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Hany M, Shafei ME, Ibrahim M, Agayby ASS, Abouelnasr AA, Aboelsoud MR, Elmongui E, Torensma B. The Role of Preoperative Abdominal Ultrasound in the Preparation of Patients Undergoing Primary Metabolic and Bariatric Surgery: A Machine Learning Algorithm on 4418 Patients' Records. Obes Surg 2024; 34:3445-3458. [PMID: 39115577 DOI: 10.1007/s11695-024-07433-9] [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: 05/10/2024] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND The utility of preoperative abdominal ultrasonography (US) in evaluating patients with obesity before metabolic bariatric surgery (MBS) remains ambiguously defined. METHOD Retrospective analysis whereby patients were classified into four groups based on ultrasound results. Group 1 had normal findings. Group 2 had non-significant findings that did not affect the planned procedure. Group 3 required additional or follow-up surgeries without changing the surgical plan. Group 4, impacting the procedure, needed further investigations and was subdivided into 4A, delaying surgery for more assessments, and 4B, altering or canceling the procedure due to critical findings. Machine learning techniques were utilized to identify variables. RESULTS Four thousand four hundred eighteen patients' records were analyzed. Group 1 was 45.7%. Group 2, 35.7%; Group 3, 17.0%; Group 4, 1.5%, Group 4A, 0.8%; and Group 4B, 0.7%, where surgeries were either canceled (0.3%) or postponed (0.4%). The hyperparameter tuning process identified a Decision Tree classifier with a maximum tree depth of 7 as the most effective model. The model demonstrated high effectiveness in identifying patients who would benefit from preoperative ultrasound before MBS, with training and testing accuracies of 0.983 and 0.985. It also showed high precision (0.954), recall (0.962), F1 score (0.958), and an AUC of 0.976. CONCLUSION Our study found that preoperative ultrasound demonstrated clinical utility for a subset of patients undergoing metabolic bariatric surgery. Specifically, 15.9% of the cohort benefited from the identification of chronic calculous cholecystitis, leading to concomitant cholecystectomy. Additionally, surgery was postponed in 1.4% of the cases due to other findings. While these findings indicate a potential benefit in certain cases, further research, including a cost-benefit analysis, is necessary to fully evaluate routine preoperative ultrasound's overall utility and economic impact in this patient population.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt.
- Madina Women's Hospital, Alexandria, Egypt.
| | - Mohamed El Shafei
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Anwar Ashraf Abouelnasr
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Moustafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Ehab Elmongui
- Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Abokhozima A, Zidan MH, Altabbaa H, Abo Elmagd A, Alokl M, Fathy F, Amgad A, Al Shaqran O, Eissa MH, Selim A. Can Incidental Gastric GISTs During Bariatric Surgeries Change the Primary Plan of Surgery? A Single Team Experience and a Systematic Review of Literature. Obes Surg 2024; 34:2186-2197. [PMID: 38684584 PMCID: PMC11127811 DOI: 10.1007/s11695-024-07224-2] [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: 02/27/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy.
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Affiliation(s)
- Ahmed Abokhozima
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| | - Mohamed H Zidan
- Alexandria Main University Hospital, Alexandria University, AlexandriaAlexandria, 5372066, Egypt.
- Alexandria University, Alexandria, 21526, Egypt.
- Ekbal Hospital, Alexandria, Egypt.
| | | | - Ahmed Abo Elmagd
- Alexandria Main University Hospital, Alexandria University, AlexandriaAlexandria, 5372066, Egypt
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| | - Mohammed Alokl
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
| | | | - Ahmed Amgad
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | | | - Aliaa Selim
- Alexandria University, Alexandria, 21526, Egypt
- Ekbal Hospital, Alexandria, Egypt
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Teke E, Esen Bulut N, Onur E, Güneş Y, Fersahoglu MM, Ergin A, Taşdelen İ, Köroğlu M, Çavuş B, Akyüz Ü, Akyüz F. Investigation of the Relationship Between Laparoscopic Sleeve Gastrectomy and Gastroesophageal Reflux Disease Using 24-hour Multichannel Intraluminal Impedance With pH Testing According to Current Consensus. Surg Laparosc Endosc Percutan Tech 2024; 34:9-13. [PMID: 38078925 DOI: 10.1097/sle.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/04/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss procedure with potential effects on gastroesophageal reflux disease (GERD). However, research on the association between LSG and GERD using objective evaluation criteria, such as multichannel intraluminal impedance combined with pH testing (MII-pH), is limited. This study aimed to investigate the impact of LSG on GERD using MII-pH and current consensus guidelines. MATERIALS AND METHODS It was conducted as a prospective clinical study on 33 patients who underwent LSG between January 2022 and August 2022. MII-pH and high-resolution manometry were performed preoperatively and 3 to 6 months postoperatively. GERD diagnosis was based on MII-pH results using the Lyon and Update Porto consensus guidelines. RESULTS Postoperative MII-pH analysis revealed a significant increase in acid reflux time, acid exposure time, reflux index, esophageal clearance, total reflux time, and longest reflux period. Weak acid reflux episodes decreased, while Demeester score and alkaline reflux showed nonsignificant increases. Pathologic reflux significantly increased postoperatively based on MII-pH diagnosis. High-resolution manometry showed a significant increase in unsuccessful motility. CONCLUSION Although the Demeester score calculation consists of 6 metrics, including acid exposure time, the acid exposure time is more specific in detecting pathologic reflux. Pathologic GERD increases significantly with LSG in the early period. Therefore, preoperative and postoperative endoscopy and MII-pH can provide valuable information regarding the need for closer follow-up after LSG.
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Affiliation(s)
| | | | | | | | | | | | | | - Mehmet Köroğlu
- Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Bilger Çavuş
- Istanbul University Istanbul Medical Faculty/Gastroenterohepatology Department, İstanbul University, İstanbul Medical School, Turgut Özal Millet Street, Fatih/İstanbul
| | - Ümit Akyüz
- Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Filiz Akyüz
- Istanbul University Istanbul Medical Faculty/Gastroenterohepatology Department, İstanbul University, İstanbul Medical School, Turgut Özal Millet Street, Fatih/İstanbul
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Kohli DR, Aqel BA, Segaran NL, Harrison ME, Fukami N, Faigel DO, Moss A, Mathur A, Hewitt W, Katariya N, Pannala R. Outcomes of endoscopic retrograde cholangiography and percutaneous transhepatic biliary drainage in liver transplant recipients with a Roux-en-Y biliary-enteric anastomosis. Ann Hepatobiliary Pancreat Surg 2023; 27:49-55. [PMID: 36245257 PMCID: PMC9947378 DOI: 10.14701/ahbps.22-037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 02/16/2023] Open
Abstract
Backgrounds/Aims Data regarding outcomes of endoscopic retrograde cholangiography (ERC) in liver transplant (LT) recipients with biliary-enteric (BE) anastomosis are limited. We report outcomes of ERC and percutaneous transhepatic biliary drainage (PTBD) as first-line therapies in LT recipients with BE anastomosis. Methods All LT recipients with Roux-BE anastomosis from 2001 to 2020 were divided into ERC and PTBD subgroups. Technical success was defined as the ability to cannulate the bile duct. Clinical success was defined as the ability to perform cholangiography and therapeutic interventions. Results A total of 36 LT recipients (25 males, age 53.5 ± 13 years) with Roux-BE anastomosis who underwent biliary intervention were identified. The most common indications for a BE anastomosis were primary sclerosing cholangitis (n = 14) and duct size mismatch (n = 10). Among the 29 patients who initially underwent ERC, technical success and clinical success were achieved in 24 (82.8%) and 22 (75.9%) patients, respectively. The initial endoscope used for the ERC was a single balloon enteroscope in 16 patients, a double balloon enteroscope in 7 patients, a pediatric colonoscope in 5 patients, and a conventional reusable duodenoscope in 1 patient. Among the 7 patients who underwent PTBD as the initial therapy, six (85.7%) achieved technical and clinical success (p = 0.57). Conclusions In LT patients with Roux-BE anastomosis requiring biliary intervention, ERC with a balloon-assisted enteroscope is safe with a success rate comparable to PTBD. Both ERC and PTBD can be considered as first-line therapies for LT recipients with a BE anastomosis.
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Affiliation(s)
- Divyanshoo Rai Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States,Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, WA, United States,Corresponding author: Divyanshoo Rai Kohli, MD Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, 105 W 8th Ave Suite 7050, Spokane, WA 99204, United States Tel: +1-509-252-1711, Fax: +1-509-747-0416, E-mail: ORCID: https://orcid.org/0000-0002-7801-0044
| | - Bashar A. Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Nicole L. Segaran
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - M. Edwyn Harrison
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Douglas O. Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
| | - Adyr Moss
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Amit Mathur
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Winston Hewitt
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Nitin Katariya
- Department of Surgery, Mayo Clinic Transplant Center, Phoenix, AZ, United States
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, United States
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Li JZ, Broderick RC, Huang EY, Serra J, Wu S, Genz M, Sandler BJ, Jacobsen GR, Horgan S. Post Sleeve Reflux: indicators and impact on outcomes. Surg Endosc 2022; 37:3145-3153. [PMID: 35948805 DOI: 10.1007/s00464-022-09454-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: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Post-operative gastroesophageal reflux disease (GERD) remains a significant morbidity following sleeve gastrectomy (SG). We aim to evaluate the incidence and impact within a single center experience. MATERIALS AND METHODS A retrospective review of a prospectively maintained database was performed identifying laparoscopic or robotic SG patients. Primary outcomes included weight loss, rates of post-operative GERD (de-novo or aggravated), and re-intervention. Subgroup analysis was performed between patients with (Group 1) and without (Group 2) post-operative GERD. De-novo GERD and aggravated was defined as persistent GERD complaints or new/increased PPI usage in GERD naive or prior GERD patients, respectively. RESULTS 392 patients were identified between 2014 and 2019. Average demographics: age 42.3 (18-84) years, Charlson Comorbidity Index (CCI) 1.12 (0-10), and body mass index (BMI) 47.7 (28-100). 98% were performed laparoscopically. Average excess weight loss (EWL) was 51.0% and 46.4% at 1 and 2 years post-operatively. Average follow up was 516 (6-2694) days. 69 (17%) patients developed post operative de-novo or aggravated GERD. Group 1 had significantly higher EWL at 9 months (57% vs 47%, p 0.003). 13 (3%) patients required operative re-intervention for GERD and other morbidities: 4 RYGB conversions, 4 diagnostic laparoscopies, 3 HHR, 1 MSA placement. Group 1 had higher rates of post-operative intervention (14% vs 1%, p 0.0001). Subanalysis demonstrated that Group 1 had elevated preoperative DeMeester scores on pH testing (34.8 vs 18.9, p 0.03). De-novo GERD had an elevated post-operative total acid exposure when compared to aggravated GERD (12.7% vs 7.0% p 0.03). No significant differences were found between preoperative endoscopy findings, pre and postoperative total acid exposure, post-operative DeMeester scores, and high-resolution manometry values regarding de-novo/aggravated GERD development. CONCLUSION Preoperative DeMeester scores may serve as risk indicators regarding post-operative GERD. Outcomes such as reintervention remain elevated in post-operative GERD patients.
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Affiliation(s)
- Jonathan Z Li
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Estella Y Huang
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Joaquin Serra
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Samantha Wu
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Michael Genz
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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Abboud DM, Yao R, Rapaka B, Ghazi R, Ghanem OM, Abu Dayyeh BK. Endoscopic Management of Weight Recurrence Following Bariatric Surgery. Front Endocrinol (Lausanne) 2022; 13:946870. [PMID: 35909531 PMCID: PMC9329792 DOI: 10.3389/fendo.2022.946870] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Metabolic and bariatric surgery is the most effective therapy for weight loss and improving obesity-related comorbidities, comprising the Roux-en-Y gastric bypass (RYGB), gastric banding, sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch. While the effectiveness of weight loss surgery is well-rooted in existing literature, weight recurrence (WR) following bariatric surgery is a concern. Endoscopic bariatric therapy presents an anatomy-preserving and minimally invasive option for managing WR in select cases. In this review article, we will highlight the endoscopic management techniques for WR for the most commonly performed bariatric surgeries in the United States -RYGB and SG. For each endoscopic technique, we will review weight loss outcomes in the short and mid-terms and discuss safety and known adverse events. While there are multiple endoscopic options to help address anatomical issues, patients should be managed in a multidisciplinary approach to address anatomical, nutritional, psychological, and social factors contributing to WR.
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Affiliation(s)
- Donna Maria Abboud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Rebecca Yao
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Babusai Rapaka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Rabih Ghazi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Omar M. Ghanem
- Department of Surgery Mayo Clinic, Rochester, MN, United States
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
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Chang HM, Zhan WP, Tsai HC, Yang MR. Poly(vinylidene fluoride) Intestinal Sleeve Implants for the Treatment of Obesity and Type 2 Diabetes. Polymers (Basel) 2022; 14:polym14112178. [PMID: 35683855 PMCID: PMC9183030 DOI: 10.3390/polym14112178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Currently, treatment of diabetes and associated obesity involves Roux-en-Y gastric bypass or sleeve gastrectomy to reduce the absorption of nutrients from the intestine to achieve blood glucose control. However, the surgical procedure and subsequent recovery are physically and psychologically burdensome for patients, with possible side effects, so alternative treatments are being developed. In this study, two methods, solution casting and machine direction orientation (MDO), were used to prepare intestinal implants made of poly(vinylidene fluoride) (PVDF) film and implant them into the duodenum of type 2 diabetic rats for the treatment of obesity and blood glucose control. The PVDF film obtained by the MDO process was characterized by FT-IR, Raman spectroscopy, XRD and piezoelectricity tests, which showed higher composition of β crystalline phase and better elongation and mechanical strength in specific directions. Therefore, the material was finally tested on rats after it was proven to be non-toxic by biological toxicity tests. The PVDF was implanted into alloxan-induced diabetic rats, which were used as a model of impaired insulin secretion due to pancreatic beta cell destruction rather than obesity-induced diabetes, and rats were tracked for 24 days, showing significantly improved body weight and blood glucose levels. As an alternative therapeutic option, intestinal sleeve implant showed future potential for application.
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Affiliation(s)
- Hao-Ming Chang
- Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Wei-Ping Zhan
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (W.-P.Z.); (M.-R.Y.)
| | - Hsieh-Chih Tsai
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (W.-P.Z.); (M.-R.Y.)
- Advanced Membrane Materials Center, National Taiwan University of Science and Technology, Taipei 106, Taiwan
- R&D Center for Membrane Technology, Chung Yuan Christian University, Chungli, Taoyuan 320, Taiwan
- Correspondence:
| | - Meng-Ru Yang
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (W.-P.Z.); (M.-R.Y.)
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Galloro G, Musella M, Siciliano S, Berardi G, Vitiello A, Velotti N, Rizzello F, Gionchetti P, Calabrese C. New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era. Endosc Int Open 2022; 10:E183-E191. [PMID: 35178336 PMCID: PMC8847058 DOI: 10.1055/a-1723-3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Obesity represents a major health concern; bariatric surgery is the most effective treatment reducing and maintaining weight loss. The role of a routine esophagogastroduodenoscopy (EGD) prior bariatric surgery is still debated. Moreover, in this scenario of COVID-19 pandemic, EGD is even more questionable due to the procedural risk of viral transmission. A new model of video-endoscopic capsule (VEC) recently has been introduced as a good alternative to the EGD. The aim of this study was to determine if this new capsule is an adequate diagnostic alternative to EGD in the work-up of patients selected for bariatric surgery, particularly in the setting of COVID-19. Patients and methods From January to November 2020, 27 patients selected for bariatric surgery were enrolled in this pilot study to assess for noninferiority of VEC compared to EGD in detection of upper gastrointestinal disease. Results VEC had sensitivity, specificity, and positive and negative predictive values in identification of significant lesions of 91.3 %, 83.33 %, 98.01 %, and 51.57 %, respectively, compared with EGD as the standard criterion. The accuracy was 90.51 % (95 % CI, 73.75 %-98.18 %) and the chi-square statistic is 0.1153 ( P = 0.73). Conclusions Our report confirms the diagnostic noninferiority of VEC in preoperative work-up of patients selected for bariatric surgery, compared to EGD. This is very important, particularly during the COVID-19 pandemic, given the high risk of contamination with EGD. Larger multicenter studies are required to confirm our preliminary results.
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Affiliation(s)
- Giuseppe Galloro
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Mario Musella
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Saverio Siciliano
- University of Naples Federico II – School of Medicine, Department of Clinical Medicine and Surgery – Surgical Endoscopy Unit, Naples, Italy
| | - Giovanna Berardi
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Antonio Vitiello
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Nunzio Velotti
- University of Naples Federico II – School of Medicine, Department of Advanced Biomedical Sciences – Bariatric and Metabolic Surgery Unit, Naples, Italy
| | - Fernando Rizzello
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Paolo Gionchetti
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
| | - Carlo Calabrese
- University of Bologna Alma Mater – School of Medicine, Department of Medical and Surgical Sciences – Regional Referral Center for IBD, Bologna, Italy
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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10
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Sivan RF, Bar Lev MR, Silbermintz A, Mozer-Glassberg Y, Seguier-Lipzyc E, Shalitin S, Stafler P, Tiroler S, Shamir R, Waisbourd-Zinman O. Clinical and Esophagogastroduodenoscopy Findings in Pediatric Patients With Severe Obesity Evaluated Before Bariatric Surgery. J Pediatr Gastroenterol Nutr 2021; 72:854-858. [PMID: 33633080 DOI: 10.1097/mpg.0000000000003109] [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: 12/10/2022]
Abstract
OBJECTIVES Severe obesity in the pediatric population has lifelong consequences. Bariatric surgery has been suggested for selected adolescents with severe obesity after careful evaluation. The indications for preoperative esophagogastroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD before bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities. METHODS We conducted a retrospective chart review in a single tertiary pediatric medical center of adolescents treated during 2011 to 2018. Data collected from electronic medical records included patient demographics, endoscopic findings, and laboratory parameters. RESULTS A total of 80 patients (40 boys) underwent evaluation. Macroscopic abnormalities were detected in 54% of the endoscopies, including gastritis, esophagitis, and duodenitis in 46%, 16%, and 13%, respectively. Forty-nine percentage of the biopsies showed histological abnormalities; in 35 (44%) patients, Helicobacter pylori was detected. Thirty-three patients (41%) received medical treatment and 2 (2.5%) required a second EGD. Metabolic comorbidities included hypertriglyceridemia (38% of the patients), low high-density lipoprotein (23%), and prediabetic (16%) or diabetic levels of HbA1C (4%). Fifty-five percentage of the cohort had elevated alanine aminotransferase (ALT), suggestive of nonalcoholic fatty liver disease (NAFLD). CONCLUSIONS Endoscopies performed before bariatric surgeries suggest a higher prevalence of clinically significant findings, many of which required treatment. These findings support incorporating an EGD into the preoperative evaluation of this patient population.
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Affiliation(s)
- Rachel Frenklak Sivan
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Michal Rozenfeld Bar Lev
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Ari Silbermintz
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Yael Mozer-Glassberg
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Shlomit Shalitin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes
| | - Patrick Stafler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Division of Pulmonology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | | | - Raanan Shamir
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Orith Waisbourd-Zinman
- Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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11
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Temperley L, Sullivan A, Ruban A. Bariatric surgery and the endoscopist. Frontline Gastroenterol 2020; 12:683-689. [PMID: 34917327 PMCID: PMC8640407 DOI: 10.1136/flgastro-2020-101681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/04/2023] Open
Abstract
Bariatric surgery is an effective treatment for obesity and its metabolic related disorders. With the numbers of bariatric procedures being performed rising annually endoscopists are now more likely than ever to encounter this patient cohort on routine diagnostic lists. Endoscopy plays a vital role in both the pre and postoperative periods to diagnose and treat certain complications associated with bariatric surgery. Preoperative endoscopy may be useful in identifying pathologies that then influence the type of bariatric surgery being proposed. Postoperative endoscopy has an established role in identifying and managing complications such as anastomotic leaks and gastrointestinal bleeding. As endoscopic techniques develop, these complications may be managed without the need for surgical intervention or revision. Increased knowledge and awareness of the indications for endoscopy, together with the altered anatomy and common complications of bariatric surgery, is paramount in managing these patients effectively.
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Affiliation(s)
- Laura Temperley
- Clinical Fellow, Hepatology, King's College Hospital, London, UK
| | - Andrew Sullivan
- Clinical Fellow, Cardiology, Barts Health NHS Trust, London, UK
| | - Aruchuna Ruban
- Consultant Gastroenterologist, Imperial College Healthcare NHS Trust, London, UK
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12
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Wang L, Sang Q, Zheng X, Du D, Zhang N, Lian D. Early Weight Loss Following Laparoscopic Sleeve Gastrectomy Is Predictive of Long-Term Weight Loss in Morbidly Obese Chinese. Obes Surg 2020; 31:820-828. [PMID: 33057884 DOI: 10.1007/s11695-020-05037-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical approach often used to treat Chinese individuals suffering from morbid obesity. OBJECTIVES To verify the long-term safety and efficiency of LSG and to evaluate the predictive effect of initial weight loss on long-term weight maintenance after LSG in morbidly obese Chinese. METHODS Follow-up was conducted by telephone or in hospital. We measured the body mass index (BMI), percentage of total body weight loss (%TWL), and excess weight loss (%EWL), and assessed patients for the alleviation of co-morbidities. Relationships between initial weight loss and successful weight maintenance were assessed via linear regression analyses, while optimal cutoff values were determined based on receiver operative characteristic (ROC) curves. RESULTS We included 384 patients in this study. Before surgery, these patients had median weight and BMI values of 110 (91.00-130.75) kg and 38.49 (32.82-44.12) kg/m2, respectively. Successful weight loss of > 50% EWL was accomplished in 91.21%, 82.69%, and 79.37% of patients at 1, 3, and 5 years after surgery. In addition, the %EWL at 6 months was significantly correlated with the %EWL up to 5 years (P < 0.001) in morbidly obese Chinese. Based on the ROC curve, the EWL of 56.54% at 6 months was the best predictor of successful weight loss at 5 years (sensitivity 72.38%, specificity 82.69%) in morbidly obese Chinese. CONCLUSION LSG has long-term safety and efficacy for morbidly obese Chinese patients. The %EWL at 6 months can be used to predict weight maintenance up to 5 years after LSG.
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Affiliation(s)
- Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Dexiao Du
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China.
| | - Dongbo Lian
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China.
- Shijitan Hospital, Tieyi Road, Haidian District, Beijing, China.
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13
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Marillier M, Bernard AC, Reimao G, Castelli G, Alqurashi H, O'Donnell DE, Neder JA. Breathing at Extremes. Chest 2020; 158:1576-1585. [DOI: 10.1016/j.chest.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
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14
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Şen O, Türkçapar AG, Yerdel MA. Screening Esophagogastroduodenoscopy Before Laparoscopic Sleeve Gastrectomy: Results in 819 Patients. J Laparoendosc Adv Surg Tech A 2020; 31:672-675. [PMID: 32882153 DOI: 10.1089/lap.2020.0541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: The routine use of esophagogastroduodenoscopy (EGD) during the preoperative evaluation of surgical weight loss candidates is controversial. The aim of this study is to evaluate the findings of preoperative EGD in patients who are scheduled for a primary laparoscopic sleeve gastrectomy (LSG). The probable effect of these findings on the medical and surgical strategy that was followed is assessed. Methods: Findings of EGD obtained from consecutive LSG candidates and all data were prospectively recorded and retrieved from the database. Results: A total of 819 patients underwent EGD successfully. Mean age and body mass index were 38 ± 11.3 and 43.17 ± 7.2 kg/m2, respectively. Fifty-eight percent were female. EGD of 263 (32.1%) patients was normal and 687 (84%) patients were asymptomatic. At least one abnormal finding was detected in 65% of the asymptomatic patients. Abnormal findings that did not change the surgical strategy were found in 550 patients (67.2%). Findings such as gastritis or duodenitis that changed the medical management before surgery were found in 309 patients (38.2%). Helicobacter pylori was positive in 218 (26.6%) patients but eradication treatment was not applied in the preoperative period. No pathology was detected that would create absolute contraindication or change the type of surgery in any patient. Only technical modifications were required in 13% due to hiatal hernia. The timing of the planned surgery has changed in only 6 patients (0.74%) (early stage neuroendocrine tumor, leiomyoma, severe ulcer). Conclusions: Routine EGD performed before LSG did not change the planned bariatric option in any patient, but led to 13% rate of technical modifications due to the presence of hiatal hernia. At least one abnormal finding was detected in 65% of asymptomatic patients. Due to endoscopic findings, the rate of patients who started medical acid-suppression treatment in the preoperative period was 38%.
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Affiliation(s)
- Ozan Şen
- Türkçapar Bariatrics, Obesity Center, İstanbul, Turkey.,İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey.,Department of Health Sciences, Nişantaşı University, İstanbul, Turkey
| | | | - Mehmet Ali Yerdel
- İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey
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15
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Fernández JA, Frutos MD, Ruiz-Manzanera JJ. Incidental Gastrointestinal Stromal Tumors (GISTs) and Bariatric Surgery: A Review. Obes Surg 2020; 30:4529-4541. [DOI: 10.1007/s11695-020-04853-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
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16
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Turchi MJ, Kingma F, Laborda N, Montanelli A, Maldonado JM, Fiolo FE. Roux-en-Y gastric bypass in the elderly: is age a determining factor in our outcomes? Surg Obes Relat Dis 2020; 16:1514-1520. [PMID: 32665112 DOI: 10.1016/j.soard.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND While patients are becoming older and the prevalence of obesity increases worldwide, literature on the impact of age on outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) is scarce. The balance between surgical risks and clinical benefits of LRYGB are unclear in relation to age. OBJECTIVES To evaluate the impact of age on the risk of postoperative complications, postoperative weight loss, and remission of co-morbidities for patients who underwent LRYGB. SETTING A high-volume center for bariatric surgery. METHODS A retrospective analysis of 582 patients who underwent LRYGB was performed. Linear logistic regression analyses were performed to evaluate the potential impact of age on the postoperative percentage of total weight loss (%TWL). Multivariable binary logistic regression analyses were performed to evaluate whether age was independently associated with the risk of postoperative complications and likelihood of remission of co-morbidities (hypertension, diabetes, and dyslipidemia). In addition, these outcomes were descriptively analyzed for the following 3 age groups: the young (18-39 yr), the middle aged (40-59 yr), and the elderly (≥60 yr). RESULTS Patients with hypertension were more prone to developing postoperative complications (odds ratio 2.435, 95% confidence interval: 1.241-4.777) and no other factors were found to be associated with the risk of postoperative complications. Older age was significantly associated with lower %TWL at a postoperative follow-up of 6 (ß = -.117, P = .004), 12 (ß = -.177, P < .001), and 36 months (ß = -.169, P = .001), but not at 60 months (ß = -.097, P = .161). Nonetheless, a %TWL of 30% was observed in patients who were >60 years at the time of surgery. Age was not associated with the likelihood of co-morbidity resolution after LRYGB. The remission of hypertension was less likely in patients with co-existence of diabetes (odds ratio .334, 95% confidence interval: .136-.821) and in patients with a longer length of postoperative follow-up (odds ratio .982, 95% confidence interval: .966-.998). CONCLUSIONS Although older age seems to be associated with lower postoperative %TWL, elderly patients can still achieve a %TWL of 30% after LRYGB. In this study, age was not found to be an independent predictor of postoperative complications nor the likelihood of co-morbidity resolution. Therefore, older age alone should not be an absolute contraindication for LRYGB.
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Affiliation(s)
- Matías J Turchi
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina.
| | - Feike Kingma
- University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Nicolás Laborda
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Agostina Montanelli
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Juan M Maldonado
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Felipe E Fiolo
- Bariatric and Metabolic Surgery Section, Department of General Surgery, Hospital Privado de Comunidad, Mar del Plata, Argentina
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17
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Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique. Obes Surg 2020; 30:4375-4380. [PMID: 32588172 DOI: 10.1007/s11695-020-04800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. MATERIALS AND METHODS A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. RESULTS A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. CONCLUSION Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.
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18
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Takahashi K, Seki Y, Kasama K, Amiki M, Baba S, Ito M, Tanaka T, Kanehira E. Prevalence of reflux esophagitis in obese Japanese undergoing bariatric surgery. JGH OPEN 2020; 4:519-524. [PMID: 32514464 PMCID: PMC7273729 DOI: 10.1002/jgh3.12293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/20/2019] [Accepted: 12/01/2019] [Indexed: 12/22/2022]
Abstract
Background Currently, the data on the relationship between obesity and gastroesophageal reflux disease (GERD) in Asian populations are scarce. Methods The aim of this study is to investigate the prevalence of reflux esophagitis (RE) among obese Japanese patients in each body mass index (BMI) range group. In addition, we aim to investigate the risk factors for RE in obese Japanese patients. The present retrospective cohort study included 674 obese Japanese patients who underwent bariatric surgery between January 2003 and April 2016. The patients were stratified into five groups based on BMI range. Results The mean BMI was 42.7 ± 9.24 kg/m2. The prevalence of RE among each of the groups was as follows: Group 1 (BMI 30–34.9) = 20.7%; Group 2 (BMI 35–39.9) = 24.0%; Group 3 (BMI 40–44.9) = 25.2%; Group 4 (BMI 45–49.9) = 26.7%; and Group 5 (BMI ≥50) = 24.8%. Overall, the prevalence of RE was 24.2% in our study. Furthermore, no significant difference in BMI was noted between the RE and non‐RE groups (43.4 ± 9.3 kg/m2 and 42.5 ± 10.2 kg/m2, respectively; p = 0.24). According to the multivariate logistic regression model, gender, Helicobacter pylori infection status, GERD‐related symptoms, and hiatal hernia were significantly correlated with RE. Conclusion Our study shows that the prevalence of RE in severely obese Japanese patients was significantly higher than the average prevalence of RE in Japan. However, the prevalence of RE did not increase with BMI in our cohort.
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Affiliation(s)
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center Yotsuya Medical Cube Tokyo Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center Yotsuya Medical Cube Tokyo Japan
| | - Manabu Amiki
- Weight Loss and Metabolic Surgery Center Yotsuya Medical Cube Tokyo Japan
| | - Satoshi Baba
- Department of Gastroenterology Yotsuya Medical Cube Tokyo Japan
| | - Masayoshi Ito
- Department of Gastroenterology Yotsuya Medical Cube Tokyo Japan
| | - Tatsuro Tanaka
- Department of Gastroenterology Yotsuya Medical Cube Tokyo Japan
| | - Eiji Kanehira
- Department of Surgery Medical Topia Soka Saitama Japan
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Ruiz-Tovar J, Sanchez-Santos R, Martín-García-Almenta E, García Villabona E, Hernandez AM, Hernández-Matías A, Ramírez JM. Rehabilitación multimodal en cirugía bariátrica. Cir Esp 2019; 97:551-559. [DOI: 10.1016/j.ciresp.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 05/01/2019] [Indexed: 12/21/2022]
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20
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Şen O, Türkçapar AG. Finding carcinoid tumor before bariatric surgery. Is preoperative endoscopy necessary? Case report. Int J Surg Case Rep 2019; 62:132-134. [PMID: 31499413 PMCID: PMC6734182 DOI: 10.1016/j.ijscr.2019.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 12/16/2022] Open
Abstract
The routine use of upper GI endoscopy in preoperative evaluation of bariatric surgery patients still remains controversial. The incidence of cancer increases in obese patients. The incidence of gastric neuroendocrine tumors in obese patients is higher than the general population (0.6% to 0.0006%). Endoscopic evaluation before bariatric surgery is important in terms of revealing many stomach pathologies that may change the treatment of the patient.
Introduction Carcinoid tumors are endocrine system-related lesions and 4% of the gastrointestinal tract's neuroendocrine tumors (NET) originate from stomach. In recent years, gastric carcinoid tumors have been reported at increasing rates on endoscopies. In this article, we will present a case of gastric carcinoid tumor detected at the upper gastrointestinal (GI) endoscopy during preoperative bariatric surgery workup. Case presentation A 55 years old male patient with body mass index (BMI) 46 kg/m2 was scheduled for bariatric surgery. Upper GI endoscopy revealed 2 separate 4–5 mm nodular lesions at gastric corpus and antrum. Biopsies were taken and both lesions were reported as neuroendocrine tumors. It was decided that the Laparoscopic sleeve gastrectomy (LSG) operation would be performed because both lesion areas would remain in the extracted part of stomach. Discussion The routine use of upper GI endoscopy in preoperative evaluation of bariatric surgery patients still remains controversial. Conclusion Upper GI endoscopy is very important in determining various gastric pathologies and determining the most appropriate surgical method before bariatric surgery.
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Affiliation(s)
- Ozan Şen
- Türkçapar Bariatrics, Obesity Center, Istanbul, Turkey; Acibadem Fulya Hospital, Istanbul, Turkey.
| | - Ahmet Gökhan Türkçapar
- Türkçapar Bariatrics, Obesity Center, Istanbul, Turkey; Acibadem Fulya Hospital, Istanbul, Turkey
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21
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Mazahreh TS, Aleshawi AJ, Al-Zoubi NA, Allouh MZ, Jadallah KA, Elayyan R, Novotny NM. Preoperative esophagogastroduodenoscopy in patients without reflux symptoms undergoing laparoscopic sleeve gastrectomy: utility or futility? Clin Exp Gastroenterol 2019; 12:295-301. [PMID: 31456645 PMCID: PMC6620317 DOI: 10.2147/ceg.s216188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Aim To evaluate the value of esophagogastroduodenoscopy (EGD) as a preoperative investigation in individuals without symptoms of Gastro-Esophageal Reflux Disease (GERD) who will undergo laparoscopic sleeve gastrectomy (LSG). Materials and methods After Institutional Review Board approval was obtained, patients scheduled for LSG were prospectively enrolled in the study between January 2016 and March 2018. Patients with symptoms of GERD were excluded from the study. Participants were randomly allocated to two groups: individuals who underwent EGD before the surgery as a usual routine investigation (Group A), and individuals who were scheduled without preoperative EGD (Group B). Patient demographics, endoscopic findings, endoscopic biopsy results, and histopathological findings of the resected parts of the stomach after LSG were analyzed and recorded. Additionally, operative characteristics and outcomes, and follow up findings were recorded and analyzed with appropriate statistical methods. Results A total of 219 individuals without symptoms of GERD underwent LSG were enrolled. Group A included 111 individuals (25 males and 86 females). Group B comprised 108 individuals (20 males and 88 females). The mean age and mean Body Mass Index (BMI) were similar in both groups. From Group A, 86 out of 111 individuals (77.5%) had no pathology identified on EGD, while 21 individuals (18.9%) were found to have areas of gastric erythema and biopsies showed active gastritis. All LSG operations were performed without any major complication. After one year, all individuals were assessed for the presence of symptomatic GERD and no significant difference was found between the two groups. Conclusion Preoperative EGD may not be mandatory for asymptomatic GERD individuals undergoing LSG as post-operative complications and early follow up for GERD symptoms are not significantly different. Further prospective studies with longer follow up are needed to evaluate the role of EGD in individuals undergoing LSG.
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Affiliation(s)
- Tagleb S Mazahreh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Abdelwahab J Aleshawi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nabil A Al-Zoubi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan.,Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain 17666, UAE
| | - Khaled A Jadallah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Rasheed Elayyan
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nathan M Novotny
- Department of Pediatric Surgery, Beaumont Children's, Oakland University William Beaumont School of Medicine, Michigan 48073, USA
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22
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Major P, Stefura T, Walędziak M, Janik M, Pędziwiatr M, Wysocki M, Rubinkiewicz M, Witowski J, Szeliga J, Budzyński A. What Makes Bariatric Operations Difficult-Results of a National Survey. ACTA ACUST UNITED AC 2019; 55:medicina55060218. [PMID: 31141961 PMCID: PMC6631593 DOI: 10.3390/medicina55060218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
Abstract
Background and objective: The most commonly performed bariatric procedures include laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB). A study comparing the degree of difficulty among those procedures could serve as a guide for decision making in bariatric surgery and further improve training programs for general surgery trainees. The aim of this study was to compare the subjective level of technical difficulty of LSG, LRYGB, and OAGB-MGB as perceived by surgeons and surgical residents. Materials and Methods: An anonymous internet-based survey was designed to evaluate the subjective opinions of surgeons and surgical residents in training in Poland. It covered baseline characteristics of the participants, difficulty of LSG, OAGB-MGB, LRYGB and particular stages of each operation assessed on a 1-5 scale. Results: Overall, 70 surgeons and residents participated in our survey. The mean difficulty degree of LSG was 2.34 ± 0.89. The reinforcing staple line with sutures was considered most difficult stage of this operation (3.17 ± 1.19). The LRYGB operation had an average difficulty level of 3.87 ± 1.04. Creation of the gastrojejunostomy was considered the most difficult stage of LRYGB with a mean difficulty level (3.68 ± 1.16). Responders to our survey assessed the mean degree of difficulty of OAGB-MGB as 2.34 ± 0.97. According to participating surgeons, creating the gastrojejunostomy is the most difficult phase of this operation (3.68 ± 1.16). Conclusion: The LSG is perceived by surgeons as a relatively easy operation. The LRYGB was considered to be the most technically challenging procedure in our survey. Operative stages, which require intra-abdominal suturing with laparoscopic instruments, seem to be the most difficult phases of each operation.
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Affiliation(s)
- Piotr Major
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Tomasz Stefura
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland.
| | - Michał Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland.
| | - Michał Pędziwiatr
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Michał Wysocki
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
| | - Mateusz Rubinkiewicz
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Jan Witowski
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
| | - Jacek Szeliga
- Department of General, Gastroenterological, and Oncological Surgery Collegium Medicum, Nicolaus Copernicus University, 87-100 Torun, Poland.
| | - Andrzej Budzyński
- nd Department of General Surgery, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), 31-501 Krakow, Poland.
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Liu S, Nicoara M, Morin N, Ferzli G. Dieulafoy's lesion discovered after laparoscopic sleeve gastrectomy. BMJ Case Rep 2018; 11:11/1/e227423. [PMID: 30567207 DOI: 10.1136/bcr-2018-227423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shinban Liu
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
| | - Michael Nicoara
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
| | - Nicholas Morin
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
| | - George Ferzli
- General Surgery, NYU Langone Medical Center, Brooklyn, New York, USA
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The Impact of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Intestinal Microbiota Differs from that of Laparoscopic Sleeve Gastrectomy in Japanese Patients with Obesity. Clin Drug Investig 2018; 38:545-552. [PMID: 29508311 DOI: 10.1007/s40261-018-0638-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Bariatric surgery improves metabolic diseases and alters the intestinal microbiota in animals and humans, but different procedures reportedly have different impacts on the intestinal microbiota. We developed laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) as an alternative to laparoscopic Roux-en-Y gastric bypass (LRYGB) in addition to laparoscopic sleeve gastrectomy (LSG) for Japanese patients with obesity. We investigated the precise change in the intestinal microbiota induced by these procedures in the present study. METHODS A prospective observational study of 44 Japanese patients with obesity was conducted [22 patients underwent LSG, 18 underwent LSG-DJB, and 4 underwent laparoscopic adjustable gastric banding (LAGB)]. The patients' clinical parameters and intestinal microbiota were investigated before and for 6 months after surgery. The microbiota was analyzed by a 16S rDNA method. RESULTS LSG and LSG-DJB significantly improved the metabolic disorders in the patients with obesity. The proportion of the phylum Bacteroidetes and order Lactobacillales increased significantly in the LSG group, and that of the order Enterobacteriales increased significantly in the LSG-DJB group. CONCLUSIONS LSG and LSG-DJB improved obesity and type 2 diabetes in Japanese patients with obesity, but the impact of LSG-DJB on the intestinal microbiota differed from that of LSG. This difference in the impact on the intestinal environment could explain the different efficacies of LSG and LSG-DJB in terms of their ability to resolve metabolic disorders in the clinical setting.
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Endo Y, Ohta M, Tada K, Saga K, Takayama H, Hirashita T, Uchida H, Iwashita Y, Inomata M. Clinical significance of upper gastrointestinal endoscopy before laparoscopic bariatric procedures in Japanese patients. Surg Today 2018; 49:27-31. [DOI: 10.1007/s00595-018-1705-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/19/2018] [Indexed: 01/01/2023]
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Abstract
INTRODUCTION Routine use of preoperative abdominal ultrasound for patients undergoing bariatric surgery is controversial. Despite that some physicians routinely implement it, others consider it unnecessary and not cost effective because it does not have a clear clinical significance in the preparation of bariatric patients. AIM OF THE STUDY To investigate whether routine abdominal ultrasound prior to bariatric surgery affects the surgical plan or not. PATIENTS AND METHODS We reviewed medical records of patients with abdominal ultrasound before bariatric surgery in Rashid Hospital between June 2014 and December 2016. Patients were divided into four groups: group 0 included patients with normal abdominal ultrasound, group 1 included abnormalities that did not affect timing or type of procedure, group 2 included findings that did not affect surgical plan but needed postoperative follow-up, and group 3 included abnormalities that had a direct impact on the procedure. RESULTS One thousand one hundred twenty files were reviewed. Results were missing in 183 files, thus excluded; remaining 937 files were included. Mean age of patients was 37 ± 12 years, 589 (63%) were females and 348 (37%) were males. Mean BMI was 45.1 ± 9.8 kg/m2. Ultrasound was normal in 354 (37.7%) of patients and abnormal in 583 (62.3%). CONCLUSION Routine abdominal ultrasound does not seem to have an important part in preoperative preparation of patients before bariatric surgery. Further studies could be helpful in discussing this role and building up clear solid evidence and guidelines that could be approved by international bariatric associations regarding the indication of preoperative abdominal ultrasound before bariatric surgery.
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Saarinen T, Kettunen U, Pietiläinen KH, Juuti A. Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass? Surg Obes Relat Dis 2018; 14:757-762. [PMID: 29477376 DOI: 10.1016/j.soard.2018.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux-en-Y gastric bypass (RYGB). OBJECTIVES We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB). We also studied how many reoperations were performed due to postoperative GERD in SG-patients. SETTING University hospital. METHODS We investigated preoperative EGD-findings and gastrointestinal symptoms before bariatric surgery in all patients with a primary bariatric operation in our unit between December 2007 and May 2016. RESULTS We performed 1474 operations: 1047 (71.0%) RYGB, 407 (27.6%) SG, and 20 (1.4%) others. One thousand two hundred seventy-five (86.5%) preoperative EGD reports were analyzed: 647 (50.7%) EGDs were completely normal. Altogether, 294 patients (23.0% of total) had a clinically significant finding that was relevant for SG (hiatal hernia, esophagitis, Barrett's esophagus, esophageal dysplasia), 144 (49.0%) of whom reported gastrointestinal symptoms. Twenty patients (1.6%) had a significant finding relevant for RYGB (peptic ulcer, atrophic gastritis, gastrointestinal stromal tumor), and 6 (30%) reported gastrointestinal symptoms. Thirteen (3.2%) SGs were converted into RYGB due to GERD. CONCLUSIONS Preoperative EGD is indicated before SG but not before RYGB for asymptomatic patients without a risk for gastric pathology.
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Affiliation(s)
- Tuure Saarinen
- Helsinki University Hospital, Abdominal Center, Department of Gastrointestinal Surgery, helsinki, Finland; Obesity Research Unit, Research Programs Unit, Diabetes and Obesity, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland.
| | - Ulla Kettunen
- Helsinki University Hospital, Abdominal Center, Department of Gastrointestinal Surgery, helsinki, Finland; Obesity Research Unit, Research Programs Unit, Diabetes and Obesity, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Helsinki University Hospital, Abdominal Center, Department of Gastrointestinal Surgery, helsinki, Finland; Obesity Research Unit, Research Programs Unit, Diabetes and Obesity, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland
| | - Anne Juuti
- Helsinki University Hospital, Abdominal Center, Department of Gastrointestinal Surgery, helsinki, Finland
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Csendes A. "Upper Gastrointestinal Endoscopy Prior to Bariatric Surgery. Mandatory or Expendable? An Analysis of 801 Cases". Obes Surg 2018; 28:1148. [PMID: 29417485 DOI: 10.1007/s11695-018-3133-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mocanu V, Dang JT, Switzer N, Skubleny D, Shi X, de Gara C, Birch DW, Karmali S. The Effect of Helicobacter pylori on Postoperative Outcomes in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2018; 28:567-573. [PMID: 29159552 DOI: 10.1007/s11695-017-3024-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori (HP) occurs in 50% of people worldwide with higher rates reported in the bariatric population. HP has been associated with adverse outcomes following bariatric surgery; however, its true impact has not yet been defined. We aimed to systematically review the effect of HP on bariatric surgery outcomes. A comprehensive literature review was conducted yielding seven studies with 255,435 patients. Meta-analysis found comparable rates of bleeding, leak, hospital length of stay, and weight loss between HP-positive and HP-negative patients. HP was, however, found to be the largest independent predictor of marginal ulceration in those undergoing RYGB, with a tenfold increase versus HP-negative patients. Overall, HP is associated with increased marginal ulceration rates, but has little impact on other bariatric surgery outcomes.
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Affiliation(s)
- Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
- Department of Surgery, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Jerry T Dang
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Noah Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel Skubleny
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Xinzhe Shi
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Chris de Gara
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Daniel W Birch
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, AB, Canada
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Georgia D, Stamatina T, Maria N, Konstantinos A, Konstantinos F, Emmanouil L, Georgios Z, Dimitrios T. 24-h Multichannel Intraluminal Impedance PH-metry 1 Year After Laparocopic Sleeve Gastrectomy: an Objective Assessment of Gastroesophageal Reflux Disease. Obes Surg 2017; 27:749-753. [PMID: 27592124 DOI: 10.1007/s11695-016-2359-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION It is not yet clear if laparoscopic sleeve gastrectomy (LSG) causes newly onset gastroesophageal reflux (GERD) or worsens already existing GERD. This is due to the absence of prospective studies using objective assessment measures of GERD such as pH monitoring. Our study aims at assessing GERD 1-year post-LSG procedure for obesity. MATERIALS AND METHODS Twelve asymptomatic obese patients were studied prospectively by using 24-h multichannel intraluminal impedance-pHmetry (MIIpH) pre- and 12 months post-LSG. RESULTS Of patients' 1-year post-LSG, 83.33 % of patients' suffer from GERD (either newly onset or worsening of already existing) as indicated by abnormal DeMeester score. Mean DeMeester score 1-year post LSG was 47, almost 2.5 times higher than the preoperative score (p = 0.072). The percentage of total time with pH lower than four was statistically significant higher postoperatively (13.27 % vs 3.87 %, p = 0.048). CONCLUSION This study is one of the few assessing GERD post-LSG by using 24-h MIIpH. The majority of patients suffer from GERD 12 months postoperatively, implying that close postoperative monitor for GERD with the use of pH testing and upper gastrointestinal endoscopy in order to early diagnose GERD and identify possible mucosal injury and also a prophylactic proton pump inhibitor use may be of great importance.
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Affiliation(s)
- Doulami Georgia
- Foregut Department, 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas Sofias Av, 115 27, Athens, Greece.
| | - Triantafyllou Stamatina
- Foregut Department, 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas Sofias Av, 115 27, Athens, Greece
| | - Natoudi Maria
- Bariatric Surgery Department, 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Albanopoulos Konstantinos
- Bariatric Surgery Department, 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Filis Konstantinos
- 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Leandros Emmanouil
- Bariatric Surgery Department, 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Zografos Georgios
- 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodorou Dimitrios
- Foregut Department, 1st Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas Sofias Av, 115 27, Athens, Greece
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Early weight loss after laparoscopic sleeve gastrectomy predicts midterm weight loss in morbidly obese Asians. Surg Obes Relat Dis 2017; 13:1966-1972. [DOI: 10.1016/j.soard.2017.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/30/2017] [Accepted: 05/11/2017] [Indexed: 01/07/2023]
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Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2017; 40:2065-83. [PMID: 26943657 DOI: 10.1007/s00268-016-3492-3] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. METHODS The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. RESULTS Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. CONCLUSIONS A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
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Affiliation(s)
- A Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital & Department of Surgery, Ersta Hospital, 116 91, Stockholm, Sweden.
| | - A D MacCormick
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau Health, Auckland, New Zealand
| | - S Awad
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK.,School of Clinical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - N Reynolds
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - D Roulin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - M Vignaud
- Département d'anesthésie reanimation Service de chirurgie digestive, CHU estaing 1, place Lucie et Raymond Aubrac, Clermont Ferrand, France
| | - A Alvarez
- Department of Anesthesia, Hospital Italiano de Buenos Aires, Buenos Aires University, 1179, Buenos Aires, Argentina
| | - P M Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D N Lobo
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Childerhose JE, Alsamawi A, Mehta T, Smith JE, Woolford S, Tarini BA. Adolescent bariatric surgery: a systematic review of recommendation documents. Surg Obes Relat Dis 2017; 13:1768-1779. [DOI: 10.1016/j.soard.2017.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/25/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
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Abstract
A substantial decrease in Helicobacter pylori-associated peptic ulcer disease has been observed during the last decades. Drug-related ulcers as well as idiopathic ulcers are becoming predominant and are more refractory to treatment; however, H. pylori infection still plays an important role in ulcer bleeding and recurrence after therapy. The effect of H. pylori eradication upon functional dyspepsia symptoms has been reviewed in this article and generally confirms the results of previous meta-analyses. Additional evidence suggests a lack of impact upon the quality of life, in spite of improvement in symptoms. The association of H. pylori with gastroesophageal reflux disease and Barrett's esophagus remains controversial with a majority of published studies showing a negative association. Furthermore, a strong inverse relationship between the presence of H. pylori and the esophageal eosinophilia was also reported. Several studies and a review addressed the role of H. pylori in autoimmune gastritis and pernicious anemia. The association of the above still remains controversial. Finally, the necessity of routine endoscopy and H. pylori eradication before bariatric surgery is discussed. Several studies suggest the rationale of preoperative upper endoscopy and H. pylori eradication prior to surgery. However, the prevalence of H. pylori infection prior to surgery in these studies generally reflects the overall prevalence of the infection in the particular geographic area. In addition, results on the role of H. pylori in developing postoperative complications remain controversial.
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Affiliation(s)
- Olga Sjomina
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | - Frederic Heluwaert
- Hepato-gastroenterology department, Annecy Genevois Hospital, Pringy, France
| | - Driffa Moussata
- Gastroenterology department, Tours University Hospital, Tours, France
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia.,Riga East University Hospital, Riga, Latvia.,Digestive Diseases Centre GASTRO, Riga, Latvia
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Safaan T, Bashah M, El Ansari W, Karam M. Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination. Obes Surg 2017; 27:1741-1749. [PMID: 28063114 PMCID: PMC5489580 DOI: 10.1007/s11695-016-2525-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history. METHODS Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011-July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes. RESULTS Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each). CONCLUSION Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.
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Affiliation(s)
- Tamer Safaan
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
| | - Moataz Bashah
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
- College of Medicine, Doha, State of Qatar
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Mohsen Karam
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
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Strømmen M, Helland A, Kulseng B, Spigset O. Bioavailability of Methadone After Sleeve Gastrectomy: A Planned Case Observation. Clin Ther 2016; 38:1532-1536. [PMID: 27181614 DOI: 10.1016/j.clinthera.2016.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Morbidly obese patients on opioid-replacement therapy may be at risk for treatment refusal with regard to bariatric surgery. However, patients on opioid replacement may have the personal skills to facilitate the lifestyle changes required for successful outcomes after bariatric surgery. This planned case observation assessed the effects of sleeve gastrectomy on the pharmacokinetic properties of methadone. METHODS A white woman in her 40s on methadone maintenance therapy and with morbid obesity was referred for bariatric surgery. Serial blood samples for methadone concentration measurements were obtained before and at 5 days and 1, 7, and 11 months after surgery. FINDINGS Serum methadone concentrations increased from before to 5 days after surgery and continued to increase for 7 months thereafter. The predose measurement at 11 months postoperatively suggests a further increase compared with the previous predose measurements. IMPLICATIONS Clinicians should beware the potential for altered effects of methadone after bariatric surgery. We recommend that serum concentrations be routinely measured pre- and postoperatively, and that the dose be adjusted according to these measurements and regular clinical assessments.
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Affiliation(s)
- Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway; Department of Neuroscience, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Helland
- Department of Clinical Pharmacology, Clinic of Laboratory Medicine, St. Olav University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bård Kulseng
- Centre for Obesity Research, Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, Clinic of Laboratory Medicine, St. Olav University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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A randomised, single blinded trial, assessing the effect of a two week preoperative very low calorie diet on laparoscopic cholecystectomy in obese patients. HPB (Oxford) 2016; 18:456-61. [PMID: 27154810 PMCID: PMC4857069 DOI: 10.1016/j.hpb.2016.01.545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) can be technically challenging in the obese. The primary aim of the trial was to establish whether following a Very Low Calorie Diet (VLCD) for two weeks pre-operatively reduces operation time. Secondary outcomes included perceived operative difficulty and length of hospital stay. METHODS A single-blinded, randomized controlled trial of consecutive patients with symptomatic gallstones and BMI >30 kg/m(2) 46 patients were randomized to a VLCD or normal diet for two weeks prior to LC. Food diaries were used to document dietary intake. The primary outcome measure was operation time. Secondary outcomes were length of stay, weight change operative complications, day case rates and perceived difficulty of operation. RESULTS The VLCD was well tolerated and had significantly greater preoperative weight loss (3.48 kg vs. 0.98 kg; p < 0.0001). Median operative time was significantly reduced by 6 min in the VLCD group (25 vs. 31 min; p = 0.0096). There were no differences in post-operative complications, length of stay, or day case rates between the groups. Dissection of Calot's triangle was deemed significantly easier in the VLCD group. CONCLUSION A two week VLCD prior to elective laparoscopic cholecystectomy in obese patients is safe, well tolerated and was shown to significantly reduce pre-operative weight and operative time. ISRCTN 61630192. http://www.isrctn.com/ISRCTN61630192 Trial registration.
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Bennett S, Gostimir M, Shorr R, Mallick R, Mamazza J, Neville A. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2016; 12:1116-1125. [PMID: 27320221 DOI: 10.1016/j.soard.2016.04.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The necessity of routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery is controversial. European guidelines recommend routine EGD while North American guidelines recommend a selective approach. OBJECTIVE Perform a systematic review and meta-analysis to determine the proportion and scope of clinical findings discovered at preoperative EGD. SETTING Academic hospital, Canada. METHODS A search of MEDLINE, Embase, and Cochrane databases included MeSH terms "bariatric surgery," "endoscopy," and "preoperative." Inclusion criteria were any case series, cohort study, or clinical trial describing results of preoperative EGD for any bariatric surgery. Exclusion criteria were studies with<10 patients, patients<18 years of age, or revisional operations. Changes in surgical and medical management and proportions of pathologic findings were extracted and combined in a meta-analysis using the random effects model. RESULTS Initial search identified 532 citations. Forty-eight were included after full text review. Included studies comprised 12,261 patients with a mean (SD) age of 40.5 (1.3) years and body mass index of 46.3 (1.5) kg/m(2). The majority of patients (77.1%) were female. The proportion of EGDs resulting in a change in surgical management was 7.8%. After removing benign findings with controversial impact on management (hiatal hernia, gastritis, peptic ulcer), this was found to be .4%. Changes in medical management were seen in 27.5%, but after eliminating Helicobacter pylori eradication, this was found to be 2.5%. CONCLUSION Preoperative EGD in average-risk, asymptomatic bariatric surgery patients should be considered optional, as the proportion of EGDs that resulted in important changes in management was low.
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Affiliation(s)
- Sean Bennett
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Risa Shorr
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Mamazza
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amy Neville
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Yang B, Yang HP, Ward KK, Sahasrabuddhe VV, McGlynn KA. Bariatric Surgery and Liver Cancer in a Consortium of Academic Medical Centers. Obes Surg 2016; 26:696-700. [PMID: 26757918 PMCID: PMC4769957 DOI: 10.1007/s11695-016-2051-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Obesity is implicated as an important factor in the rising incidence of liver cancer in the USA. Bariatric surgery is increasingly used for treating morbid obesity and comorbidities. Using administrative data from UHC, a consortium of academic medical centers in the USA, we compared the prevalence of liver cancer among admissions with and without a history of bariatric surgery within a 3-year period. Admissions with a history of bariatric surgery had a 61 % lower prevalence of liver cancer compared to those without a history of bariatric surgery (prevalence ratio 0.39, 95 % confidence interval 0.35-0.44), and these inverse associations persisted within strata of sex, race, and ethnicity. This hospital administrative record-based analysis suggests that bariatric surgery could play a role in liver cancer prevention.
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Affiliation(s)
- Baiyu Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
| | - Hannah P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
| | - Kristy K Ward
- Division of Gynecologic Oncology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, 32209, USA.
| | - Vikrant V Sahasrabuddhe
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, 20892-9783, USA.
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
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Early outcomes of laparoscopic sleeve gastrectomy in a multiethnic Asian cohort. Surg Obes Relat Dis 2016; 12:330-7. [DOI: 10.1016/j.soard.2015.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 05/15/2015] [Indexed: 12/12/2022]
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Previous weight loss as a predictor of weight loss outcomes after laparoscopic adjustable gastric banding. Surg Endosc 2015. [DOI: 10.1007/s00464-015-4441-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Echaverry-Navarrete DJ, Maldonado-Vázquez A, Cortes-Romano P, Cabrera-Jardines R, Mondragón-Pinzón EE, Castillo-González FA. [Gastric band erosion: Alternative management]. CIR CIR 2015; 83:418-23. [PMID: 26164136 DOI: 10.1016/j.circir.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 09/04/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity is a public health problem, for which the prevalence has increased worldwide at an alarming rate, affecting 1.7 billion people in the world. OBJECTIVE To describe the technique employed in incomplete penetration of gastric band where endoscopic management and/or primary closure is not feasible. MATERIAL AND METHODS Laparoscopic removal of gastric band was performed in five patients with incomplete penetrance using Foley catheterization in the perforation site that could lead to the development of a gastro-cutaneous fistula. CLINICAL CASES The cases presented include a leak that required surgical lavage with satisfactory outcome, and one patient developed stenosis 3 years after surgical management, which was resolved endoscopically. In all cases, the penetration site closed spontaneously. DISCUSSION Gastric band erosion has been reported in 3.4% of cases. The reason for inserting a catheter is to create a controlled gastro-cutaneous fistula, allowing spontaneous closure. CONCLUSIONS Various techniques have been described: the totally endoscopic, hybrid techniques (endoscopic/laparoscopic) and completely laparoscopic. A technique is described here that is useful and successful in cases where the above-described treatments are not viable.
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Affiliation(s)
| | | | - Pablo Cortes-Romano
- Instituto de Obesidad y Síndrome Metabólico, Hospital Ángeles del Pedregal, México, D.F., México
| | - Ricardo Cabrera-Jardines
- Instituto de Obesidad y Síndrome Metabólico, Hospital Ángeles del Pedregal, México, D.F., México
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Chawla AS, Hsiao CW, Romney MC, Cohen R, Rubino F, Schauer P, Cremieux P. Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications. PHARMACOECONOMICS 2015; 33:629-641. [PMID: 26063335 DOI: 10.1007/s40273-015-0302-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite consistently supportive evidence of clinical effectiveness and economic advantages compared with currently available non-surgical obesity treatments, patient access to bariatric and metabolic surgery (BMS) is impeded. To address this gap and better understand the relationship between value and access, the objectives of this study were twofold: (i) identify the multidimensional barriers to adoption of BMS created by clinical guidelines, public policies, and health technology assessments; and, most importantly, (ii) develop recommendations for stakeholders to improve patient access to BMS. Updated public policies focused on treatment and clinical guidelines that reflect the demonstrated advantages of BMS, patient education on safety and effectiveness, updated reimbursement policies, and additional data on long-term BMS effectiveness are needed to improve patient access.
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Affiliation(s)
- Amarpreet S Chawla
- Quintiles Advisory Services, 4820, Emperor Blvd, Durham, NC, 27703, USA,
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ESTEVEZ FERNANDEZ SERGIO. Esophagogastric pathology in morbid obese patient: Preoperative diagnosis and influence in the selection of surgical technique. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015. [DOI: 10.17235/reed.2015.3530/2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Conflicting evidence exists regarding age as a predictive factor in excess weight loss after bariatric surgery. The objective of this cross-sectional study is to evaluate differences in excess BMI loss (%EBMIL) 1 year after surgery in patients older and younger than 45 years. METHODS Adult obese patients fulfilling selection criteria underwent either Roux-en-Y gastric bypass or sleeve gastrectomy and were grouped according to age < and ≥45 years with follow-up at least 1 year. Both groups were compared in terms of excess BMI loss (%EBMIL) and other clinical outcomes. Possible relationship between %EBMIL, age, surgical technique, and presence of comorbidities such as diabetes mellitus, hypertension (HT), and dyslipidemia (DL) was searched. RESULTS Three hundred thirty-seven patients (72.5 % female), 196 (50.1 %) younger than 45 years and 141 (49.9 %) with age ≥45 years. There was significant difference between age group and %EBMIL 12 months after surgery (p < 0.001), showing better results in younger patients. No differences were found in terms of gender, preoperative body mass index (BMI), surgical technique, nor presence of DL. Using multiple regression, we found significant interaction effect between age group (p < 0.001), presence of HT (p = 0.001), and %EBMIL at follow-up. CONCLUSIONS Patients younger than 45 years lose greater amount of excess BMI than older patients after bariatric surgery. This tendency might be useful as a preoperative weight loss predictor in bariatric patients.
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Hazey JW, Marks JM, Mellinger JD, Trus TL, Chand B, Delaney CP, Dunkin BJ, Fanelli RD, Fried GM, Martinez JM, Pearl JP, Poulose BK, Sillin LF, Vassiliou MC, Melvin WS. Why fundamentals of endoscopic surgery (FES)? Surg Endosc 2013; 28:701-3. [DOI: 10.1007/s00464-013-3299-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/30/2013] [Indexed: 10/25/2022]
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Liss MA, Park SK, Kopp RP, Raheem OA, Bazzi WM, Mehrazin R, Palazzi KL, Stroup SP, Derweesh IH. Is Laparoendoscopic Single-site Surgery a Viable Approach for Radical Nephrectomy With Renal Vein Thrombus? Comparison With Multiport Laparoscopy. Urology 2013; 82:105-10. [DOI: 10.1016/j.urology.2013.01.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/07/2012] [Accepted: 01/08/2013] [Indexed: 10/26/2022]
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Abstract
Enhanced recovery after surgery (ERAS) programs have been shown to minimise morbidity in other types of surgery, but comparatively less data exist investigating ERAS in bariatric surgery. This article reviews the existing literature to identify interventions which may be included in an ERAS program for bariatric surgery. A narrative literature review was conducted. Search terms included 'bariatric surgery', 'weight loss surgery', 'gastric bypass', 'ERAS', 'enhanced recovery', 'enhanced recovery after surgery', 'fast-track surgery', 'perioperative care', 'postoperative care', 'intraoperative care' and 'preoperative care'. Interventions recovered by the database search, as well as interventions garnered from clinical experience in ERAS, were used as individual search terms. A large volume of evidence exists detailing the role of multiple interventions in perioperative care. However, efficacy and safety for a proportion of these interventions for ERAS in bariatric surgery remain unclear. This review concludes that there is potential to implement ERAS programs in bariatric surgery.
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Ramón JM, González CG, Dorcaratto D, Goday A, Benaiges D, González S, Pera M, Grande L. Calidad de la ingesta alimentaria tras la cirugía bariátrica: gastrectomía vertical vs bypass gástrico. Cir Esp 2012; 90:95-101. [DOI: 10.1016/j.ciresp.2011.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/20/2011] [Accepted: 10/03/2011] [Indexed: 12/15/2022]
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