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Laster J, Papademetriou M. How to Build an Endobariatric Practice: Set Up, Branding, and Marketing. Gastrointest Endosc Clin N Am 2024; 34:757-763. [PMID: 39277303 DOI: 10.1016/j.giec.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
In the last decade there has been significant development of novel devices and techniques in the field of endoscopic bariatric and metabolic therapies (EBMTs). Bariatric endoscopy fulfills an unmet need within the current paradigm of obesity management. The expansion of this field is an important step in offering complete care to patients with obesity and metabolic disease. Nevertheless, information, mentorship and guidance through starting a practice in EBMTs are limited. We discuss important considerations when beginning a practice in obesity care with a focus on endobariatrics in a variety of practice settings.
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Affiliation(s)
- Janese Laster
- Georgetown University Medical Center; Gut Theory Total Digestive Care, 1712 North Street Northwest Suite 101, Washington, DC 20036, USA.
| | - Marianna Papademetriou
- Georgetown University Medical Center, Washington DC VA Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA
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2
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Domènech E, Ciudin A, Balibrea JM, Espinet-Coll E, Cañete F, Flores L, Ferrer-Márquez M, Turró R, Hernández-Camba A, Zabana Y, Gutiérrez A. Recommendations on the management of severe obesity in patients with inflammatory bowel disease of the Spanish Group on Crohn's Disease and Ulcerative Colitis (GETECCU), Spanish Society of Obesity (SEEDO), Spanish Association of Surgery (AEC) and Spanish Society of Digestive Endoscopy (SEED). GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:906-923. [PMID: 38290648 DOI: 10.1016/j.gastrohep.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
Obesity is a multifactorial, chronic, progressive and recurrent disease considered a public health issue worldwide and an important determinant of disability and death. In Spain, its current prevalence in the adult population is about 24% and an estimated prevalence in 2035 of 37%. Obesity increases the probability of several diseases linked to higher mortality such as diabetes, cardiovascular disease, hyperlipidemia, arterial hypertension, non-alcoholic fatty liver disease, several types of cancer, or obstructive sleep apnea. On the other hand, although the incidence of inflammatory bowel disease (IBD) is stabilizing in Western countries, its prevalence already exceeds 0.3%. Paralleling to general population, the current prevalence of obesity in adult patients with IBD is estimated at 15-40%. Obesity in patients with IBD could entail, in addition to its already known impact on disability and mortality, a worse evolution of the IBD itself and a worse response to treatments. The aim of this document, performed in collaboration by four scientific societies involved in the clinical care of severe obesity and IBD, is to establish clear and concise recommendations on the therapeutic possibilities of severe or typeIII obesity in patients with IBD. The document establishes general recommendations on dietary, pharmacological, endoscopic, and surgical treatment of severe obesity in patients with IBD, as well as pre- and post-treatment evaluation.
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Affiliation(s)
- Eugeni Domènech
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Andreea Ciudin
- Departament de Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Barcelona, España; Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - José María Balibrea
- Servicio de Cirugía General y Digestiva, Hospital Universitari Germans Trias i Pujol; Departamento de Cirugía, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Eduard Espinet-Coll
- Unidad de Endoscopia Bariátrica, Hospital Universitario Dexeus y Clínica Diagonal, Barcelona, España
| | - Fiorella Cañete
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)
| | - Lilliam Flores
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM); Unidad de Obesidad, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España
| | - Manuel Ferrer-Márquez
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
| | - Román Turró
- Unidad de Endoscopia Digestiva, Bariátrica y Metabólica, Servicio de Aparato Digestivo, Centro Médico Teknon y Hospital Quirón, Barcelona, España
| | - Alejandro Hernández-Camba
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Servicio de Aparato Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Servicio de Aparato Digestivo, Hospital General Universitario Dr. Balmis, ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
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3
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Walradt T, Thompson CC. Endoscopic Sleeve Gastroplasty: Practical Considerations, Current Techniques, and Troubleshooting. Gastrointest Endosc Clin N Am 2024; 34:671-685. [PMID: 39277298 DOI: 10.1016/j.giec.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective treatment for obesity over the past decade. This procedure, however, is technically challenging and requires frequent troubleshooting, even among experts. In this article the authors discuss current techniques, common pitfalls and adverse outcomes associated with ESG, how to avoid them, and how to address them if they occur.
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Affiliation(s)
- Trent Walradt
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. https://twitter.com/TrentWalradt
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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4
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Lahooti A, Johnson KE, Sharaiha RZ. The Future of Endobariatrics: Bridging the Gap. Gastrointest Endosc Clin N Am 2024; 34:805-818. [PMID: 39277306 DOI: 10.1016/j.giec.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
With the growing global burden of obesity, the field of endobariatrics has emerged as a promising alternative, filling the void between lifestyle interventions with modest efficacy and more invasive surgical procedures. This article explores the latest advancements in endobariatric therapies, encompassing endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGB), endoscopic metabolic therapies, and promising pharmacologic and surgical combination approaches that integrate multiple therapeutic modalities. It also outlines the critical factors and strategic considerations necessary for the successful integration of endobariatric interventions into clinical practice.
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Affiliation(s)
- Ali Lahooti
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York
| | - Kate E Johnson
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York.
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White ME, Kushnir V. Combination Therapies: Anti-Obesity Medications and Endoscopic Bariatric Procedures. Gastrointest Endosc Clin N Am 2024; 34:743-756. [PMID: 39277302 DOI: 10.1016/j.giec.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
The obesity epidemic continues to worsen in the United States with currently 40% of adults with obesity. While lifestyle changes, pharmacologic and surgical treatments are the mainstay of therapy, they often are either inadequate to meet desired weight loss or underutilized due to patient preference. Endoscopic bariatric treatment can fill these gaps. Combination of endoscopic therapy with pharmacologic therapy can help narrow the gap between endoscopic and surgical bariatric treatment, as well as treat weight recidivism, inadequate weight loss, or further improve associated medical comorbidities in patients who have undergone or are undergoing endoscopic bariatric treatment.
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Affiliation(s)
- Megan E White
- Division of Gastroenterology, Washington University School of Medicine, Washington University/Barnes Jewish Hospital, 660 South Euclid #8124, St Louis, MO 63110, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Washington University School of Medicine, Washington University, 660 South Euclid #8124, St Louis, MO 63110, USA.
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Manivel R, Sivalingam AM. New Perspectives on Sleeve Gastroplasty Trials for Patients with Autonomic and Hypothalamic Obesity. Obes Surg 2024; 34:3911-3912. [PMID: 39172290 DOI: 10.1007/s11695-024-07480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Rajajeyakumar Manivel
- Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Deemed University, Thandalam, Chennai, 602105, India.
| | - Azhagu Madhavan Sivalingam
- Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Deemed University, Thandalam, Chennai, 602105, India
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7
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Lahooti A, Rizvi A, Canakis A, Akagbosu C, Johnson KE, Hassan K, Lahooti I, Abu-Hammour M, Dawod E, Dawod Q, Newberry C, Sampath K, Carr-Locke D, Mahadev S, Afaneh C, Dakin G, Kumar S, Yeung M, Barenbaum S, Tchang B, Shukla AP, Aronne LJ, Sharaiha RZ. Navigating the Predictive Landscape: DiaRem's Role in Unveiling Outcomes for Diabetes Remission following ESG. Obes Surg 2024; 34:3358-3365. [PMID: 39117857 DOI: 10.1007/s11695-024-07408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE Rising obesity and type 2 diabetes mellitus (T2DM) rates can be mitigated by various strategies, with a 10% total body weight loss (TBWL) threshold often required for T2DM remission. T2DM remission rates after bariatric surgery like Roux-en-Y gastric bypass (RYGB) are well established; endoscopic sleeve gastroplasty (ESG) is a less invasive option that averages 15% TBWL and allows for T2DM remission. This study explores the DiaRem (Diabetes Remission post-RYGB) score's ability to predict T2DM remission 1-year post-ESG. MATERIALS AND METHODS We conducted a retrospective cohort study on 39 individuals with T2DM who underwent ESG. Age, utilization of diabetes medications, insulin administration, and hemoglobin A1c levels were used to calculate the DiaRem score. The area under the receiver operating characteristic curve (AUC) was employed to evaluate the discriminative ability of DiaRem in distinguishing diabetes remission. RESULTS Among the 39 patients with a median hemoglobin A1c of 6.7, 12.8% required insulin, and 43.6% used diabetes medication. At 1-year post-ESG, 69.2% of patients experienced diabetes remission with a median %TWBL of 12.7. The DiaRem score's ability to detect diabetes resolution for ESG patients had a sensitivity of 100% and a specificity of 58.3%, at the optimal cutoff value of 10. The AUC was 0.779 (95% CI 0.546-0.959). CONCLUSION Our study demonstrated the DiaRem score's predictive value for T2DM remission post-ESG, highlighting its utility in clinical decision-making for ESG-related outcomes. Further investigation is needed to identify alternative indicators that may enhance predictive accuracy, thus refining personalized decision-making for this patient group.
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Affiliation(s)
- Ali Lahooti
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Anam Rizvi
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cynthia Akagbosu
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Kate E Johnson
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Kamal Hassan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Ila Lahooti
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Mohamed Abu-Hammour
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Qais Dawod
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Carolyn Newberry
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - David Carr-Locke
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | | | - Gregory Dakin
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sonal Kumar
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Michele Yeung
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah Barenbaum
- Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA
| | - Beverly Tchang
- Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA
| | - Alpana P Shukla
- Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
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8
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Sharaiha RZ, Wilson EB, Zundel N, Ujiki MB, Dayyeh BKA. Randomized Controlled Trial Based US Commercial Payor Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty Versus Lifestyle Modification Alone for Adults With Class I/II Obesity. Obes Surg 2024; 34:3275-3284. [PMID: 39107454 DOI: 10.1007/s11695-024-07324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT. MATERIALS We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was assumed. RESULTS In our base-case analysis over a 5-year time horizon, ESG was cost-effective versus lifestyle modification alone with an incremental cost-effectiveness ratio of $23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons. CONCLUSION ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients.
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Affiliation(s)
- Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, 1283 York Avenue, 9 Floor, New York, NY, 10021, USA.
| | - Erik B Wilson
- Department of Surgery, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Natan Zundel
- Department of Surgery, University at Buffalo, Buffalo, NY, 14203, USA
| | - Michael B Ujiki
- Department of Surgery, North Shore University Health System, Evanston, IL, 60201, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
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9
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Matteo MV, Gualtieri L, Bove V, Palumbo G, Pontecorvi V, De Siena M, Barbaro F, Spada C, Boškoski I. Endoscopic sleeve gastroplasty for metabolic dysfunction-associated steatotic liver disease. Expert Rev Gastroenterol Hepatol 2024; 18:397-405. [PMID: 39234763 DOI: 10.1080/17474124.2024.2387231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly nonalcoholic fatty liver disease - NAFLD) is a chronic liver condition linked to obesity and metabolic syndrome. It affects one-third of people globally and, in some cases, can lead to metabolic dysfunction-associated steatohepatitis (MASH, formerly nonalcoholic steatohepatitis, NASH) and fibrosis. Weight loss is crucial for the treatment of MASLD, but diet and lifestyle modifications often fail. AREAS COVERED In recent years, endoscopic sleeve gastroplasty (ESG) has gained popularity as an effective and minimally invasive option for obesity treatment, with widespread use worldwide. We present a current overview of the most significant studies conducted on ESG for the management of obesity and MASLD. Our report includes data from published studies that have evaluated the impact of ESG on noninvasive hepatic parameters used to estimate steatosis and fibrosis. However, at present, there are no data available on liver histology. EXPERT OPINION ESG has shown promising results in treating MASLD evaluated by noninvasive tests, but current data is limited to small, nonrandomized studies. More research is needed, particularly on the effects of ESG on histologically proven MASH. If future research confirms its efficacy, ESG may be incorporated into treatment guidelines in the future.
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Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulia Palumbo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Shah RH, Amin S. Emerging indications for third space endoscopy. Best Pract Res Clin Gastroenterol 2024; 71:101911. [PMID: 39209414 DOI: 10.1016/j.bpg.2024.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/03/2024] [Indexed: 09/04/2024]
Abstract
This chapter will explore the recent advancements and innovations in the field of third space endoscopy. The traditional principles of per-oral endoscopic myotomy and endoscopic submucosal dissection have been applied to offer solutions to traditionally difficult to manage problems including esophageal diverticula, post-fundoplication dysphagia, post-sleeve gastrectomy stricture, bariatric procedure and Hirschsprung disease. Typically, these problems were managed surgically with potentially high rates of morbidity and mortality; however, the principles of third space endoscopy offer a safer and less invasive option for management. All of these applications of third space endoscopy are less than a decade old with some emerging in the last 1-2 years. In this chapter, we will explore the pathophysiology of these diseases and how third space endoscopy can offer a solution. We will also review the relevant literature along with the safety and effectiveness of the proposed innovations.
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Affiliation(s)
- Rahil H Shah
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA.
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11
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Hajifathalian K, Amer K, Shamoon D, Westerveld D, Aronne L, Mehta A, Wong A, Lo G, Oh S, Kierans AS, Hassan KM, Lahooti A, Sharaiha RZ. Fundus-to-Antrum Ratio Measured with Fluoroscopy within One Week after Endoscopic Sleeve Gastroplasty Predicts Total Body Weight Loss over Time. J Clin Med 2024; 13:3933. [PMID: 38999498 PMCID: PMC11242761 DOI: 10.3390/jcm13133933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background and Aims: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure to induce weight loss through restrictive physiology. This study was designed to evaluate the fluoroscopic measurement of gastric dimensions after ESG as a predictor of Total Body Weight Loss (TBWL) over time. Methods: Post-ESG patients were enrolled prospectively between August 2013 and August 2019. An upper gastrointestinal (GI) fluoroscopy was obtained within 7 days after the procedure. Two blinded, independent radiologists reviewed fluoroscopic images and measured the gastric lumen transverse diameter in three separate areas of the fundus, body, and antrum. The primary outcome was achieving a TBWL of ten percent or more after ESG. Results: In total, 162 patients were included in the analysis (65% female) and had a mean body mass index (BMI) of 39 ± 6 at baseline. Patients had a mean maximum TBWL of 16.5 ± 8.3%. Respectively, 92%, 75%, and 50% of patients achieved a TBWL of 5%, 10%, or 15% or more. The mean post-procedural UGI gastric fundus/antrum transverse measurement ratio was 1.2 ± 0.6. A higher fundus-to-antrum ratio was significantly associated with a TBWL of 10% or more during follow-up in the multivariable model (OR 2.49, 95% CI 1.31-4.71; p-value 0.005). The prediction score based on the fundus-to-antrum ratio hd an area under the ROC curve of 0.79 (95% CI 0.75-0.83) for predicting a TBWL of 10% or more during follow-up. Conclusions: Measuring gastric the fundus/antrum ratio within one week of endoscopic sleeve gastroplasty (ESG) is a consistent and independent predictive measure of sustained TBWL during long-term follow-up.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, University Hospital, Newark, NJ 07103, USA
| | - Kamal Amer
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, University Hospital, Newark, NJ 07103, USA
| | - Dema Shamoon
- Division of Gastroenterology and Hepatology, St. Michael's Medical Center, 111 Central Avenue, Newark, NJ 07102, USA
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Louis Aronne
- Division of Endocrinology Diabetes and Metabolism, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Angela Wong
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Grace Lo
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Sarah Oh
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Andrea Siobhan Kierans
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Kamal M Hassan
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Ali Lahooti
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY 10065, USA
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Wooley C, Maselli DB, Donnangelo LL, Waseem A, Casey S, Coan B, McGowan CE. Endoscopic sleeve gastroplasty using mixed-tooth grasping forceps as an alternative to the tissue helix. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:317-319. [PMID: 39070677 PMCID: PMC11281925 DOI: 10.1016/j.vgie.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Affiliation(s)
| | | | | | | | | | - Brian Coan
- True You Weight Loss, Cary, North Carolina
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13
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Frey S, Sejor E, Cougard PA, Benamran D, Sebbag H. From Early to Mid-Term Results of Endoscopic Sleeve Gastroplasty: A Retrospective Analysis of a Bariatric Center. Obes Surg 2024; 34:2537-2545. [PMID: 38819723 DOI: 10.1007/s11695-024-07313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Global obesity rates have surged, necessitating effective interventions beyond traditional bariatric and metabolic surgery (BMS). Endoscopic Sleeve Gastroplasty (ESG) has emerged as a minimally invasive alternative, addressing limitations of eligibility criteria and patient reluctance associated with BMS. This study aims to present a 3-year experience with ESG, focusing on its mid-term efficacy in weight loss. MATERIALS AND METHODS A retrospective, single-center study included 143 consecutive ESG patients (BMI > 30 kg/m2 or > 25 kg/m2 with obesity associated-diseases) from February 2019 to March 2023. Data on demographics, comorbidities, operative details, and follow-up outcomes were collected. The primary outcome was %TWL ≥ 15% at 12 months. Secondary outcomes were an optimal clinical response (OCR) at 24 and 36 months defined by %TWL ≥ 10% or %EWL ≥ 25%. RESULTS ESG demonstrated a mean %TWL of 14.37% at 12 months, aligning with previous studies. Early postoperative complications were minimal (2.1%), with no mortality. Follow-up revealed a peak in weight loss at 9 months, but mid-term OCR was achieved in 41.2% at 3 years. The learning curve showed efficiency improvements after 26 procedures. CONCLUSION ESG proves effective at one year, with a %TWL of 14.37%. However, mid-term efficacy beyond 12 months remains challenging, raising questions about the durability of weight loss. Despite a low complication rate, strategies for maintaining a long-term OCR, including potential repeat ESG, warrant further investigation.
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Affiliation(s)
- Sébastien Frey
- Department of Digestive Surgery, Hospital Archet, University Hospital of Nice, Nice, France
- University of Côte d'Azur, Nice, France
| | - Eric Sejor
- Department of Digestive Surgery, Hospital Archet, University Hospital of Nice, Nice, France
| | - Pierre-Alain Cougard
- Department of Bariatric Surgery, Private Hospital of Provence, 235 All. Nicolas de Staël, 13080, Aix-en-Provence, France
| | - Dorith Benamran
- Department of Digestive Surgery, Hospital Archet, University Hospital of Nice, Nice, France
- University of Côte d'Azur, Nice, France
| | - Hugues Sebbag
- Department of Bariatric Surgery, Private Hospital of Provence, 235 All. Nicolas de Staël, 13080, Aix-en-Provence, France.
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14
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Abuawwad M, Tibude A, Bansi D, Idris I, Madhok B. A commentary review on endoscopic sleeve gastroplasty: Indications, outcomes and future implications. Diabetes Obes Metab 2024; 26:2546-2553. [PMID: 38685614 DOI: 10.1111/dom.15613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
Metabolic and bariatric surgeries have been shown to be the most effective strategy to induce and maintain significant weight loss for people living with severe obesity. However, ongoing concerns regarding operative risks, irreversibility and excess costs limit their broader clinical use. Endoscopic bariatric therapies are pragmatic alternatives for patients who are not suitable for metabolic and bariatric surgeries or who are concerned regarding their long-term safety. Endoscopic sleeve gastroplasty has emerged as a novel technique of endoscopic bariatric therapies, which have garnered significant interest and evidence in the past few years. Its safety, efficacy and cost-effectiveness have been shown in various studies, while comparisons with sleeve gastrectomy have been widely made. This review brings together current evidence pertaining to the technicality of the procedure itself, current indications, safety and efficacy, cost-effectiveness, as well as its future role and development.
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Affiliation(s)
- Mahmoud Abuawwad
- East Midlands Bariatric and Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
- Bariatric Surgery - General Surgery Department, Royal Sunderland Hospital, Sunderland, UK
| | - Ameya Tibude
- East Midlands Bariatric and Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
| | - Devinder Bansi
- Honorary Clinical Senior Lecturer, Faculty of Medicine, Imperial College London, London, UK
| | - Iskandar Idris
- East Midlands Bariatric and Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, Clinical, Metabolic and Molecular Physiology, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute (EMBMI), Royal Derby Hospital, Derby, UK
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Jirapinyo P, Hadefi A, Thompson CC, Patai ÁV, Pannala R, Goelder SK, Kushnir V, Barthet M, Apovian CM, Boskoski I, Chapman CG, Davidson P, Donatelli G, Kumbhari V, Hayee B, Esker J, Hucl T, Pryor AD, Maselli R, Schulman AR, Pattou F, Zelber-Sagi S, Bain PA, Durieux V, Triantafyllou K, Thosani N, Huberty V, Sullivan S. American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity. Gastrointest Endosc 2024; 99:867-885.e64. [PMID: 38639680 DOI: 10.1016/j.gie.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 04/20/2024]
Abstract
This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development. The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥ 30 kg/m2, or with a BMI of 27.0-29.9 kg/m2 with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Alia Hadefi
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Árpád V Patai
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Stefan K Goelder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Vladimir Kushnir
- Department of Medicine-Division of Gastroenterology, Washington University, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Marc Barthet
- Department of Hepatogastroenterology, Faculty of Medicine, Aix-Marseille University, Chemin des Bourrely, Marseille, France
| | - Caroline M Apovian
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, and Centre for Endoscopic Research Therapeutics and Training, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christopher G Chapman
- Center for Interventional and Therapeutic Endoscopy, Division of Digestive Diseases and Nutrition, Rush University, Chicago, Illinois USA
| | - Paul Davidson
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France and Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bu Hayee
- Division of Gastroenterology, Kings College London, London, United Kingdom
| | - Janelle Esker
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Aurora D Pryor
- Department of Surgery, Long Island Jewish Medical Center, Queens, New York, USA
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francois Pattou
- Department of Endocrine and Metabolic Surgery, CHU Lille, University of Lille, Inserm, Institut Pasteur Lille, Lille, France
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel and Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles, Brussels, Belgium
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth, Division of Gastroenterology Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA
| | - Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Shelby Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Jirapinyo P, Hadefi A, Thompson CC, Patai ÁV, Pannala R, Goelder SK, Kushnir V, Barthet M, Apovian CM, Boskoski I, Chapman CG, Davidson P, Donatelli G, Kumbhari V, Hayee B, Esker J, Hucl T, Pryor AD, Maselli R, Schulman AR, Pattou F, Zelber-Sagi S, Bain PA, Durieux V, Triantafyllou K, Thosani N, Huberty V, Sullivan S. American Society for Gastrointestinal Endoscopy-European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity. Endoscopy 2024; 56:437-456. [PMID: 38641332 DOI: 10.1055/a-2292-2494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development. The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥30 kg/m2, or with a BMI of 27.0-29.9 kg/m2 with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alia Hadefi
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Árpád V Patai
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Rahul Pannala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Stefan K Goelder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Vladimir Kushnir
- Department of Medicine-Division of Gastroenterology, Washington University, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Marc Barthet
- Department of Hepatogastroenterology, Faculty of Medicine, Aix-Marseille University, Chemin des Bourrely, Marseille, France
| | - Caroline M Apovian
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, and Centre for Endoscopic Research Therapeutics and Training, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christopher G Chapman
- Center for Interventional and Therapeutic Endoscopy, Division of Digestive Diseases and Nutrition, Rush University, Chicago, Illinois USA
| | - Paul Davidson
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France and Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bu Hayee
- Division of Gastroenterology, Kings College London, London, United Kingdom
| | - Janelle Esker
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Aurora D Pryor
- Department of Surgery, Long Island Jewish Medical Center, Queens, New York, USA
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francois Pattou
- Department of Endocrine and Metabolic Surgery, CHU Lille, University of Lille, Inserm, Institut Pasteur Lille, Lille, France
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel and Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles, Brussels, Belgium
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth, Division of Gastroenterology Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA
| | - Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Shelby Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Matteo MV, Bove V, Ciasca G, Carlino G, Di Santo R, Vinti L, Polidori G, Pontecorvi V, Papi M, Spada C, Boškoski I. Success Predictors of Endoscopic Sleeve Gastroplasty. Obes Surg 2024; 34:1496-1504. [PMID: 38451369 PMCID: PMC11031450 DOI: 10.1007/s11695-024-07109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that proved to be safe and effective in obesity treatment. However, not all subjects respond to treatment in the same way, and, with a view to personalized care, it is essential to identify predictors of success or failure. METHODS A retrospective 2-year followed-up cohort of ESG subjects was analyzed to investigate the presence of any baseline or early indicators of long-term optimal or suboptimal ESG outcomes. RESULTS A total of 315 subjects (73% women) were included, with 73% of patients exhibiting an Excess weight loss percentage (%EWL) >25% at the 24 months. Neither demographic parameters (age and sex), smoking habits, and menopause in women nor the presence of comorbidities proved potential predictive value. Interestingly, the %EWL at 1 month after ESG was the strongest predictor of 24-month therapeutic success. Subsequently, we estimated an "early threshold for success" for 1 month-%EWL by employing Youden's index method. CONCLUSIONS ESG is a safe and effective bariatric treatment that can be offered to a wide range of subjects. Early weight loss seems to impact long-term ESG results significantly and may allow proper early post-operative care optimization.
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Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, 00168, Roma, Italy
| | - Giorgio Carlino
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Riccardo Di Santo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, 00168, Roma, Italy
| | - Laila Vinti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Giulia Polidori
- Department of Translational and Precision Medicine, Sapienza University of Rome, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Massimiliano Papi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, 00168, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
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Haseeb M, Chhatwal J, Xiao J, Jirapinyo P, Thompson CC. Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss. JAMA Netw Open 2024; 7:e246221. [PMID: 38607627 PMCID: PMC11015347 DOI: 10.1001/jamanetworkopen.2024.6221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their efficacy. However, their cost-effectiveness over an extended period compared with ESG is a critical gap that needs to be better explored for informed health care decision-making. Objective To assess the cost-effectiveness of semaglutide compared with ESG over 5 years for individuals with class II obesity. Design, Setting, and Participants This economic evaluation study, conducted from September 1, 2022, to May 31, 2023, used a Markov cohort model to compare ESG and semaglutide, with a no-treatment baseline strategy. The study comprised adult patients in the US health care system with class II obesity (body mass index [BMI] of 35-39.9). The base case was a 45-year-old patient with class II obesity (BMI of 37). Patients undergoing ESG were subjected to risks of perioperative mortality and adverse events with resultant costs and decrement in quality of life. Interventions Strategies included treatment with semaglutide and ESG. Main Outcomes and Measures Costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100 000/QALY. A 5-year time horizon with a cycle length of 1 month with a 3% discount rate was used. Probabilities, costs, and quality-of-life estimates of the model were derived from published literature. One-way, 2-way, and probabilistic sensitivity analyses were also performed. Results The model found that ESG was more cost-effective than semaglutide over a 5-year time horizon, with an ICER of -$595 532/QALY. Endoscopic sleeve gastroplasty added 0.06 QALYs and reduced total cost by $33 583 relative to semaglutide. The results remained robust on 1-way and probabilistic sensitivity analyses. Endoscopic sleeve gastroplasty sustained greater weight loss over 5 years vs semaglutide (BMI of 31.7 vs 33.0). To achieve nondominance, the annual price of semaglutide, currently $13 618, would need to be $3591. Conclusions and Relevance This study suggests that ESG is cost saving compared with semaglutide in the treatment of class II obesity. On price threshold analyses, a 3-fold decrease in the price of semaglutide is needed to achieve nondominance.
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Affiliation(s)
- Muhammad Haseeb
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Jade Xiao
- Georgia Institute of Technology, Atlanta
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts
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Gala K, Brunaldi V, McGowan C, Sharaiha RZ, Maselli D, VanderWel B, Kedia P, Ujiki MB, Wilson E, Vargas EJ, Storm AC, Abu Dayyeh BK. Practice patterns and outcomes of endoscopic sleeve gastroplasty based on provider specialty. Endosc Int Open 2024; 12:E253-E261. [PMID: 38415023 PMCID: PMC10898995 DOI: 10.1055/a-2251-3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/05/2024] [Indexed: 02/29/2024] Open
Abstract
Background and study aims Endoscopic sleeve gastroplasty (ESG) is performed in clinical practice by gastroenterologists and bariatric surgeons. Given the increasing regulatory approval and global adoption, we aimed to evaluate real-world outcomes in multidisciplinary practices involving bariatric surgeons and gastroenterologists across the United States. Patients and methods We included adult patients with obesity who underwent ESG from January 2013 to August 2022 in seven academic and private centers in the United States. Patient and procedure characteristics, serious adverse events (SAEs), and weight loss outcomes up to 24 months were analyzed. SPSS (version 29.0) was used for all statistical analyses. Results A total of 1506 patients from seven sites included 235 (15.6%) treated by surgeons and 1271 (84.4%) treated by gastroenterologists. There were no baseline differences between groups. Gastroenterologists used argon plasma coagulation for marking significantly more often than surgeons ( P <0.001). Surgeons placed sutures in the fundus in all instances whereas gastroenterologist placed them in the fundus in less than 1% of the cases ( P <0.001>). Procedure times were significantly different between groups, with surgeons requiring approximately 20 minutes more during the procedure than gastroenterologists ( P <0.001). Percent total body weight loss (%TBWL) and percent responders achieving >10 and >15% TBWL were similar between the two groups at 12, 18, and 24 months. Rates of SAEs were low and similar at 1.7% for surgeons and 2.7% for gastroenterologists ( P >0.05). Conclusions Data from a large US cohort show significant and sustained weight loss with ESG and an excellent safety profile in both bariatric surgery and gastroenterology practices, supporting the scalability of the procedure across practices in a multidisciplinary setting.
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Affiliation(s)
- Khushboo Gala
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Vitor Brunaldi
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
- Gastroenterology department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Daniel Maselli
- GI, True You Weight Loss Georgia LLC, Cary, United States
| | | | - Prashant Kedia
- Gastroenterology, Methodist Dallas Medical Center, Dallas, United States
| | - Michael B Ujiki
- NorthShore Center for Simulation and Innovation, NorthShore University Health Systems, Evanston, United States
| | - Erik Wilson
- Surgery, University of Texas McGovern Medical School, Houston, United States
| | - Eric J. Vargas
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Andrew C Storm
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
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20
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Jirapinyo P, Thompson CC, Garcia-Tsao G, Zucker SD, Ryou M. The effect of endoscopic gastric plication on portosystemic pressure gradient in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease. Endoscopy 2024; 56:56-62. [PMID: 37532114 DOI: 10.1055/a-2146-8857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND The goals of therapy for patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease include weight loss and reduction of the portosystemic pressure gradient (PPG) to decrease the risk of hepatic decompensation. Endoscopic gastric plication (EGP) is an effective endoscopic weight loss procedure. This study aimed to assess the effect of EGP on PPG. METHODS In this prospective pilot study, patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease underwent endoscopic ultrasound-guided PPG measurement prior to and at 6 months following EGP. Primary outcomes were the change in PPG and proportion of patients experiencing ≥ 20 % reduction in PPG at 6 months. Secondary outcomes included percent total weight loss (TWL) and changes in noninvasive tests of fibrosis. RESULTS 20 patients were included. Baseline median body mass index and liver stiffness measurement were 40.2 kg/m2 (range 30.1-56.7) and 14.7 kPa (range 8.2-36), respectively. At 6 months, median PPG decreased from 5.4 mmHg (range 0.7-19.6) to 1.8 mmHg (range 0.4-17.6) (P = 0.002), with 79 % (11/14) experiencing ≥ 20 % reduction. Patients experienced 12.5 % (6.5 %-26.1 %) TWL (P < 0.001) at 6 months, with 89 % (17/19) achieving ≥ 7 % and 68 % (13/19) achieving ≥ 10 % TWL. There were significant improvements in noninvasive tests of fibrosis. CONCLUSION EGP appeared to be effective at reducing PPG in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, United States
- Section of Digestive Diseases, VA-CT Healthcare System, West Haven, Connecticut, United States
| | - Stephen D Zucker
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
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21
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Gala K, Brunaldi V, McGowan C, Sharaiha RZ, Maselli D, Vanderwel B, Kedia P, Ujiki M, Wilson E, Vargas EJ, Storm AC, Abu Dayyeh BK. Performance of Endoscopic Sleeve Gastroplasty by Obesity Class in the United States Clinical Setting. Clin Transl Gastroenterol 2024; 15:e00647. [PMID: 37787450 PMCID: PMC10810569 DOI: 10.14309/ctg.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Endoscopic sleeve gastroplasty (ESG) has gained popularity over the past decade and has been adopted in both academic and private institutions globally. We present outcomes of the largest cohort of patients from the United States undergoing ESG and evaluate these according to obesity class. METHODS We performed a retrospective analysis of adult patients who underwent ESG. Medical information was abstracted from the electronic record with weight records up to 2 years after ESG. Percent total body weight loss (%TBWL) at 6, 12, 18, and 24 months was calculated based on baseline weight at the procedure. SPSS (version 29.0) was used for all statistical analyses. RESULTS A total of 1,506 patients from 7 sites were included (501 Class I obesity, 546 Class II, and 459 Class III). Baseline demographics differed according to obesity class due to differences in age, body mass index (BMI), height, sex distribution, and race. As early as 6 months post-ESG, mean BMI for each class dropped to the next lower class and remained there through 2 years. %TWBL achieved in the Class III group was significantly greater when compared with other classes at all time points. At 12 months, 83.2% and 60.9% of patients had ≥10% and ≥15% TBWL for all classes. There were no differences in adverse events between classes. DISCUSSION Real-world data from a large cohort of patients of all BMI classes across the United States shows significant and sustained weight loss with ESG. ESG is safe to perform in a higher obesity class with acceptable midterm efficacy.
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Affiliation(s)
- Khushboo Gala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitor Brunaldi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Michael Ujiki
- NorthShore University Health System, Evanston, Illinois, USA
| | - Eric Wilson
- University of Texas Health Science Center-Houston, Houston, Texas, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Ostrominski JW, Powell-Wiley TM. Risk Stratification and Treatment of Obesity for Primary and Secondary Prevention of Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:11-23. [PMID: 38159162 DOI: 10.1007/s11883-023-01182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW In this review, we discuss contemporary and emerging approaches for risk stratification and management of excess adiposity for the primary and secondary prevention of cardiovascular disease. RECENT FINDINGS Obesity is simultaneously a pandemic-scale disease and major risk factor for the incidence and progression of a wide range of cardiometabolic conditions, but risk stratification and treatment remain clinically challenging. However, sex-, race-, and ethnicity-sensitive anthropometric measures, body composition-focused imaging, and health burden-centric staging systems have emerged as important facilitators of holistic risk prediction. Further, expanding therapeutic approaches, including comprehensive lifestyle programs, anti-obesity pharmacotherapies, device/endoscopy-based interventions, metabolic surgery, and novel healthcare delivery resources offer new empowerment for cardiovascular risk reduction in individuals with obesity. Personalized risk stratification and weight management are central to reducing the lifetime prevalence and impact of cardiovascular disease. Further evidence informing long-term safety, efficacy, and cost-effectiveness of novel approaches targeting obesity are critically needed.
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Affiliation(s)
- John W Ostrominski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10, Room 5-5332, 10 Center Dr., Bethesda, MD, 20892, USA.
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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23
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Hajifathalian K, Simmons O, Abu-Hammour M, Hassan K, Sharaiha RZ. Efficacy of endoscopic resuturing versus pharmacotherapy to treat weight recidivism after endoscopic sleeve gastroplasty. Gastrointest Endosc 2023; 98:944-949. [PMID: 37473967 DOI: 10.1016/j.gie.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND AIMS A subset of patients experience weight recidivism after primary endoscopic sleeve gastroplasty (P-ESG). Available options for management of weight regain include initiation of antiobesity medications (AOMs) or redo ESG (R-ESG). The comparative effectiveness of these options is not clear. METHODS This was a retrospective analysis of a prospectively maintained database of patients undergoing ESG. From 2013 to 2021, 79 patients who were started on AOM or underwent R-ESG for management of weight recidivism after P-ESG were included. The primary outcome of this study was final total body weight loss (TBWL) at the end of follow-up. RESULTS Fifty-five patients were started on AOM and 24 patients underwent R-ESG. Age, gender distribution, and baseline body mass index did not differ significantly between groups. The proportion of noncompliant patients (defined as patients who missed their first post-ESG follow-up visit) was significantly higher in the AOM group compared with the R-ESG group (67% vs 35%, P = .012). The additional TBWL after R-ESG was significantly (both clinically and statistically) better than after initiation of AOM (9.5% ± 7.2% vs 2.1% ± 8.6%, respectively; P = .001). Final TBWL clearly favored R-ESG over AOM for treatment of weight recidivism (19.9% ± 10.4% vs 13.6% ± 9.2%, P = .028). CONCLUSIONS R-ESG is an effective treatment to induce weight loss after experiencing weight recidivism. These results highlight an important advantage of ESG as a repeatable minimally invasive procedure.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA
| | - Okeefe Simmons
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Mohamed Abu-Hammour
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Kamal Hassan
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
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24
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Saumoy M, Gandhi D, Buller S, Patel S, Schneider Y, Cote G, Kochman ML, Thiruvengadam NR, Sharaiha RZ. Cost-effectiveness of endoscopic, surgical and pharmacological obesity therapies: a microsimulation and threshold analyses. Gut 2023; 72:2250-2259. [PMID: 37524445 DOI: 10.1136/gutjnl-2023-330437] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Weight loss interventions to treat obesity include sleeve gastrectomy (SG), lifestyle intervention (LI), endoscopic sleeve gastroplasty (ESG) and semaglutide. We aimed to identify which treatments are cost-effective and identify requirements for semaglutide to be cost-effective. DESIGN We developed a semi-Markov microsimulation model to compare the effectiveness of SG, ESG, semaglutide and LI for weight loss in 40 years old with class I/II/III obesity. Extensive one-way sensitivity and threshold analysis were performed to vary cost of treatment strategies and semaglutide adherence rate. Outcome measures were incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay threshold of US$100 000/quality-adjusted life-year (QALY). RESULTS When strategies were compared with each other, ESG was cost-effective in class I obesity (US$4105/QALY). SG was cost-effective in class II obesity (US$5883/QALY) and class III obesity (US$7821/QALY). In class I/II/III, obesity, SG and ESG were cost-effective compared with LI. However, semaglutide was not cost-effective compared with LI for class I/II/III obesity (ICER US$508 414/QALY, US$420 483/QALY and US$350 637/QALY). For semaglutide to be cost-effective compared with LI, it would have to cost less than US$7462 (class III), US$5847 (class II) or US$5149 (class I) annually. For semaglutide to be cost-effective when compared with ESG, it would have to cost less than US$1879 (class III), US$1204 (class II) or US$297 (class I) annually. CONCLUSIONS Cost-effective strategies were: ESG for class I obesity and SG for class II/III obesity. Semaglutide may be cost-effective with substantial cost reduction. Given potentially higher utilisation rates with pharmacotherapy, semaglutide may provide the largest reduction in obesity-related mortality.
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Affiliation(s)
- Monica Saumoy
- Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey, USA
| | - Devika Gandhi
- Department of Gastroenterology and Hepatology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Seth Buller
- Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Shae Patel
- Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Yecheskel Schneider
- Department of Gastroenterology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Gregory Cote
- Department of Gastroenterology, Oregon Health Sciences University, Portland, Oregon, USA
| | - Michael L Kochman
- Department of Gastroenterology, Perelman School of Medicine the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhil R Thiruvengadam
- Department of Gastroenterology and Hepatology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Reem Z Sharaiha
- Department of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, New York, USA
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25
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Bahdi F, Labora A, Shah S, Farooq M, Wangrattanapranee P, Donahue T, Issa D. From Scalpel to Scope: How Surgical Techniques Made Way for State-of-The-Art Endoscopic Procedures. GASTRO HEP ADVANCES 2023; 3:370-384. [PMID: 39131137 PMCID: PMC11307641 DOI: 10.1016/j.gastha.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/30/2023] [Indexed: 08/13/2024]
Abstract
The continuous evolution of endoscopic tools over the years has paved the way for minimally invasive alternatives to surgical procedures for multiple gastrointestinal conditions. While few endoscopic techniques have supplanted their surgical counterparts like percutaneous gastrostomy tubes, many have emerged as noninferior, less morbid alternatives for such diverse conditions as achalasia (peroral endoscopic myotomy), obesity (endoscopic sleeve gastroplasty), drainage of pancreatic walled off necrosis (EUS-guided cystogastrostomy), and gastric outlet obstruction (EUS-guided gastrojejunostomy). These techniques were based on surgical concepts and would not have been feasible without collaboration between surgeons and endoscopists. Such collaboration is exemplified by the antireflux fundoplication, which features combined hiatal hernia repair with transoral and incisionless fundoplication. The burgeoning armamentarium of endoscopic alternatives to traditional surgical procedures requires a multidisciplinary discussion and individually tailored treatment plans that consider patient preferences as well as the relative risks and benefits of surgical and endoscopic approaches. As technological advances give rise to ever more innovative endoscopic techniques, studies to evaluate clinical outcomes and define their role in treatment algorithms will be required.
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Affiliation(s)
- Firas Bahdi
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Amanda Labora
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sagar Shah
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Maryam Farooq
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Peerapol Wangrattanapranee
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Timothy Donahue
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Danny Issa
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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26
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Fehervari M, Fadel MG, Alghazawi LOK, Das B, Rodríguez-Luna MR, Perretta S, Wan A, Ashrafian H. Medium-Term Weight Loss and Remission of Comorbidities Following Endoscopic Sleeve Gastroplasty: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3527-3538. [PMID: 37700147 PMCID: PMC10602997 DOI: 10.1007/s11695-023-06778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1-19.4%) in 23 studies (n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7-17.2%) in 10 studies (n = 4040). Diabetes resolution was 55.4% (95% CI 46-64%), hypertension resolution was 62.8% (95% CI 43-82%), dyslipidaemia resolution was 56.3% (95% CI 49-63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2-87.3%) in four studies (n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.
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Affiliation(s)
- Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Department of Upper Gastrointestinal and Bariatric Surgery, St. George's University Hospitals NHS Foundation Trust, London, UK.
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
| | - Michael G Fadel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Silvana Perretta
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
- Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
| | - Andrew Wan
- Department of Upper Gastrointestinal and Bariatric Surgery, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
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27
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Sharaiha RZ, Shikora S, White KP, Macedo G, Toouli J, Kow L. Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO). J Clin Gastroenterol 2023; 57:967-976. [PMID: 37831466 PMCID: PMC10566600 DOI: 10.1097/mcg.0000000000001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Reem Z. Sharaiha
- Department of Gastroenterology, Weill Cornell Medical College, New York, NY
| | - Scott Shikora
- Center for Metabolic and Bariatric Surgery, Brigham and Women’s Hospital Harvard Medical School, Boston, MA
| | - Kevin P. White
- ScienceRight International Health Research Consulting (SRIHRC), London, ON, Canada
| | - Guilherme Macedo
- Department of Gastroenterology & Hepatology, São João University Hospital Center, Porto, Portugal
| | - Jim Toouli
- Department of Surgery, Flinders University, Adelaide, SA, Australia
| | - Lillian Kow
- Department of Surgery, Flinders University, Adelaide, SA, Australia
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28
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Kelly J, Menon V, O'Neill F, Elliot L, Combe E, Drinkwater W, Abbott S, Hayee B. UK cost-effectiveness analysis of endoscopic sleeve gastroplasty versus lifestyle modification alone for adults with class II obesity. Int J Obes (Lond) 2023; 47:1161-1170. [PMID: 37674032 PMCID: PMC10599990 DOI: 10.1038/s41366-023-01374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that has been demonstrated in the MERIT randomised, controlled trial to result in substantial and durable additional weight loss in adults with obesity compared with lifestyle modification (LM) alone. We sought to conduct the first cost-effectiveness analysis of ESG versus LM alone in adults with class II obesity (BMI 35.0-39.9 kg/m2) from a national healthcare system perspective in England based on results from this study. METHODS A 6-state Markov model was developed comprising 5 BMI-based health states and an absorbing death state. Baseline characteristics, utilities, and transition probabilities were informed by patient-level data from the subset of patients with class II obesity in MERIT. Adverse events (AEs) were based on the MERIT safety population. Mortality was estimated by applying BMI-specific hazard ratios from the published literature to UK general population mortality rates. Utilities for the healthy weight and overweight health states were informed from the literature; disutility associated with increasing BMI in the class I-III obesity health states was estimated using MERIT utility data. Disutility due to AEs and the prevalence of obesity-related comorbidities were based on the literature. Costs included intervention costs, AE costs, and comorbidity costs. RESULTS ESG resulted in higher overall costs than LM alone but led to an increase in quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for ESG vs LM alone was £2453/QALY gained. ESG was consistently cost effective across a wide range of sensitivity analyses, with no ICER estimate exceeding £10,000/QALY gained. In probabilistic sensitivity analysis, the mean ICER was £2502/QALY gained and ESG remained cost effective in 98.25% of iterations at a willingness-to-pay threshold of £20,000/QALY. CONCLUSION Our study indicates that ESG is highly cost effective versus LM alone for the treatment of adults with class II obesity in England.
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Affiliation(s)
- Jamie Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Vinod Menon
- University Hospitals Coventry & Warwickshire NHS Foundation Trust, Coventry, UK
- University of Warwick, Coventry, UK
| | | | | | | | | | - Sally Abbott
- University Hospitals Coventry & Warwickshire NHS Foundation Trust, Coventry, UK
- Research Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
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29
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Hanscom M, Ghoneim S. Clinical Applications of Endoscopic Bariatric Therapies: Potential and Pitfalls. Gastroenterology 2023; 165:807-812. [PMID: 37549752 DOI: 10.1053/j.gastro.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Mark Hanscom
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Sara Ghoneim
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska
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30
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Norton BC, Telese A, Papaefthymiou A, Aslam N, Makaronidis J, Murray C, Haidry R. Metabolic and Bariatric Endoscopy: A Mini-Review. Life (Basel) 2023; 13:1905. [PMID: 37763308 PMCID: PMC10532500 DOI: 10.3390/life13091905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
We are currently in a worldwide obesity pandemic, which is one of the most significant health problems of the 21st century. As the prevalence of obesity continues to rise, new and innovate treatments are becoming available. Metabolic and bariatric endoscopic procedures are exciting new areas of gastroenterology that have been developed as a direct response to the obesity crisis. These novel interventions offer a potentially reversible, less invasive, safer, and more cost-effective method of tackling obesity compared to traditional bariatric surgery. Minimally invasive endoscopic treatments are not entirely novel, but as technology has rapidly improved, many of the procedures have been proven to be extremely effective for weight loss and metabolic health, based on high-quality clinical trial data. This mini-review examines the existing evidence for the most prominent metabolic and bariatric procedures, followed by a discussion on the future trajectory of this emerging subspecialty.
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Affiliation(s)
- Benjamin Charles Norton
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
- Department of Gastroenterology, University College London Hospital Euston Road, London NW1 2BU, UK
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London WC1E 6BT, UK
| | - Andrea Telese
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London WC1E 6BT, UK
| | - Apostolis Papaefthymiou
- Department of Gastroenterology, University College London Hospital Euston Road, London NW1 2BU, UK
| | - Nasar Aslam
- Department of Gastroenterology, University College London Hospital Euston Road, London NW1 2BU, UK
| | - Janine Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London WC1E 6BT, UK
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London WC1E 6BT, UK
- Department of Endocrinology and Diabetes, University College London Hospital, London WC1E 6BT, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London W1T 7DN, UK
| | - Charles Murray
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
| | - Rehan Haidry
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
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31
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Sharaiha RZ. Top tips for performing endoscopic sleeve gastroplasty (with video). Gastrointest Endosc 2023; 98:428-431. [PMID: 36720291 DOI: 10.1016/j.gie.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Reem Z Sharaiha
- Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
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Chen YK, Liu TT, Teia FKF, Xie MZ. Exploring the underlying mechanisms of obesity and diabetes and the potential of Traditional Chinese Medicine: an overview of the literature. Front Endocrinol (Lausanne) 2023; 14:1218880. [PMID: 37600709 PMCID: PMC10433171 DOI: 10.3389/fendo.2023.1218880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Obesity and diabetes are closely related metabolic disorders that have become major public health concerns worldwide. Over the past few decades, numerous studies have explored the underlying mechanisms of these disorders and identified various risk factors, including genetics, lifestyle, and dietary habits. Traditional Chinese Medicine (TCM) has been increasingly recognized for its potential to manage obesity and diabetes. Weight loss is difficult to sustain, and several diabetic therapies, such as sulfonylureas, thiazolidinediones, and insulin, might make it harder to lose weight. While lifestyle changes should be the primary approach for people interested in lowering weight, drugs are also worth investigating. Since some of the newer glucose-lowering medications that cause weight loss, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), are additionally utilized or are under consideration for use as anti-obesity drugs, the frontier between glucose-lowering medication and weight loss drugs appears to be shifting. This review provides an overview of the literature on the underlying mechanisms of obesity and diabetes and the prospect of TCM in their management. We discuss the various TCM interventions, including acupuncture, herbal medicine, and dietary therapy, and their effects on metabolic health. We also highlight the potential of TCM in regulating gut microbiota, reducing inflammation, and improving insulin sensitivity. The findings suggest that TCM may provide a promising approach to preventing and managing obesity and diabetes. However, further well-designed studies are needed to confirm the efficacy and safety of TCM interventions and to elucidate their underlying mechanisms of action.
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Affiliation(s)
- Yan-kun Chen
- School of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Engineering Technology Research Center for Medicinal and Functional Food, Hunan University of Chinese Medicine, Changsha, China
- Key Laboratory of TCM Heart and Lung Syndrome Differentiation and Medicated Diet and Dietotherapy, Hunan University of Chinese Medicine, Changsha, China
| | - Ting-ting Liu
- School of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Engineering Technology Research Center for Medicinal and Functional Food, Hunan University of Chinese Medicine, Changsha, China
- Key Laboratory of TCM Heart and Lung Syndrome Differentiation and Medicated Diet and Dietotherapy, Hunan University of Chinese Medicine, Changsha, China
| | - Farah Khameis Farag Teia
- Department of Agro-technology, Medicinal and Aromatic Plants and Traditional Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Meng-zhou Xie
- School of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- Hunan Engineering Technology Research Center for Medicinal and Functional Food, Hunan University of Chinese Medicine, Changsha, China
- Key Laboratory of TCM Heart and Lung Syndrome Differentiation and Medicated Diet and Dietotherapy, Hunan University of Chinese Medicine, Changsha, China
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Shenoy A, Schulman AR. Advances in endobariatrics: past, present, and future. Gastroenterol Rep (Oxf) 2023; 11:goad043. [PMID: 37483864 PMCID: PMC10361810 DOI: 10.1093/gastro/goad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023] Open
Abstract
The obesity epidemic in the USA and worldwide is well documented and continues to grow. Endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention. This article will review advances in endobariatrics over the last several decades, addressing the past and current state of bariatric and metabolic endoscopy. Food and Drug Administration-cleared devices and interventions currently under investigation are described including gastric devices, gastric remodeling procedures, small-bowel devices, duodenal ablation, as well as procedures to address weight regain after bariatric surgery. Future studies evaluating gastric and duodenal combination therapy, adjunctive pharmacotherapy, as well as individualized precision-health algorithms are underway.
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Affiliation(s)
- Abhishek Shenoy
- Corresponding author. Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48105, USA. Tel: +1-908-3381691; Fax: +1-734-9365458;
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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Bakheet N, Badurdeen D, Sartoretto A, Kumbhari V. Endoluminal bariatric and metabolic therapies: state-of-the-art. Curr Opin Gastroenterol 2023:00001574-990000000-00087. [PMID: 37522920 DOI: 10.1097/mog.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoluminal bariatric and metabolic procedures. RECENT FINDINGS The landscape of endoluminal devices and techniques for treating obesity has expanded significantly, with FDA-approved therapies currently available to patients with a body mass index values as high as 50 kg/m2. Although notable advancements have been made in this area, there is a need for further emphasis to be placed on the metabolic improvements resulting from these therapies, in addition to the conventional focus on weight loss outcomes. Some of these procedures are now FDA approved for the treatment of metabolic disease as opposed to weight loss. To achieve the most favorable results, it is imperative that all endoluminal interventions are combined with a moderately intensive diet and lifestyle program lasting at least 12 months. SUMMARY Endoluminal metabolic and bariatric therapy represents a bridge between lifestyle counseling, pharmaceutical interventions, and the most efficacious treatment for obesity, bariatric surgery. By virtue of its minimally invasive approach, this therapy may be an appealing option for patients who are ineligible for, or averse to, bariatric surgery and who have experienced suboptimal outcomes or unable to afford medical treatments. Furthermore, these interventions may be particularly beneficial in the early stages of obesity.
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Affiliation(s)
- Nader Bakheet
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Maselli DB, Hoff AC, Kucera A, Weaver E, Sebring L, Gooch L, Walton K, Lee D, Cratty T, Beal S, Nanduri S, Rease K, Gainey CS, Eaton L, Coan B, McGowan CE. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc 2023; 15:469-479. [PMID: 37397974 PMCID: PMC10308273 DOI: 10.4253/wjge.v15.i6.469] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
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/m2 who 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 comorbidities and an acceptable safety profile.
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Affiliation(s)
- Daniel Barry Maselli
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Anna Carolina Hoff
- Bariatric Endoscopy, Angioskope Clinic, São José dos Campos 12243-680, São Paulo, Brazil
| | - Ashley Kucera
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Emily Weaver
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Laura Sebring
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Lori Gooch
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kathleen Walton
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Taylor Cratty
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Selena Beal
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Srikar Nanduri
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kendall Rease
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Christina S Gainey
- Gastroenterology and Hepatology, University of North Carolina System, Chapel Hill, NC 27599, United States
| | - Laura Eaton
- UltaMed Corporation, UltaMed Corporation, Fort Lauderdale, FL 33308, United States
| | - Brian Coan
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
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Dave N, Dawod E, Simmons OL. Endobariatrics: a Still Underutilized Weight Loss Tool. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2023; 21:172-184. [PMID: 37284352 PMCID: PMC10163575 DOI: 10.1007/s11938-023-00420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 06/08/2023]
Abstract
Purpose of review Bariatric and metabolic endoscopic therapies provide an option for patients seeking clinically significant weight loss with fewer adverse events than conventional bariatric surgery. Our aims are to provide an overview of the current state of primary endoscopic treatment options for weight loss and to emphasize the importance of including these therapies when presenting weight loss options to qualified patients. Recent findings Bariatric endoscopy procedures are associated with a lower adverse event rate when compared to bariatric surgery and result in more weight loss than most existing pharmacotherapies approved by the Food and Drug Administration. Summary Sufficient evidence exists to implement bariatric endoscopic therapies-namely, the intragastric balloon and endoscopic sleeve gastroplasty-as safe and effective treatment options for weight loss when used in combination with lifestyle changes. However, bariatric endoscopy remains an underutilized option by weight management providers. Future studies are needed to identify patient and provider-level barriers to adopting endoscopic bariatric therapies as an option for the treatment of obesity.
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Affiliation(s)
- Niel Dave
- Division of Gastroenterology at HCA Florida Aventura Hospital, 20900 Biscayne Blvd, Aventura, FL 33180 USA
| | - Enad Dawod
- Division of Gastroenterology, Weill Cornell Medicine, New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY 10021 USA
| | - Okeefe L. Simmons
- Simmons MD Advanced Weight Loss Solutions, 2820 NE 214th Street, Suite 1002, Miami, FL 33180 USA
- Division of Gastroenterology, Miami Veterans Affairs Healthcare System, 1201 NW 16th Street, Miami, FL 33125 USA
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Nduma BN, Mofor KA, Tatang JT, Ekhator C, Ambe S, Fonkem E. Endoscopic Gastric Sleeve: A Review of Literature. Cureus 2023; 15:e36353. [PMID: 37082499 PMCID: PMC10112045 DOI: 10.7759/cureus.36353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
For morbid obesity, one of the treatment options that have been deemed the most effective is bariatric surgery. Specifically, endoscopic sleeve gastrectomy (ESG) has emerged as one of the minimally invasive procedures for weight loss to be developed recently. In this procedure, there is the endoscopic placement of sutures in a quest to ensure reductions in the stomach volume. In this review, the main aim was to review the literature concerning ESG's efficacy and safety. Secondary sources of data were used and electronic databases were searched to identify articles focused on assessing the safety or efficacy of ESG. They included several databases such as Clinicaltrials.gov, Embase (Excerpta Medica Database), and MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online) to select relevant articles. Both the titles and abstracts of the articles were used to determine their inclusion or exclusion from the current review. Additionally, some keywords were used to search and obtain relevant articles such as: ESG, obesity, bariatric surgery, and total body weight loss. This review relied on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for the identification of articles, screening, determination of eligibility, and inclusion and exclusion as deemed appropriate. From the findings, the review established that ESG is effective when used as an alternative intervention for obesity. The beneficial effects are felt particularly in terms of the procedure's capacity to ensure that the total body weight loss mean percentage is significant. Apart from the benefit of ensuring weight loss, ESG was also found to impair gastric emptying, pose metabolic effects that are key to controlling obesity-associated metabolic dysregulation, and the ability to increase satiety. However, the procedure was documented to yield a few adverse events in some studies. Some of the notable adverse events include pulmonary embolism, potential pneumoperitoneum, and possible post-procedure leak in the posterior aspect of the gastric fundus as sutures exert tension and also cause thin walls. Emerging as a minimally-invasive procedure, ESG is a cost-effective alternative through which weight loss can be achieved significantly in obese populations. It leads to a slowdown of gastric emptying, causes an increase in satiety, and leads to an improvement in the metabolic profile. Therefore, for obese individuals not undergoing bariatric surgery, ESG can be an ideal treatment option, including individuals in need of a bridge to surgery and also those diagnosed with moderate obesity. Overall, when it comes to the management of obesity, this review established that ESG provides a paradigm shift targeting existing therapeutic gaps.
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Abstract
The rising prevalence of obesity in Singapore is a harbinger for a corresponding increase in obesity-related complications such as type 2 diabetes mellitus (T2DM) and coronary heart disease. Obesity is a complex disease driven by multiple factors, and hence, treatment cannot follow a 'one-size-fits-all' approach. Lifestyle modifications involving dietary interventions, physical activity and behavioural changes remain the cornerstone of obesity management. However, similar to other chronic diseases such as T2DM and hypertension, lifestyle modifications are often insufficient on their own, hence the importance of other treatment modalities including pharmacotherapy, endoscopic bariatric therapy and metabolic-bariatric surgery. Weight loss medications currently approved in Singapore include phentermine, orlistat, liraglutide and naltrexone-bupropion. In recent years, endoscopic bariatric therapies have evolved as an effective, minimally invasive and durable therapeutic option for obesity. Metabolic-bariatric surgery remains the most effective and durable treatment for patients with severe obesity, with an average weight loss of 25%-30% after one year.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Boškoski I, Pontecorvi V, Ibrahim M, Huberty V, Maselli R, Gölder SK, Kral J, Samanta J, Patai ÁV, Haidry R, Hollenbach M, Pérez-Cuadrado-Robles E, Silva M, Messmann H, Tham TC, Bisschops R. Curriculum for bariatric endoscopy and endoscopic treatment of the complications of bariatric surgery: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55:276-293. [PMID: 36696907 DOI: 10.1055/a-2003-5818] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Obesity is a chronic, relapsing, degenerative, multifactorial disease that is associated with many co-morbidities. The global increasing burden of obesity has led to calls for an urgent need for additional treatment options. Given the rapid expansion of bariatric endoscopy and bariatric surgery across Europe, the European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. This curriculum is set out in terms of the prerequisites prior to training, minimum number of procedures, the steps for training and quality of training, and how competence should be defined and evidenced before independent practice. 1: ESGE recommends that every endoscopist should have achieved competence in upper gastrointestinal endoscopy before commencing training in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. 2: Trainees in bariatric endoscopy and the endoscopic treatment of the complications of bariatric surgery should have basic knowledge of the definition, classification, and social impact of obesity, its pathophysiology, and its related co-morbidities. The recognition and management of gastrointestinal diseases that are more common in patients with obesity, along with participation in multidisciplinary teams where obese patients are evaluated, are mandatory. 3 : ESGE recommends that competency in bariatric endoscopy and the endoscopic treatment of the complications of bariatric surgery can be learned by attending validated training courses on simulators initially, structured training courses, and then hands-on training in tertiary referral centers.
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Affiliation(s)
- Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Roberta Maselli
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefan K Gölder
- Department of Internal Medicine, Ostalb Klinikum Aalen, Aalen, Germany
| | - Jan Kral
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Árpád V Patai
- Division of Gastroenterology, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Marcus Hollenbach
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, TARGID, KU Leuven, Leuven, Belgium
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Bhandari M, Kosta S, Reddy M, Mathur W, Neto MG, Bhandari M. Four-year outcomes for endoscopic sleeve gastroplasty from a single centre in India. J Minim Access Surg 2023; 19:101-106. [PMID: 36124467 PMCID: PMC10034804 DOI: 10.4103/jmas.jmas_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Bariatric endoscopy has emerged for non-surgical treatment of obesity, providing a treatment option for weight loss and associated comorbidities. Outcomes of endoscopic sleeve gastroplasty (ESG) of 12 months have been published by our team and there is a need for longer follow-up period understanding the effects of ESG techniques. Aim This report emphasises on weight loss pattern in follow-up time points and monitors the post-procedure improvement in comorbidities with minimum 4-year follow-up of patients undergoing ESG at a single academic centre in India. Subjects and Methods This was a prospective cohort study. All procedures were performed by the same surgeon. Patients with a body mass index of >30 kg/m2 (or >27 with comorbidities) underwent ESG for treatment of obesity. Patients were systematically followed yearly after their procedure. Data collected on the primary outcome and secondary outcomes were analysed and presented. Results 612 patients (69.3% female) with a mean age of 40.70 ± 12.66 years and mean body mass index of 34.30 ± 5.05 kg/m2 underwent ESG. Out of 612 patients, follow-up rates for a 1-2-3 and 4 years were 93.1%, 90.2%, 81.7% and 81.9%, respectively. The mean percentage total body weight loss was 18.19% (95% confidence interval [CI]: 17.72-18.57) and %EWL was 49.30% (95% CI: 48.91-49.68) with 90% of participants-maintaining a percentage of total weight loss of ≥5% and 70% of patients maintaining an EWL of ≥25% at 4 years, respectively. Resolution/improvement of comorbidities was 51.2% cases of T2DM, 65.8% cases of hypertension, 73.6% cases of dyslipidaemia and 89.9% remission were in obstructive sleep apnoea. No patient required an emergency intervention, and there was no mortality or significant morbidity. Conclusions This study shows acceptable results with ESG at 4 years in our unit. Regular monitoring by a multidisciplinary nurtures weight loss, resolution or improvement of comorbidities and improvement of quality of life with low perioperative complications. There is a need for more reports with this approach to determine the amount and duration of weight loss outcome and medical intervention.
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Affiliation(s)
- Mahak Bhandari
- Department of Surgery, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Susmit Kosta
- Department of Central Research Lab, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Manoj Reddy
- Department of Surgery, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Department of Surgery, Mohak Bariatrics and Robotics, Indore, Madhya Pradesh, India
| | - Manoel Galvao Neto
- Department of Surgery, Mohak Bariatrics and Robotics, Indore, Madhya Pradesh, India
| | - Mohit Bhandari
- Department of Surgery, Mohak Bariatrics and Robotics, Indore, Madhya Pradesh, India
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Endobariatrics: well past infancy and maturing rapidly. Curr Opin Gastroenterol 2022; 38:592-599. [PMID: 36219127 DOI: 10.1097/mog.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the key developments with regard to FDA-approved endoscopic bariatric metabolic therapies (EBMTs) in the last 2 years. RECENT FINDINGS The prevalence of obesity has increased during the coronavirus disease 2019 (COVID-19) pandemic, and obesity worsens COVID-19 related outcomes. Several studies have confirmed the safety and short-term efficacy of intragastric balloons (IGBs). In the short-term IGBs may improve steatosis and fibrosis in nonalcoholic fatty liver disease and improve quality of life and mental health. Unfortunately weight loss from these temporarily placed devices is not sustained long-term. Endoscopic sleeve gastroplasty (ESG) may be more effective and durable than IGBs, and result in fewer adverse events compared to bariatric surgery. The recently completed MERIT trial may catapult ESG as a first-line EBMT. Aspiration therapy meets safety and effectiveness thresholds for incorporation into routine practice, but overall acceptance has been lower than other FDA-approved EBMTs. SUMMARY The field of endobariatrics is rapidly maturing. Significant knowledge gaps remain with regards to combining EBMTs with pharmacologic therapy to improve durability of weight loss. The rapid expansion in the literature supporting safety and long-term efficacy ESG may prompt revision of existing guidelines.
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Thompson CC, Jirapinyo P, Shah R, Simsek C. Gastroplasty With Endoscopic Myotomy (GEM) for the Treatment of Obesity: Preliminary Efficacy and Physiologic Results. Gastroenterology 2022; 163:1173-1175. [PMID: 35961376 DOI: 10.1053/j.gastro.2022.07.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts
| | - Raj Shah
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts
| | - Cem Simsek
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts
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Wei Y, Li P, Zhang S. From surgery to endoscopy: the evolution of the bariatric discipline. Chin Med J (Engl) 2022; 135:2427-2435. [PMID: 36583861 PMCID: PMC9945508 DOI: 10.1097/cm9.0000000000002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 12/31/2022] Open
Abstract
ABSTRACT Obesity, with its increasing morbidity and prevalence, is now a worldwide public health problem. Obesity and its related comorbidities impose a heavy burden on societal health and the economy. The practice of bariatric surgery has evolved from its early surgical procedures, many of which are no longer routine operations. With clinical practice, research, and experience, bariatric surgery has gradually become an important last resort for the control of weight and obesity-related metabolic diseases in moderately and severely obese patients. However, there is still room for further improvements in bariatric surgical procedures, especially with regard to long-term issues and complications. Endoscopic weight loss technology has developed rapidly in recent years. The advantages of this technology include minimal invasiveness, an obvious weight loss effect, and few complications, thus filling the gap between medications and lifestyle adjustments and surgical treatment of obesity. Endoscopic weight loss technology may even replace surgical bariatric procedures. This review summarized the current status of bariatric metabolic surgery and newly developed bariatric endoscopic procedures.
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Affiliation(s)
- Yongqiu Wei
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050 China
| | - Peng Li
- Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050 China
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Jirapinyo P, Thompson CC. Comparison of distal primary obesity surgery endolumenal techniques for the treatment of obesity (with videos). Gastrointest Endosc 2022; 96:479-486. [PMID: 35568242 DOI: 10.1016/j.gie.2022.04.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/30/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Distal primary obesity surgery endolumenal (POSE) procedures involve plication of the gastric body, sparing the fundus. We aim to assess the efficacy of distal POSE procedures and to compare plication techniques (single-helix vs double-helix approaches). METHODS This is a prospective registry study of patients who underwent distal POSE procedures using 2 techniques: the single-helix plication technique, in which a single plication with serosa-to-serosa approximation is obtained with each device activation, and the double-helix plication technique, where 2 serosa-to-serosa plications with an internal mucosa-to-mucosa approximation are obtained with each device activation. RESULTS One hundred ten patients (90 women; mean age, 43 ± 13 years) underwent distal POSE procedures. Baseline body mass index was 38.2 ± 6.1 kg/m2. Technical success was 100%. An average of 21 ± 5 plications were placed per case. The gastric body was shortened by 74%. At 12 months, patients experienced 15.8% ± 8.9% total weight loss (TWL) (P < .0001), with 93% and 61% achieving at least 5% and 10% TWL, respectively. Blood pressure, insulin resistance, and liver enzymes improved. The serious adverse event rate was .9%, including a case of gastric perforation. Of 110 patients, 42 and 68 underwent distal POSE procedures using a single- or double-helix technique, respectively. The double-helix technique resulted in greater reduction in gastric volume (length reduction by 78% vs 65%, P < .0001), weight loss (20.3% ± 8.3% vs 13.4% ± 8.3% TWL, P = .005), and proportion of patients achieving 10% TWL (94.7% vs 58.3%, P = .03) than the single-helix technique. CONCLUSIONS Distal POSE techniques appear to be effective at treating obesity and its related comorbidities. The double-helix technique is associated with greater gastric volume reduction, weight loss, and response rate.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Ghazi R, Vargas EJ, Abboud D, Abdul Razak F, Mahmoud T, Storm AC, Chandrasekhara V, Abu Dayyeh BK. Future of Metabolic Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1754335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractObesity has been escalating as one of the worst public health epidemics. Conservative therapies including lifestyle modifications and weight loss medications have limited efficacy and long-term sustainability. Bariatric surgeries, although effective, remain underutilized due to their cost, safety concerns, and patient acceptance. In the past two decades, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as safe, effective, and less invasive options for the treatment of obesity and its comorbidities, with recent studies reporting favorable outcomes in terms of weight loss and metabolic parameters. This article reviews the major and newly developed EBMTs, with emphasis on their metabolic effects and potential use in the management of metabolic conditions.
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Affiliation(s)
- Rabih Ghazi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Eric J. Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Donna Abboud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Farah Abdul Razak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Andrew C. Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minnesota, United States
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Kuo CY, Wu JW, Yeh JH, Wang WL, Tu CH, Chiu HM, Liao WC. Implementing precision medicine in endoscopy practice. J Gastroenterol Hepatol 2022; 37:1455-1468. [PMID: 35778863 DOI: 10.1111/jgh.15933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
In contrast to the "one-size-fits-all" approach, precision medicine focuses on providing health care tailored to individual variabilities. Implementing precision medicine in endoscopy practice involves selecting the appropriate procedures among the endoscopic armamentarium in the diagnosis and management of patients in a logical sequence, jointly considering the pretest probabilities of possible diagnoses, patients' comorbidities and preference, and risk-benefit ratio of the individual procedures given the clinical scenario. The aim of this review is to summarize evidence-supported strategies and measures that may enhance precision medicine in general endoscopy practice.
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Affiliation(s)
- Chen-Ya Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Jer-Wei Wu
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Jen-Hao Yeh
- Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Chih Liao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Dials J, Demirel D, Halic T, De S, Ryason A, Kundumadam S, Al-Haddad M, Gromski MA. Hierarchical task analysis of endoscopic sleeve gastroplasty. Surg Endosc 2022; 36:5167-5182. [PMID: 34845547 PMCID: PMC9148380 DOI: 10.1007/s00464-021-08893-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic weight loss procedure used to treat obesity. The long-term goal of this project is to develop a Virtual Bariatric Endoscopy (ViBE) simulator for training and assessment of the ESG procedure. The objectives of this current work are to: (a) perform a task analysis of ESG and (b) create metrics to be validated in the created simulator. METHODS We performed a hierarchical task analysis (HTA) by identifying the significant tasks of the ESG procedure. We created the HTA to show the breakdown and connection of the tasks of the procedure. Utilizing the HTA and input from ESG experts, performance metrics were derived for objective measurement of the ESG procedure. Three blinded video raters analyzed seven recorded ESG procedures according to the proposed performance metrics. RESULTS Based on the seven videos, there was a positive correlation between total task times and total performance scores (R = 0.886, P = 0.008). Endoscopists expert were found to be more skilled in reducing the area of the stomach compared to endoscopists novice (34.6% reduction versus 9.4% reduction, P = 0.01). The mean novice performance score was significantly lower than the mean expert performance score (34.7 vs. 23.8, P = 0.047). The inter-rater reliability test showed a perfect agreement among three raters for all tasks except for the suturing task. The suturing task had a significant agreement (Inter-rater Correlation = 0.84, Cronbach's alpha = 0.88). Suturing was determined to be a critical task that is positively correlated with the total score (R = 0.962, P = 0.0005). CONCLUSION The task analysis and metrics development are critical for the development of the ViBE simulator. This preliminary assessment demonstrates that the performance metrics provide an accurate assessment of the endoscopist's performance. Further validation testing and refinement of the performance metrics are anticipated.
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Affiliation(s)
- James Dials
- Department of Computer Science, Florida Polytechnic University, 4700 Research Way, Lakeland, FL, 33805, USA
| | - Doga Demirel
- Department of Computer Science, Florida Polytechnic University, 4700 Research Way, Lakeland, FL, 33805, USA.
| | - Tansel Halic
- Department of Computer Science, University of Central Arkansas, Conway, USA
| | - Suvranu De
- Department of Mechanical, Aerospace and Nuclear Engineering, Rensselear Polytechnic Institute, Troy, USA
| | - Adam Ryason
- Department of Mechanical, Aerospace and Nuclear Engineering, Rensselear Polytechnic Institute, Troy, USA
| | - Shanker Kundumadam
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Mark A Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
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Kanwal F, Shubrook JH, Cusi K. Reply. Gastroenterology 2022; 162:2132-2134. [PMID: 35183548 DOI: 10.1053/j.gastro.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, Texas
| | - Jay H Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, California
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes, and Metabolism, University of Florida, Gainesville, Florida
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Sullivan S, Jirapinyo P, Kumbhari V. Clinical Care Pathway for the Risk Stratification and Management of Patients With Non-alcoholic Fatty Liver Disease. Gastroenterology 2022; 162:2131-2132. [PMID: 35032500 DOI: 10.1053/j.gastro.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/02/2022]
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Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, Kashyap S, Mechanick JI, Mouzaki M, Nadolsky K, Rinella ME, Vos MB, Younossi Z. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract 2022; 28:528-562. [PMID: 35569886 DOI: 10.1016/j.eprac.2022.03.010] [Citation(s) in RCA: 377] [Impact Index Per Article: 188.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations regarding the diagnosis and management of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) to endocrinologists, primary care clinicians, health care professionals, and other stakeholders. METHODS The American Association of Clinical Endocrinology conducted literature searches for relevant articles published from January 1, 2010, to November 15, 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RECOMMENDATION SUMMARY This guideline includes 34 evidence-based clinical practice recommendations for the diagnosis and management of persons with NAFLD and/or NASH and contains 385 citations that inform the evidence base. CONCLUSION NAFLD is a major public health problem that will only worsen in the future, as it is closely linked to the epidemics of obesity and type 2 diabetes mellitus. Given this link, endocrinologists and primary care physicians are in an ideal position to identify persons at risk on to prevent the development of cirrhosis and comorbidities. While no U.S. Food and Drug Administration-approved medications to treat NAFLD are currently available, management can include lifestyle changes that promote an energy deficit leading to weight loss; consideration of weight loss medications, particularly glucagon-like peptide-1 receptor agonists; and bariatric surgery, for persons who have obesity, as well as some diabetes medications, such as pioglitazone and glucagon-like peptide-1 receptor agonists, for those with type 2 diabetes mellitus and NASH. Management should also promote cardiometabolic health and reduce the increased cardiovascular risk associated with this complex disease.
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Affiliation(s)
- Kenneth Cusi
- Guideine and Algorithm Task Forces Co-Chair, Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida
| | - Scott Isaacs
- Guideline and Algorithm Task Forces Co-Chair, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia
| | - Diana Barb
- University of Florida, Gainesville, Florida
| | - Rita Basu
- Division of Endocrinology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sonia Caprio
- Yale University School of Medicine, New Haven, Connecticut
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jeffrey I Mechanick
- The Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai
| | | | - Karl Nadolsky
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Mary E Rinella
- AASLD Representative, University of Pritzker School of Medicine, Chicago, Illinois
| | - Miriam B Vos
- Center for Clinical and Translational Research, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Zobair Younossi
- AASLD Representative, Inova Medicine, Inova Health System, Falls Church, Virginia
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