastrectomy（LSG） in patients aged more than 55 *** performed2 a retrospective review of a prospectively collected *** patients with body mass index（BMI） §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the ***,peri-operative data,weight loss and surgical complications were all recorded and *** age and BMI of these 68 patients22（22 males and 46 female） were 58.8 years（55-79 years） and 39.5 kg/m（32.00-60.40 kg/m）.LRYGB was performed in 44 patients and LSG in 24 *** two groups were comparable in their preoperative BMI,American society of Anaesthesia（ASA） score and gender *** patients were significantly older than patients receiving *** proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients（88.63% vs.50%; P,0.01）.The prevalence of other co-morbidities was similar and comparable2 between the *** BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss（%EWL） at 1 *** percentage of resolution of diabetes was significantly higher in LRYGB（69.2%） as compared to LSG（33.3%）.On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver *** overall morbidity and re-operation rate was higher in LRYGB *** morbidly elderly patients,both surgeries achieved good weight loss and resolution of *** is s

关键词： obesity metabolic surgery Roux-en-Y gastric bypass laparoscopic sleeve gastrectomy effiacy safety

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Do different bariatric surgical procedures influence plasma levels of matrix metalloproteinase-2,-7,and-9 among patients with type 2 diabetes mellitus?

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World Journal of Diabetes 2020年第6期11卷 252-260页

作者： Wen-Chi Wu Wei-Jei Lee Tzong-His Lee Shu-Chun Chen Chih-Yen Chen Department of Medicine Taipei Veterans General HospitalTaipei 11217Taiwan Department of surgery Min-Sheng General HospitalTaoyuan 330Taiwan taiwan society for metabolic and bariatric surgery Taipei 11031Taiwan Division of Gastroenterology and Hepatology Department of Internal MedicineFar Eastern Memorial HospitalNew Taipei City 220Taiwan Department of Nursing Chang-Gung Institute of TechnologyGuishanTaoyuan 333Taiwan Division of Gastroenterology and Hepatology Department of MedicineTaipei Veterans General HospitalTaipei 11217Taiwan Faculty of Medicine and Institute of Emergency and Critical Medicine National Yang-Ming University School of MedicineTaipei 11221Taiwan Association for the Study of Small Intestinal Diseases GuishanTaoyuan 33305Taiwan Chinese Taipei society for the Study of Obesity Taipei 110Taiwan

BACKGROUND bariatric surgery is an efficient strategy for body weight and type 2 diabetes mellitus(T2 DM) management. Abnormal lipid deposition in visceral organs,especially the pancreas and liver, might cause beta-cell dysfunction and insulin resistance. Extracellular matrix(ECM) remodeling allows adipose expansion, and matrix metalloproteinases(MMPs) play essential roles in ECM ***-2 and MMP-9 are the substrates of MMP-7. Different studies have reported that MMP-2,-7, and-9 increase in patients with obesity and metabolic syndromes or T2 DM and are considered biomarkers in obesity and hyperglycemia *** prospectively investigate whether MMP-2, MMP-7, and MMP-9 differ after two bariatric surgeries: Gastric bypass(GB) and sleeve gastrectomy(SG).METHODS We performed GB in 23 and SG in 19 obese patients with T2 DM. We measured body weight, waist circumference, body mass index(BMI), and serum concentrations of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood sugar(FBS),hemoglobin A1 c(Hb A1 c), C-peptide, homeostasis model assessments of insulin resistance, and MMP-2, MMP-7, and MMP-9 levels at baseline and at 3, 12, and 24 mo *** Twenty-three patients aged 44.7 ± 9.7 years underwent GB, and 19 patients aged40.1 ± 9.1 years underwent SG. In the GB group, BMI decreased from 30.3 ± 3.4 to24.4 ± 2.4 kg/m2, Hb A1 c decreased from 9.2% ± 1.5% to 6.7% ± 1.4%, and FBS decreased from 171.6 ± 65.0 mg/d L to 117.7 ± 37.5 mg/d L 2 years post-operation(P < 0.001). However, the MMP-2, MMP-7, and MMP-9 levels pre-and post-GB were similar even 2 years post-operation(P = 0.107, 0.258, and 0.466,respectively). The SG group revealed similar results: BMI decreased from 36.2 ±5.1 to 26.9 ± 4.7 kg/m2, Hb A1 c decreased from 7.9% ± 1.7% to 5.8% ± 0.6%, and FBS decreased from 138.3 ± 55.6 mg/d L to 95.1 ± 3.1 mg/d L(P < 0.001). The serum MMP-2,-7, and-9 levels pre-and post-SG we

关键词： Matrix metalloproteinases Extracellular matrix Obesity Type 2 diabetes mellitus Gastric bypass Sleeve gastrectomy

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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

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Current status of endoscopic sleeve gastroplasty: An opinion review

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World Journal of Gastroenterology 2020年第11期26卷 1107-1112页

作者： Jiunn-Wei Wang Chih-Yen Chen Division of Gastroenterology Department of Internal medicineKaohsiung Medical University HospitalKaohsiung 80756Taiwan Department of Medicine College of MedicineKaohsiung Medical UniversityKaohsiung 80756Taiwan Graduate Institute of Clinical Medicine College of MedicineKaohsiung Medical UniversityKaohsiung 80756Taiwan Division of Gastroenterology and Hepatology Department of MedicineTaipei Veterans General HospitalTaipei 11217Taiwan Endoscopy Center for Diagnosis and Treatment Taipei Veterans General HospitalTaipei 11217Taiwan Faculty of Medicine and Institute of Emergency and Critical Medicine National Yang-Ming University School of MedicineTaipei 11217Taiwan Institutional Review Board Taipei Veterans General HospitalTaipei 11217Taiwan Chinese Taipei society for the Study of Obesity Taipei 11031Taiwan

bariatric surgeries have been demonstrated to be safe and effective treatment options for morbid obesity patients, but operative risks and high health care costs limit their clinical application. Endoscopic bariatric therapies are emerging as valuable alternatives for patients with doubts about bariatric surgery or ineligible for it. Endoscopic sleeve gastroplasty(ESG), a relatively novel technique of endoscopic bariatric therapies, has gained standing in the past few years. The safety, feasibility, repeatability, and potential for reversibility of ESG have been proven by multicenter studies. Compared to other weight loss strategies, current evidence demonstrates that ESG offers satisfactory efficacy in weight loss. Even though it is inferior to laparoscopic sleeve gastrectomy, it has lower risks of adverse events than surgical interventions and intragastric balloon within oneyear follow-up. Furthermore, ESG may be the ideal weight control strategy for patients who have poor adherence to behavioral interventions. Even so, trends in decreased weight loss effect over time, post-procedure weight regain, postprocedure gut hormone alteration, and possible effects of race and ethnicity on ESG still remain undetermined due to very limited reports and very short followups. Further clinical trials are required to validate and answer these questions.

关键词： Obesity Endoscopic bariatric therapy Endoscopic sleeve gastroplasty Laparoscopic sleeve gastrectomy Intragastric balloon Behavioral weight loss intervention

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Risk of anemia in morbidly obese patients after bariatric surgery in taiwan

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World Journal of Diabetes 2020年第10期11卷 447-458页

作者： Tse-Yao Wang Hsien-Hao Huang Ming-Shun Hsieh Chih-Yen Chen Department of Emergency Medicine Taipei Veterans General HospitalTaipei 112Taiwan College of Medicine National Yang-Ming University of MedicineTaipei 112Taiwan Department of Emergency Medicine Taipei Veterans General HospitalTaoyuan BranchTaoyuan 330Taiwan Institute of Occupational Medicine and Industrial Hygiene National Taiwan University College of Public HealthTaipei 112Taiwan Division of Gastroenterology and Hepatology Department of MedicineTaipei Veterans General HospitalTaipei 112Taiwan Faculty of Medicine and Institute of Emergency and Critical Medicine National Yang-Ming University School of MedicineTaipei 112Taiwan Chinese Taipei society for the Study of Obesity Taipei 110Taiwan

BACKGROUND bariatric surgery is one of most effective long-term treatments for morbid ***,post-bariatric surgery anemia is identified as a common adverse effect and remains a challenge *** To estimate the risk of post-bariatric surgery anemia and to stratify the association between age,gender,and types of *** This study is a population-based cohort *** conducted this nationwide study using claims data from National Health Insurance Research Database in *** were 4373 morbidly obese patients in this study *** Among patients who were diagnosed with morbid obesity,2864 received bariatric *** obesity-associated comorbidities decreased in the surgical *** risk of post-bariatric surgery anemia among obese patients was found by Cox proportional hazards regression[adjusted hazard ratio(HR):2.36].Also,we found significantly increasing cumulative incidence rate of anemia among patients receiving bariatric surgery by log-rank *** adjusting for age and gender,the increasing incidence of post-bariatric surgery anemia was found among women(adjusted HR:2.48),patients in the 20–29-year-old group(adjusted HR:3.83),and patients in the 30-64-year-old group(adjusted HR:2.37).Moreover,malabsorptive and restrictive procedures had significantly higher adjusted HRs,3.18 and 1.55,*** bariatric surgery give rise to anemia risk among obese patients,specifically in women,young-and middle-aged patients,and patients undergoing malabsorptive procedures in our population-based cohort study in taiwan.

关键词： Anemia bariatric surgery Malabsorptive procedure Obesity Restrictive procedure Women

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Non-invasive prediction of non-alcoholic steatohepatitis in Japanese patients with morbid obesity by artificial intelligence using rule extraction technology

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World Journal of Hepatology 2018年第12期10卷 934-943页

作者： Daisuke Uehara Yoichi Hayashi Yosuke Seki Satoru Kakizaki Norio Horiguchi Hiroki Tojima Yuichi Yamazaki Ken Sato Kazuki Yasuda Masanobu Yamada Toshio Uraoka Kazunori Kasama Department of Medicine and Molecular Science Gunma University Graduate School of Medicine Department of Gastroenterology and Hepatology Gunma University Graduate School of Medicine Department of Computer Science Meiji University Tama-ku Weight Loss and metabolic surgery Center Yotsuya Medical Cube Department of metabolic Disorder Diabetes Research Center Research Institute National Center for Global Health and Medicine Department of Internal Medicine Division of Endocrinology and Metabolism Gunma University Graduate School of Medicine

AIM To construct a non-invasive prediction algorithm for predicting non-alcoholic steatohepatitis(NASH), we investigated Japanese morbidly obese patients using artificial intelligence with rule extraction *** Consecutive patients who required bariatric surgery underwent a liver biopsy during the operation. Standard clinical, anthropometric, biochemical measurements were used as parameters to predict NASH and were analyzed using rule extraction technology. One hundred and two patients, including 79 NASH and 23 non-NASH patients were analyzed in order to create the predictionmodel, another cohort with 77 patients including 65 NASH and 12 non-NASH patients were analyzed to validate the *** Alanine aminotransferase, C-reactive protein, homeostasis model assessment insulin resistance, albumin were extracted as predictors of NASH using a recursive-rule extraction algorithm. When we adopted the extracted rules for the validation cohort using a highly accurate rule extraction algorithm, the predictive accuracy was 79.2%. The positive predictive value, negative predictive value,sensitivity and specificity were 88.9%, 35.7%, 86.2% and 41.7%, *** We successfully generated a useful model for predicting NASH in Japanese morbidly obese patients based on their biochemical profile using a rule extraction algorithm.

关键词： Non-alcoholic steatohepatitis Artificial intelligence Rule extraction Morbid obesity Liver biopsy Non-invasive prediction

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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

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Is gastroscopy necessary before bariatric surgery?

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World Journal of Gastrointestinal Endoscopy 2022年第1期14卷 29-34页

作者： Burhan Hakan Kanat Serhat Doğan Department of General surgery Malatya TurgutÖzal UniversitySchool of MedicineMalatya 44100Turkey

Obesity is the abnormal accumulation of fat or adipose tissue in the *** has become a serious health problem in the world in the last 50 years and is considered a *** mass index is a widely used ***,obese individuals can be easily classified and *** is the second cause of preventable deaths after *** significantly increases mortality and *** thought of preparing a publication about routine procedures for the preoperative evaluation of *** question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was“Is esophagogastroduodenoscopy(EGD)necessary before bariatric surgery?”We found different answers in our literature *** European Association of Endoscopic surgery guidelines recommend EGD for all bariatric *** strongly recommend it for Roux-en-Y gastric bypass(RYGB).As a result of a recent study by the members of the British Obesity&metabolic surgery society,preoperative EGD is routinely recommended for patients und-ergoing sleeve gastrectomy,even if they are asymptomatic,but not recommended for *** is recommended for symptomatic patients scheduled for *** to the International Sleeve Gastrectomy Expert Panel Consensus Statement,preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy,but its routine use for RYGB is ***,a different view is that the American society for Gastrointestinal Endoscopy recom-mends endoscopy only for symptomatic patients scheduled for bariatric *** the literature,the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal *** the light of the literature,it is stated that this procedure is not necessary in America,while it is routinely recommended in the European *** medicolegal cases that may occur in the future,we are in favor of per

关键词： bariatric surgery Preoperative endoscopy Preoperative bariatric preparation Esophagogastroduodenoscopy

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