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Mohamed MW, Alkhater NR, Abubaker FO, Sharif OE. The Efficacy, Tolerance, and Adverse Events of Endoscopic Intragastric Balloon in Obese and Overweight Patients: A Retrospective Cross-Sectional Study. Cureus 2024; 16:e56528. [PMID: 38646333 PMCID: PMC11026998 DOI: 10.7759/cureus.56528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Obesity is a pandemic causing a significant burden on healthcare systems and carries increased morbidity and mortality. One of the options for managing obesity is endoscopic intragastric balloon (IGB) insertion. The aim of the study is to assess the efficacy, tolerance, and side effects of IGB insertion in overweight and obese patients. Methods This is a cross-sectional retrospective study that includes 71 patients who underwent IGB insertion from 2015 to 2019 at King Hamad University Hospital (KHUH), Kingdom of Bahrain. Records of these patients were accessed to assess the percentage of weight loss at the time of balloon removal, complications, and tolerance of the procedure. Furthermore, telephonic interviews were conducted to enquire about side effects and the satisfaction of the procedure. Results A total of 57 patients were included in the weight loss analysis. Thirteen patients did not tolerate the balloon, and one patient had a balloon rupture. The patients experienced a significant reduction in weight upon balloon removal with a mean of 9.74 ± 8.71 kg (p-value of <0.001) and percentage total body weight loss of 10.48 ± 8.07 (p-value of <0.001). A significant reduction was also seen in the body mass index of 3.67 ± 3.57 (p-value of <0.001). The most frequent side effects were nausea, vomiting, and abdominal pain. No major complications or mortalities occurred. Conclusion Intragastric balloons are effective in establishing weight loss. Among patients who tolerated the procedure, the most frequently reported side effects were nausea, vomiting, and abdominal pain.
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Affiliation(s)
| | - Noora R Alkhater
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Faisal O Abubaker
- Gastroenterology and Hepatology, King Hamad University Hospital, Muharraq, BHR
| | - Omar E Sharif
- Gastroenterology and Hepatology, King Hamad University Hospital, Muharraq, BHR
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Diallo A, Andreelli F, Pattou F, Guillot C, Servy H, Josse C, Robert M, Galtier F. Perceptions of bariatric surgery in patients with type 2 diabetes: data from a self-administered questionnaire. Surg Obes Relat Dis 2023; 19:1346-1354. [PMID: 37573156 DOI: 10.1016/j.soard.2023.06.012] [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: 04/02/2022] [Revised: 03/25/2023] [Accepted: 06/30/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Although bariatric surgery (BS) is recommended for patients with type 2 diabetes (T2D) and moderate to severe obesity, only approximately 2% of patients undergo surgery. OBJECTIVE To compare the knowledge and perception of BS with that of other treatments for diabetes among patients with diabetes. SETTING French social media platforms. METHODS A self-administered questionnaire was distributed from May 13 to June 3, 2020, via different French social media, including patients with T2D (main target), and patients with type 1 diabetes (control population). Different profiles of reluctance to BS were identified using a factorial analysis. RESULTS Of the 4481 responders (50.4% women, 33.9% aged over 65), 60% had T2D. Of the 1736 patients who had heard of BS (38.7%), 1493 declared they never addressed it with their physician. Among T2D patients, BS is the treatment that elicits the most negative response, with more than 10% showing reluctance. Four reluctance profiles were identified: (1) cluster 1 (43.4%), fear of consequences on their eating habits and irreversibility of the procedure; (2) cluster 2 (34.9%), fear of poorer diabetes control; (3) cluster 3 (9.3%), fear of surgical risk; and (4) cluster 4 (12.4%), fear of side effects. In all clusters, the opinion of their physician would be the most important factor to change their mind. CONCLUSION Bariatric surgery for T2D is rarely addressed in routine medical visits. Fear of operative risks and irreversibility of the procedure largely explains the reluctance to BS. Information and education campaigns on the benefit of metabolic surgery for patients with T2D remain necessary.
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Affiliation(s)
| | - Fabrizio Andreelli
- Cardiometabolism and Nutrition Institute (ICAN), Heart and Metabolism Department, Pitié-Salpêtrière Hospital (APHP), Paris, France; Inserm UMRS U1166 (Eq 6) Nutriomics, UPMC, Pierre et Marie Curie Faculty Paris 6, Sorbonne University, Paris, France
| | - François Pattou
- University of Lille, CHU Lille Endocrine and Metabolic Surgery, Inserm UMR 1190 Translational Research for Diabetes, 2, Lille, France
| | - Caroline Guillot
- Diabètes Lab, Fédération Française de Diabétologie (FFD), Paris, France
| | | | | | - Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré et Spécialisé de L'Obésité de Lyon, Université Lyon 1, CRNHRA, Hospices Civils de Lyon, Pierre Bénite, France
| | - Florence Galtier
- Inserm, Hôpital Gui de Chauliac, Montpellier, France; CHU Montpellier, Département des Maladies Endocriniennes, Hôpital Lapeyronie, Montpellier, France
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Choi CW, Cunha D, Helfrich C, Gill SV. Factors contributing to whether or not people with obesity undergo bariatric surgery. Obes Res Clin Pract 2023; 17:511-518. [PMID: 38000977 DOI: 10.1016/j.orcp.2023.11.003] [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: 07/14/2023] [Revised: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Bariatric surgery has been suggested as a safe and effective way to treat obesity by facilitating weight loss, but factors that predict the likelihood of bariatric surgery are unknown. The objective of this study was to describe factors associated with individuals with obesity that influence their decision to undergo bariatric surgery. SUBJECTS AND METHODS The study design was a cross-sectional study and participants were recruited via a survey link posted on the Obesity Action Coalition website. Demographic data, medical data, weight loss program data, and reports of personal experiences were gathered via an online survey. A multivariate logistic regression model was conducted to examine predictors associated with bariatric surgery (N = 4192). RESULTS Participants who took phentermine (OR=2.983), Phentermine-topiramate (Qsymia) (OR=2.863), Naltrexone-bupropion (Contrave) (OR=3.246), or Liraglutide (Saxenda) (OR=2.144) had a higher likelihood of undergoing bariatric surgery for weight loss. Participants with type 2 diabetes (OR=1.728), post-traumatic stress disorder (PTSD) (OR=1.489), or COVID-19 (OR=3.852) had a higher likelihood of undergoing bariatric surgery while sleep apnea (OR=0.760) was associated with a lower likelihood of receiving surgery. Those who used MyFitnessPal™ (OR=2.232), Noom™ (OR=1.400), Jenny Craig™ (OR=1.533), or Keto (OR=1.664) for weight loss had a higher likelihood of obtaining bariatric surgery. Personal trauma experiences of sexual abuse (OR=1.982) and physical abuse (OR=1.490) were more associated with participants who underwent surgery. CONCLUSIONS A variety of characteristics were associated with decisions to undergo bariatric surgery. These findings may help to determine ways to support individuals who are considering bariatric surgery.
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Affiliation(s)
- Chi-Whan Choi
- Sargent College of Health & Rehabilitation Sciences, Boston University, USA
| | - Daniel Cunha
- Department of Mathematics and Statistics, Boston University, USA
| | | | - Simone V Gill
- Sargent College of Health & Rehabilitation Sciences, Boston University, USA.
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Rajeev ND, Samaan JS, Premkumar A, Srinivasan N, Yu E, Samakar K. Patient and the Public's Perceptions of Bariatric Surgery: A Systematic Review. J Surg Res 2023; 283:385-406. [PMID: 36434835 DOI: 10.1016/j.jss.2022.10.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bariatric surgery is an effective therapeutic modality for obesity and related comorbidities, yet it remains significantly underutilized. Patient perceptions and expectations may influence the decisions of eligible patients in pursuing surgery. METHODS PubMed, SCOPUS, and OVID databases were searched in July 2022 to identify published studies discussing patient and the public's perceptions of bariatric surgery. RESULTS The literature shows participants often reported bariatric surgery to be a life-changing intervention known to induce weight loss, improve obesity-related comorbidities, and improve quality of life. However, a significant proportion of survey respondents perceived bariatric surgery as unsafe or risky. Patients belonging to racial minority groups cited higher concern with mortality risk, lower weight loss expectations, and different motivations to pursue bariatric surgery. Female patients were significantly more likely to have more positive perceptions of, and higher expectations of weight loss from, bariatric surgery. CONCLUSIONS The literature highlighted discordance between patient perceptions and the demonstrated clinical safety and efficacy profile of bariatric surgery. Overestimations of the risks, unrealistic expectations, and unfamiliarity with bariatric surgery outcomes were common findings. These perceptions of bariatric surgery may contribute to its underutilization among eligible patients. Perceptions and motivations often varied by race, region, sex, and age, which demonstrates the necessity of patient-centered education in the prereferral stage. The literature also demonstrated misconceptions of bariatric surgery among the public. Further research should explore the impact of education on the perceptions of patients and the public.
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Affiliation(s)
- Nithya D Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Agnes Premkumar
- Department of General Surgery, Creighton University of Phoenix, Phoenix, Arizona
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Erin Yu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California.
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Zhang W, Chen X, Wang C, Gao L, Chen W, Yang W. Perceptions and Attitudes Toward Obesity and its Management in Migrants and Rural Residents in China: a Cross-sectional Pilot Study. Obes Surg 2021; 32:152-159. [PMID: 34643851 DOI: 10.1007/s11695-021-05755-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of overweight and obesity in rural-to-urban migrants and rural residents is increasing rapidly. This study aims to explore the perceptions and attitudes toward obesity and its management among rural-urban migrants and rural residents who are left in rural regions, China. METHODS We performed a cross-sectional survey investigating migrants and rural residents aged 18-45 in China from October to November 2020. We created a questionnaire. Two hundred five questionnaires were completed. RESULTS Finally, 184 were included, of which 102 were migrants and 82 were non-migrants. More respondents were male (62%). There was no significant difference in BMI between the two groups. The migrants had good knowledge about obesity as a disease (75.5%) and agreed that obesity seriously threatens health (93.1%). It is worth noting that more non-migrant group believed that obesity was due to a lack of willpower (87.3% vs. 54.9%, p = 0.000) than the migrant group. More than half in both groups believed that obesity was caused by a bad lifestyle (69.6%) or addiction to food (58.7%). Half of the participants believed that biological factors caused obesity. Most participants in both groups still believed weight loss modalities were limited to exercise and diet while having extremely poor acceptance of pharmacotherapy and bariatric surgery. CONCLUSIONS This study found that the migrants and rural residents had a good understanding of obesity as a disease, and better among migrants than rural residents. However, they showed significant uncertainty and misconceptions about the efficacy and safety of pharmacotherapy and bariatric surgery.
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Affiliation(s)
- Wen Zhang
- School of Nursing, Jinan University, No. 601, Huangpu Avenue West, Guangzhou, Guangdong, China.,Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China
| | - Xi Chen
- School of Nursing, Jinan University, No. 601, Huangpu Avenue West, Guangzhou, Guangdong, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China.,Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Lilian Gao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China
| | - Weiju Chen
- School of Nursing, Jinan University, No. 601, Huangpu Avenue West, Guangzhou, Guangdong, China.
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China. .,Joint Institute of Metabolic Medicine between State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong and Jinan University, Guangzhou, China. .,State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. .,Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Svagera Z, Machytka E, Machackova J, Blaho M, Vasura A, Stejskal D, Huberty V, Buzga M. Nutritional consequences of endoluminal gastroplasty in the treatment of morbidly obese patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:258-263. [PMID: 34040264 DOI: 10.5507/bp.2021.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Endoscopic sleeve gastroplasty (ESG) is one of the new advanced restrictive techniques of bariatric endoscopy. The principle of this bariatric technique is the reduction of stomach volume through endoscopic plication. The long-term efficacy and metabolic effects of this procedure are the subject of this study. METHODS 20 patients were enrolled; four men, sixteen women. Then they were followed for 24 months in terms of glycemic control, body composition, vitamin, and nutritional status. Observed parameters included glucose, triacylglycerols, high- and low-density lipoprotein cholesterol, micro and macro nutrients, fat mass, and lean body mass. RESULTS We observed significant weight loss and a decrease body composition resulted from procedure vs. baseline, with levels of blood glucose also showing statistically significant reductions. The most notable decline in measured values was observed in period six months after the procedure. No significant changes were observed in measurement of micronutrients. CONCLUSIONS Good restriction results were obtained following ESG, which might be mediated via altered glucose metabolism. The ESG method has shown a positive effect on fat and muscle mass. Unlike surgical methods, there were no deficits or deficiencies, especially in terms of essential vitamin levels.
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Affiliation(s)
- Zdenek Svagera
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Evzen Machytka
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jitka Machackova
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Blaho
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Adam Vasura
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Stejskal
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Vincent Huberty
- Department of Gastroenterology, Erasme Hospital, Universite Libre de Bruxelle, Belgium
| | - Marek Buzga
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Physiology and Pathophysiology, Research Obesity Centre, Faculty of Medicine, University of Ostrava, Czech Republic
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Koutoukidis DA, Koshiaris C, Henry JA, Noreik M, Morris E, Manoharan I, Tudor K, Bodenham E, Dunnigan A, Jebb SA, Aveyard P. The effect of the magnitude of weight loss on non-alcoholic fatty liver disease: A systematic review and meta-analysis. Metabolism 2021; 115:154455. [PMID: 33259835 DOI: 10.1016/j.metabol.2020.154455] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trials show that weight loss interventions improve biomarkers of non-alcoholic fatty liver disease (NAFLD), but it is unclear if a dose-response relationship exists. OBJECTIVE We aimed to quantify the dose-response relationship between the magnitude of weight loss and improvements in NAFLD. METHODS Nine databases and trial registries were searched until October 2020. Single-arm, non-randomized comparative, or randomized trials of weight loss interventions (behavioral weight loss programs [BWLPs], pharmacotherapy, or bariatric surgery) in people with NAFLD were eligible for inclusion if they reported an association between changes in weight and changes in blood, radiological, or histological biomarkers of liver disease. The review followed Cochrane methods and the risk of bias was assessed using the Newcastle-Ottawa scale. Pooled unstandardized b coefficients were calculated using random-effect meta-analyses. RESULTS Forty-three studies (BWMPs: 26, pharmacotherapy: 9, surgery: 8) with 2809 participants were included. The median follow-up was 6 (interquartile range: 6) months. The direction of effect was generally consistent but the estimates imprecise. Every 1 kg of weight lost was associated with a 0.83-unit (95% CI: 0.53 to 1.14, p < 0.0001, I2 = 92%, n = 18) reduction in alanine aminotransferase (U/L), a 0.56-unit (95% CI: 0.32 to 0.79, p < 0.0001, I2 = 68%, n = 11) reduction in aspartate transaminase (U/L), and a 0.77 percentage point (95% CI: 0.51 to 1.03, p < 0.0001, I2 = 72%, n = 11) reduction in steatosis assessed by radiology or histology. There was evidence of a dose-response relationship with liver inflammation, ballooning, and resolution of NAFLD or NASH, but limited evidence of a dose-response relationship with fibrosis or NAFLD activity score. On average, the risk of bias for selection and outcome was medium and low, respectively. CONCLUSION Clinically significant improvements in NAFLD are achieved even with modest weight loss, but greater weight loss is associated with greater improvements. Embedding support for formal weight loss programs as part of the care pathway for the treatment of NAFLD could reduce the burden of disease. PROSPERO CRD42018093676.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - John A Henry
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Michaela Noreik
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Indrani Manoharan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Kate Tudor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Emma Bodenham
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Anna Dunnigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
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Intragastric balloon placement in the treatment of overweight and obesity: Experience at a Mexican referral center. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hernández-Lara AH, Almazán-Urbina FE, Santiago-Torres M, Rangel-Cruz E. Intragastric balloon placement in the treatment of overweight and obesity: Experience at a Mexican referral center. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 85:410-415. [PMID: 32151349 DOI: 10.1016/j.rgmx.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND AIM Intragastric balloon therapy is a temporary, minimally invasive method for inducing weight loss. Any balloon with a volume of 400mL induces satiety and delayed gastric emptying. The aim of the present study was to demonstrate its safety and efficacy. MATERIALS AND METHODS We analyzed the safety and effectiveness of balloon placement in relation to weight loss in 128patients. Subgroups were compared through the Student's t test, ANOVA test, and the chi-square test, depending on the type of variable and the number of groups evaluated. Statistical significance was set at a P≤.05 to evaluate weight loss. RESULTS Mean weight loss after balloon therapy was 10.7kg, with only 2 cases of complications due to oral feeding intolerance. Mean length of time with the balloon was 8months. There were no complications after 6months, but no further weight loss either (P=.540). Final weight loss versus initial weight loss was significant (P=.000). There was greater weight loss in the group that attended the bimonthly control appointments than in the group that did not: 12.7kg vs. 7.26kg (P=.000). CONCLUSIONS The rates of the adverse events of intolerance and complications were very low in our study, compared with results in the literature: 1.6% vs. 4.7% and 0% vs. 3%, respectively. Intragastric balloon placement had better results when the patients attended the control appointments. Intragastric balloon therapy is a safe and efficacious method for reducing weight in patients with overweight and obesity.
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Affiliation(s)
- A H Hernández-Lara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, Estados Unidos.
| | - F E Almazán-Urbina
- Departamento de Endoscopia, Hospital Central Militar, Ciudad de México, México
| | - M Santiago-Torres
- Jefatura de servicios auxiliares diagnósticos, Hospital Central Militar, Ciudad de México, México
| | - E Rangel-Cruz
- Departamento de Endoscopia, Hospital Central Militar, Ciudad de México, México
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Ames GE, Maynard JR, Collazo-Clavell ML, Clark MM, Grothe KB, Elli EF. Rethinking Patient and Medical Professional Perspectives on Bariatric Surgery as a Medically Necessary Treatment. Mayo Clin Proc 2020; 95:527-540. [PMID: 32138881 DOI: 10.1016/j.mayocp.2019.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022]
Abstract
The prevalence of class 3 obesity (body mass index ≥40 kg/m2) is 7.7% of the United States adult population; thus, more than 25 million people may be medically appropriate for consideration of bariatric surgery as therapy for severe obesity. Although bariatric surgery is the most effective therapy for patients with severe obesity, the surgery is performed in less than 1% of patients annually for whom it may be appropriate. Patients' and medical professionals' misperceptions about obesity and bariatric surgery create barriers to accessing bariatric surgery that are not given adequate attention and clinical consideration. Commonly cited patient barriers are lack of knowledge about the severity of obesity, the perception that obesity is a lifestyle problem rather than a chronic disease, and fear that bariatric surgery is dangerous. Medical professional barriers include failing to recognize causes of obesity and weight gain, providing recommendations that are inconsistent with current obesity treatment guidelines, and being uncomfortable counseling patients about treatment options for severe obesity. Previous research has revealed that medical professional counseling and accurate perception of the health risks associated with severe obesity are strong predictors of patients' willingness to consider bariatric surgery. This article reviews patient and medical professional barriers to acceptance of bariatric surgery as a treatment of medical necessity and offers practical advice for medical professionals to rethink perspectives about bariatric surgery when it is medically and psychologically appropriate.
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Affiliation(s)
- Gretchen E Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
| | | | | | - Matthew M Clark
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Karen B Grothe
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Enrique F Elli
- Division of General Surgery, Mayo Clinic, Jacksonville, FL
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Jamal MH, Almutairi R, Elabd R, AlSabah SK, Alqattan H, Altaweel T. The Safety and Efficacy of Procedureless Gastric Balloon: a Study Examining the Effect of Elipse Intragastric Balloon Safety, Short and Medium Term Effects on Weight Loss with 1-Year Follow-Up Post-removal. Obes Surg 2020; 29:1236-1241. [PMID: 30613935 DOI: 10.1007/s11695-018-03671-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The Ellipse intragastric balloon (EIGB) is a new swallowable balloon that does not require endoscopy at insertion or removal. The aim of this study is to investigate the safety of EIGB and its efficiency in weight reduction even after 1 year of expulsion. METHOD Prospective study on our initial experience with a consecutive group of patients who underwent the insertion of EIGB in the period between September 2016 and February 2017. The patients were followed up to assess pain, nausea, and vomiting after procedure. As well as, the time of balloon extraction, route of extraction, and weight loss. RESULTS Total of 112 patients underwent EIGB placement. A 1-year follow-up was obtained on 85% of patients. Mean weight and BMI before the procedure 92.2 kg and 34.3 kg/m2, respectively. One patient had small bowel obstruction. Six patients did not tolerate EIGB and three patients had early deflation. Total weight loss % (TWL%) 10.7, 10.9, and 7.9% at 3, 6, and at date of last follow-up. When data were stratified according to BMI into two groups: group 1 (BMI 27.5-34.9) and group 2 (BMI 35-49), the TWL% for group 1 at 3 months, 6 months, and last day of follow-up are as follows: 10.2%, 10.6%, and 8.8%, while it was 11.5%, 11.2%, and 6.6% for group 2. CONCLUSION EIGB are effective, safe, and feasible non-invasive method for weight loss.
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Affiliation(s)
| | - Rawan Almutairi
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Rawan Elabd
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | | | - Hala Alqattan
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Canada
| | - Talal Altaweel
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
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Abstract
Background The prevalence of obesity and obesity-related disorders is rapidly increasing among the Chinese populations. Bariatric surgery is becoming more and more popular in China, yet little cases were performed compared with western countries. The acceptance of this new treatment modality in Chinese bariatric surgery candidates was seldom studied. Objective To investigate the factors affecting the choice of bariatric surgery in Chinese patients with obesity and metabolic disorders, so as to promote the popularization of bariatric surgery in developing countries like China Methods Patients with obesity and related metabolic disorders meet the indications for bariatric surgery in the Department of Metabolic and Bariatric Surgery in the First Affiliated Hospital of Jinan University between January 2016 and April 2017 were asked to answer a questionnaire about the demographics of the patients, social economic status, present and past history, family history, etc. The data collected and the relationship of the acceptance of bariatric surgery were analyzed. Results There were 157 patients (51 males, 32.5%; 106 females, 67.5%) with mean BMI 38.7 ± 8.1 kg/m2 answered the questionnaire. One hundred twenty-three of them (78%) accepted bariatric surgery. By univariate analysis, it was found that patients’ weight, BMI, family support, medical insurance, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are correlated with the acceptance of bariatric surgery. By multivariate analysis, it was found that patients’ weight (P = 0.024), BMI (P = 0.007), family support (P < 0.001), medical insurance (P < 0.001), past surgical history (P = 0.011), family history of T2DM (P = 0.020), and obesity-related comorbidities and symptoms (P = 0.030) are statistically significant and were positively correlated with the acceptance of bariatric surgery. Age, height, gender, history of smoking and alcohol consumption, family history of obesity, history of hypertension and T2DM, education level, and marital status were not statistically significant (P < 0.05). Conclusions Patients with heavier weight, higher BMI, family support, medical insurance reimbursement, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are more likely to consider bariatric surgery in Chinese bariatric surgery candidates. It will be important to provide appropriate healthcare education and support to patients focusing on both obesity-related health risks and options of surgical treatment so to improve their acceptance of bariatric surgery.
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Turner M, Johnson AC, Lantz P. Impact of self-efficacy on risk aversion in the context of surgical weight loss decision scenarios. Clin Obes 2019; 9:e12311. [PMID: 31050137 DOI: 10.1111/cob.12311] [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: 12/05/2018] [Revised: 02/28/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
Obesity is prevalent among a third of US adults and a leading indicator for many chronic diseases. Self-efficacy is important for non-surgical weight loss interventions, but there is less information about the role of self-efficacy in the candidacy phase when there are discussions of side effects and decisions for uptake. This study conducted an experiment set within an online survey assessing risk aversion towards bariatric surgery as a weight loss intervention. The survey asked about hypothetical weight loss scenarios for bariatric surgery among a national probability-based sample of US adults aged 18 years and older. Participants answered their willingness to achieve different weight loss amounts within the context of bariatric surgery in varying risk scenarios. The analysis utilized a repeated-measures linear mixed model. A three-way interaction demonstrated that participants were more willing to take risks under ideal weight loss conditions even with the risk of death, particularly when considering self-efficacy (𝛽 = 1.20, P = .05). Margin projections showed that those with lower self-efficacy were more likely to take risks overall. This trend was significant for those with a body mass index of 30 and above in scenarios presenting one's ideal weight as the outcome of bariatric surgery. Adding a measure of self-efficacy within patient assessments could identify those eligible patients who are most likely to adopt bariatric surgery, particularly among those who may have negative post-surgical outcomes due to low self-efficacy levels. Addressing self-efficacy by way of providing support resources in tandem with candidacy consultations may enhance quality of life and post-surgical outcomes.
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Affiliation(s)
- Monique Turner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Andrea C Johnson
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Paula Lantz
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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Collazo-Clavell ML. Managing Obesity: Scaling the Pyramid to Success. Mayo Clin Proc 2019; 94:933-935. [PMID: 31171127 DOI: 10.1016/j.mayocp.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
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Johnston SS, Morton JM, Kalsekar I, Ammann EM, Hsiao CW, Reps J. Using Machine Learning Applied to Real-World Healthcare Data for Predictive Analytics: An Applied Example in Bariatric Surgery. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:580-586. [PMID: 31104738 DOI: 10.1016/j.jval.2019.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/05/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Laparoscopic metabolic surgery (MxS) can lead to remission of type 2 diabetes (T2D); however, treatment response to MxS can be heterogeneous. Here, we demonstrate an open-source predictive analytics platform that applies machine-learning techniques to a common data model; we develop and validate a predictive model of antihyperglycemic medication cessation (validated proxy for A1c control) in patients with treated T2D who underwent MxS. METHODS We selected patients meeting the following criteria in 2 large US healthcare claims databases (Truven Health MarketScan Commercial [CCAE]; Optum Clinformatics [Optum]): underwent MxS between January 1, 2007, to October 1, 2013 (first = index); aged ≥18 years; continuous enrollment 180 days pre-index (baseline) to 730 days postindex; baseline T2D diagnosis and treatment. The outcome was no antihyperglycemic medication treatment from 365 to 730 days after MxS. A regularized logistic regression model was trained using the following candidate predictor categories measured at baseline: demographics, conditions, medications, measurements, and procedures. A 75% to 25% split of the CCAE group was used for model training and testing; the Optum group was used for external validation. RESULTS 13 050 (CCAE) and 3477 (Optum) patients met the study inclusion criteria. Antihyperglycemic medication cessation rates were 72.9% (CCAE) and 70.8% (Optum). The model possessed good internal discriminative accuracy (area under the curve [AUC] = 0.778 [95% CI = 0.761-0.795] in CCAE test set N = 3527) and transportability (external AUC = 0.759 [95% CI = 0.741-0.777] in Optum N = 3477). CONCLUSION The application of machine learning techniques to real-world healthcare data can yield useful predictive models to assist patient selection. In future practice, establishment of prerequisite technological infrastructure will be needed to implement such models for real-world decision support.
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Affiliation(s)
- Stephen S Johnston
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.
| | - John M Morton
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Iftekhar Kalsekar
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Eric M Ammann
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | | | - Jenna Reps
- Epidemiology, Johnson & Johnson, Titusville, NJ, USA
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Bayraktar O, Özçelik AA, Öktemgil AR, Bayraktar B. Intragastric balloon therapy for obesity: Is it safe and effective? ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.477680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Kallies KJ, Ramirez LD, Grover BT, Kothari SN. Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference? Surg Obes Relat Dis 2018; 14:1843-1849. [PMID: 30290991 DOI: 10.1016/j.soard.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. OBJECTIVE To evaluate preferences for RYGB versus SG. SETTING Survey of U.S. adults. METHODS An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. RESULTS Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). CONCLUSIONS Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.
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Affiliation(s)
- Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Luis D Ramirez
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Brandon T Grover
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
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Abstract
Background Gastric balloons for weight loss have historically been placed after a screening endoscopy. However, the utility and yield of these endoscopies has not been studied. Therefore, we wanted to evaluate the utility of screening endoscopy and to assess patients who had balloons placed without endoscopy. Methods Data was collected on two cohorts. Cohort 1 consisted of patients who had a screening endoscopy prior to or upon balloon placement. Cohort 2 consisted of patients who were followed after having a balloon placed under fluoroscopic guidance without endoscopy. Balloon intolerance and findings on removal endoscopy were assessed in both cohorts. Results In cohort 1 (n = 253), two patients had severe symptoms on history; balloon placement was contraindicated based on screening endoscopy findings. Eleven patients with a history of hiatal hernia and the presence of severe belching demonstrated an insignificant hiatal hernia on endoscopy. In cohort 2 (n = 50), all patients had an unremarkable history. Three previously asymptomatic patients had balloon intolerance and one was found to have a 4-cm hiatal hernia and oesophagitis upon balloon removal. Out of 194 patients, 25 were either intolerant to the balloon or had relevant findings on removal endoscopy. Findings on screening endoscopy did not correlate with balloon intolerance or findings on removal endoscopy. Conclusion These results demonstrate that a careful history can identify patients who may have contraindications for balloon therapy and that balloons can be placed safely after taking a careful history without screening endoscopy. Screening endoscopy may not be useful in predicting balloon intolerance or potential complications.
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Totally endoscopic implant to effect a gastric bypass: 12-month safety and efficacy outcomes. Surg Endosc 2018; 32:4436-4442. [PMID: 29679149 DOI: 10.1007/s00464-018-6186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/06/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Only a small percentage of candidates for bariatric surgery ever undergo a procedure for weight loss. Devices duplicating key effects of bariatric surgeries with removable, fully trans-oral implants could extend their benefits to patients unwilling to undergo anatomy-altering abdominal surgeries. METHODS Thirty-two obese subjects (mean BMI: 42.3) were enrolled in a prospective, multicenter, single-arm, feasibility trial of the first fully trans-oral endoscopic gastrointestinal bypass device. The device is a cuff attached to the distal esophagus by transmural anchors and connected to a 120-cm sleeve diverting undigested nutrients to the jejunum. Bodyweight, vital signs, adverse events, medications, HbA1c, fasting glucose, and lipids were collected at baseline and follow-up visits. Device status was endoscopically assessed every 6 months. RESULTS The fully trans-oral procedure was successful in all subjects without intraoperative adverse events or postoperative infections. Twenty-eight of 32 subjects (88%) remained implanted with continuing follow-up beyond their 12-month visit. At 12 months, the 32 subjects had lost an average of 44.8% of excess body weight, 17.6% of total body weight, 20.8 kg, and 7.5 BMI points. Weight loss depended on capture of ingesta by the esophageal cuff, with 18 of 32 subjects without visible gaps around their cuffs at the 6 month endoscopy having significantly greater EWL (53.6 vs. 33.4% in the remaining subjects, p < 0.002). Mean HbA1c and fasting glucose declined by 1.1% points and 29 mg/dL in type 2 diabetic subjects, 80% of whom had remission of their diabetes at 12 months. CONCLUSION This study demonstrates the feasibility, safety, and efficacy of a fully trans-oral gastrointestinal bypass implant. This purely endoscopic device may provide a valuable addition to the armamentarium of treatment available for the management of morbid obesity.
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General Practitioners and Bariatric Surgery in France: Are They Ready to Face the Challenge? Obes Surg 2018; 28:1754-1759. [DOI: 10.1007/s11695-017-3090-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Auspitz M, Cleghorn MC, Azin A, Sockalingam S, Quereshy FA, Okrainec A, Jackson TD. Knowledge and Perception of Bariatric Surgery Among Primary Care Physicians: a Survey of Family Doctors in Ontario. Obes Surg 2018; 26:2022-2028. [PMID: 26780362 DOI: 10.1007/s11695-016-2055-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The primary objective of this study was to identify Ontario family physicians' knowledge and perceptions of bariatric surgery. METHODS The study population included all physicians practicing family medicine in Ontario who were listed in the Canadian Medical Directory. A self-administered questionnaire consisting of 28 questions was developed and validated using a focus group of seven primary care physicians. The questionnaire was distributed to 1328 physicians. RESULTS One hundred sixty-five surveys were completed. 8.8 % of physicians did not have any bariatric surgical patients, and 71.3 % had no more than five in their practice. 70.2 % referred no more than 5 % of their morbidly obese patients for surgery. Only 32.1 % had the appropriate equipment and resources to manage obese patients. 92.5 % of physicians would like to receive more education about bariatric surgery. Physicians with no history of referral (n = 21) were earlier into their practices and had less morbidly obese patients than physicians with previous referrals (n = 141). They were also less likely to discuss bariatric surgery with their patients (30 vs. 79.3 %; p < 0.001) and less likely to feel comfortable explaining procedure options (5.6 vs. 33.9 %; p = 0.013) and providing postoperative care (26.7 vs. 64.2 %; p = 0.005). 55.6 % would refer a family member for surgery, compared to 85.4 % of physicians with previous referrals; p = 0.002. CONCLUSION There appears to be a knowledge gap in understanding the role of bariatric surgery in the treatment of obesity. There is an opportunity to improve education and available resources for primary care physicians surrounding patient selection and follow-up care. This may improve access to treatment.
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Affiliation(s)
- Mark Auspitz
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Michelle C Cleghorn
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Arash Azin
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Fayez A Quereshy
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Timothy D Jackson
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada.
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Anvari M, Lemus R, Breau R. A Landscape of Bariatric Surgery in Canada: For the Treatment of Obesity, Type 2 Diabetes and Other Comorbidities in Adults. Can J Diabetes 2017; 42:560-567. [PMID: 29724616 DOI: 10.1016/j.jcjd.2017.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/07/2017] [Indexed: 01/05/2023]
Abstract
Obesity has escalated worldwide and in Canada. Many chronic conditions, including type 2 diabetes, are directly correlated with obesity, and although the benefits and effectiveness of bariatric surgery have been proven in terms of sustained weight loss and improving comorbidities, the procedure is underaccessed and underutilized in Canada. We explored the complex landscape of bariatric surgery in Canada, reviewing the current state and focusing on the volume of procedures nationwide and at the provincial level, the type of surgical procedures performed, their outcomes and their associated complications. Barriers and challenges curbing access to bariatric surgery are also explored. Approximately 8,583 publicly funded bariatric surgeries were performed in 9 of 10 provinces in 2015/2016; Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric banding and biliopancreatic diversion with or without duodenal switch are the most common procedures performed, and coverage varies among provinces and territories. Dedicated bariatric programs have been created and, in some instances, provincial networks have also emerged. Weight loss, resolution of comorbidities and rates of complications in Canada are similar to those found in the literature. The increase in the number of bariatric procedures performed over time has still not met the current demand. The rise in obesity rates, the speed and regional variations in the development and standardization of processes, adequate patient selection, funding and prioritization and gaps in knowledge and attitudes about the merits of bariatric surgery of patients, health providers and policy makers create considerable waiting times and are some of the barriers to better access to bariatric surgery.
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Affiliation(s)
| | | | - Ruth Breau
- McMaster University, Hamilton, Ontario, Canada
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Ferriby M, Pratt K, Noria S, Needleman B. A comparison of perceived and calculated weight status classification congruence between pre- and post-bariatric surgery patients. Surg Obes Relat Dis 2017; 13:1405-1411. [DOI: 10.1016/j.soard.2017.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/02/2017] [Accepted: 05/11/2017] [Indexed: 12/31/2022]
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Machytka E, Chuttani R, Bojkova M, Kupka T, Buzga M, Stecco K, Levy S, Gaur S. Elipse™, a Procedureless Gastric Balloon for Weight Loss: a Proof-of-Concept Pilot Study. Obes Surg 2016; 26:512-6. [PMID: 26253980 DOI: 10.1007/s11695-015-1783-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic gastric balloons have been used effectively as weight loss devices for decades, but the requirement for endoscopy and sedation poses several limitations. The goal of this pilot study was to evaluate the safety and performance of a prototype version of Elipse™, a procedureless gastric balloon. METHODS Eight patients (mean BMI = 31.0 kg/m(2)) participated in this study. Each patient swallowed one Elipse™ balloon intended to remain in the stomach for 6 weeks, self-empty, and then pass. Each balloon was filled with 450 mL of filling fluid. Patients returned every 2 weeks for abdominal ultrasound. No specific diet or exercise plan was prescribed. RESULTS All eight patients successfully swallowed the device. The most common adverse events were nausea and vomiting. There were no serious adverse events, and all balloons were excreted safely. Despite not being prescribed a diet or exercise plan, all eight patients lost weight. In 6/8 patients, the balloon remained full through 6 weeks, self-emptied, and passed. In one patient, the balloon appeared partially collapsed on ultrasound after 11 days and was endoscopically punctured. One asymptomatic patient elected to have the balloon endoscopically punctured after 19 days. Both balloons passed in the stool after 4 days. In both cases, endoscopic examination of the upper GI tract showed no abnormalities. CONCLUSIONS This pilot study demonstrates the safety and performance of Elipse™, a procedureless gastric balloon for weight loss. Future studies will test a commercial design filled to 550 mL intended to last in the stomach for at least 12 weeks.
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Affiliation(s)
- Evzen Machytka
- Internal Clinic, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | - Ram Chuttani
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Martina Bojkova
- Internal Clinic, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | - Tomas Kupka
- Internal Clinic, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | - Marek Buzga
- Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
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Factors Leading to Self-Removal from the Bariatric Surgery Program After Attending the Orientation Session. Obes Surg 2016; 27:102-109. [DOI: 10.1007/s11695-016-2250-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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