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Maselli DB, Wooley C, Lee D, Waseem A, Donnangelo LL, Secic M, Coan B, McGowan CE. Outcomes of Endoscopic Sleeve Gastroplasty Following Laparoscopic Adjustable Gastric Band: A Propensity Score-matched Analysis. Surg Laparosc Endosc Percutan Tech 2024; 34:185-189. [PMID: 38359348 DOI: 10.1097/sle.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND The performance of endoscopic sleeve gastroplasty (ESG) in patients with prior laparoscopic adjustable gastric band (LAGB) has not been characterized. MATERIALS AND METHODS This is a retrospective propensity score-matched study of ESG after LAGB at 2 centers with expertise in bariatric endoscopy. The primary outcome was total weight loss (TWL) at 12 months. Secondary outcomes included TWL at 3 and 6 months, 12-month excess weight loss (EWL), procedural characteristics, predictors of TWL, and serious adverse events. RESULTS Twenty-six adults (88.5% female, age 50.8 y, BMI 36.5 kg/m 2 ) with prior LAGB (median duration 8 y) underwent ESG at a median of 3 years after LAGB removal. A 2:1 age-matched, sex-matched, and BMI-matched comparator group was created, comprising ESG patients from the same organization and time frame but without prior LAGB. TWL for the LAGB-to-ESG cohort versus the ESG-only cohort was 10.1±5.5% versus 13.0±4.4% at 3 months ( P =0.0256), 12.4±7.2% versus 16.0±5.4% at 6 months ( P =0.0375), and 12.7±8.2% versus 18.4±6.5% at 12 months ( P =0.0149). At 12 months, the LAGB-to-ESG cohort had an EWL of 52.5±50.0%, and 75% achieved TWL ≥10%. There was no association between TWL at 3, 6, or 12 months and the following traits: age or BMI at the time of ESG, patient sex, and time from LAGB removal to ESG. No serious adverse events occurred in either cohort. CONCLUSION ESG after LAGB facilitates safe and clinically meaningful weight loss but is attenuated compared to primary ESG.
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Waseem A, Wawrzynski J, Maselli DB, Kucera A, Wooley C, McGowan C. Endoscopic removal of a weight-loss device with stoma closure using a tack-and-suture device. VideoGIE 2023; 8:441-442. [PMID: 38026712 PMCID: PMC10665149 DOI: 10.1016/j.vgie.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Video 1.
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Maselli DB, Chittajallu V, Wooley C, Waseem A, Lee D, Secic M, Donnangelo LL, Coan B, McGowan CE. Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice. World J Gastrointest Endosc 2023; 15:602-613. [PMID: 37900116 PMCID: PMC10600692 DOI: 10.4253/wjge.v15.i10.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting. AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB. METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics. RESULTS Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m2) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%). CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.
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Affiliation(s)
- Daniel B Maselli
- Clinical Research, True You Weight Loss, Atlanta, GA 30342, United States
| | - Vibhu Chittajallu
- Department of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Chase Wooley
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Areebah Waseem
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Michelle Secic
- Secic Statistical Consulting, Cleveland, OH 44106, United States
| | | | - Brian Coan
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
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Maselli DB, Waseem A, Lee D, Wooley C, Donnangelo LL, Coan B, McGowan CE. Performance Characteristics of Endoscopic Sleeve Gastroplasty in Patients with Prior Intragastric Balloon: Results of a Propensity Score Matched Study. Obes Surg 2023; 33:2711-2717. [PMID: 37474866 DOI: 10.1007/s11695-023-06715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION The performance characteristics of endoscopic sleeve gastroplasty (ESG) for weight recurrence after intragastric balloon (IGB) are unknown. METHODS This is a retrospective propensity score matched study of ESG after IGB (IGB-to-ESG) vs ESG without prior IGB (ESG-only). The primary outcome was total weight loss (TWL) at 12 months. Secondary outcomes included TWL at 3 and 6 months, 12-month excess weight loss (EWL), procedural characteristics, and safety. RESULTS Thirty-nine adults underwent ESG from August 2020 to September 2022 after IGB explantation a median of 24 months (range 2-56 months) prior and a median post-IGB nadir weight increase of 100.0% (range 0 to 3200%). An ESG-only 2:1 age- sex- and BMI- propensity score matched cohort was derived from 649 patients (Pearson's goodness-of-fit: 0.86). TWL for IGB-to-ESG vs. ESG-only was 12.3 ± 13.5% vs. 12.4 ± 3.7% at 3 months (p = 0.97), 10.1 ± 7.1% vs. 15.4 ± 4.6% at 6 months (p < 0.001), and 8.7 ± 7.7% vs. 17.1 ± 5.7% at 12 months (p < 0.001). Twelve-month EWL for IGB-to-ESG vs ESG-only was 27.8 ± 46.9% vs 62.0 ± 21.0% (p < 0.001). There was no difference in mean procedural duration of ESG; however, more sutures were used with IGB-to-ESG vs. ESG-only (7 vs. 6, p < 0.0002). There were no serious adverse events in either cohort. CONCLUSION ESG after IGB produces safe, acceptable weight loss but with an attenuated effect compared to ESG alone. Further study is required to understand the factors driving this discrepancy.
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Affiliation(s)
- Daniel B Maselli
- True You Weight Loss, 5673 Peachtree Dunwoody Road, Ste 470, Atlanta, GA, 30342, USA
| | - Areebah Waseem
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
| | - Daniel Lee
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
| | - Chase Wooley
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
| | - Lauren L Donnangelo
- True You Weight Loss, 5673 Peachtree Dunwoody Road, Ste 470, Atlanta, GA, 30342, USA
| | - Brian Coan
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
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Maselli DB, Hoff AC, Kucera A, Waseem A, Wooley C, Donnangelo LL, Coan B, McGowan CE. Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults. Ther Adv Gastrointest Endosc 2023; 16:26317745231210120. [PMID: 38026683 PMCID: PMC10666552 DOI: 10.1177/26317745231210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Weight recurrence after one-anastomosis gastric bypass (OAGB), the third most common metabolic and bariatric surgery performed worldwide, is observed in a subset of patients due to the chronic, progressive nature of obesity. Endoscopic revision of the OAGB (ER-OAGB) through full-thickness suturing to reduce the gastrojejunal anastomosis and gastric pouch is a potential alternative to surgical revision. Here, we present a case series of ER-OAGB and long-term nutritional support at two international centers with expertise in bariatric endoscopy. Data were retrospectively evaluated from a prospectively maintained database. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL at 3, 6, and 15 months; excess weight loss (EWL) at 3, 6, 12, and 15 months; frequency of new/worsening symptoms of gastroesophageal reflux disease (GERD); and the frequency of serious adverse events. In this series, 17 adults (70.6% female, mean age 46.8 years, mean BMI 39.1 kg/m2) successfully underwent ER-OAGB an average of 8 years (range 2-21 years) after OAGB for a mean weight recurrence of 43.2% (range 10.9-86.9%). TBWL from ER-OAGB was 9.7 ± 1.8% at 3 months, 13.4 ± 3.5% at 6 months, 18.5 ± 2.1% at 12 months, and 18.1 ± 2.2% at 15 months. EWL from ER-OAGB was 30.5 ± 14.7% at 3 months, 42.6 ± 16.2% at 6 months, 54.2 ± 11.3% at 12 months, and 54.2 ± 11.7% at 15 months. There were no instances of new/worsening GERD symptoms or serious adverse events. In this small series of adults who experienced weight recurrence after OAGB, ER-OAGB facilitated safe and clinically meaningful weight loss, without new or worsening GERD symptoms, when performed by experienced bariatric endoscopists in concert with longitudinal nutritional support.
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Affiliation(s)
| | | | | | | | | | | | | | - Christopher E. McGowan
- Medical Director and Research Director, True You Weight Loss, 2001 Weston Parkway, Cary, NC 27513, USA
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Nelson SD, Sparks EA, Graber HL, Boudoulas H, Mehdirad AA, Baker P, Wooley C. Clinical characteristics of sudden death victims in heritable (chromosome 1p1-1q1) conduction and myocardial disease. J Am Coll Cardiol 1998; 32:1717-23. [PMID: 9822101 DOI: 10.1016/s0735-1097(98)00424-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the clinical characteristics of family members at risk of sudden death. BACKGROUND The significance of sudden death in heritable cardiac disorders with delayed expression is incompletely understood. Additional insights come from a four-decade experience of seven generations of a family of German origin with autosomal dominant (chromosome 1p1-1q1) cardiac conduction and myocardial disease. METHODS AND RESULTS A total of 38 family members (20 males; 18 females) were identified with sudden death. Twenty-eight family members (mean age 48+/-8 years) from earlier generations had no pacemaker at the time of sudden death. In this group, 15 subjects were asymptomatic prior to sudden death. Ten family members with sudden death, from later generations, had chronically implanted pacemakers for high grade atrioventricular block. This group was older (mean age 57+/-2 years), with decreased functional status (New York Heart Association class II to IV), enlarged left atria, dilated left ventricles with reduced systolic function and documented ventricular fibrillation in three members. Twenty-eight family members with sudden death were descendants of sib lineages 2 or 6; 21 family members with sudden death were offspring of a parent who also suffered sudden death. CONCLUSION Sudden death is an important late outcome in heritable (chromosome 1p1-1q1) cardiac conduction and myocardial disease. Pacemaker therapy is important for the treatment of symptomatic bradycardia, but it does not prevent sudden death. Family members who are beyond the third decade of life with reduced functional capacity, left ventricular dysfunction, pacemakers and who are the offspring of a parent with sudden death appear to be at greatest risk
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MESH Headings
- Adult
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/pathology
- Arrhythmias, Cardiac/physiopathology
- Cardiomyopathies/complications
- Cardiomyopathies/genetics
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Chromosomes, Human, Pair 1
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/pathology
- Electrophysiology
- Female
- Humans
- Male
- Middle Aged
- Pacemaker, Artificial
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Affiliation(s)
- S D Nelson
- Division of Cardiology, The Ohio State University, Columbus 43210, USA.
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Verbrugge LM, Kempen GI, Kimmerly L, Wooley C, Chaffin DB. Strength profiles of older persons. Stud Health Technol Inform 1998; 48:240-2. [PMID: 10186519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Coulson SJ, Hodkinson ID, Wooley C, Webb NR, Block W, Worland MR, Bale JS, Strathdee AT. Effects of experimental temperature elevation on high-arctic soil microarthropod populations. Polar Biol 1996. [DOI: 10.1007/bf02390435] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan EC, Iugovaz I, Siboo R, Bilyk M, Barolet R, Amsel R, Wooley C, Klitorinos A. Comparison of two popular methods for removal and killing of bacteria from dentures. J Can Dent Assoc 1991; 57:937-9. [PMID: 1760779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A study was undertaken to compare the efficacy of a soaking solution (Efferdent Extra-Strength Denture Cleanser Tablets) to mechanical cleaning with a denture paste (Advanced Formula Dentu-Creme Denture Cleaning Paste) to remove and kill plaque bacteria from removable dentures. The study was conducted in a randomized, four-way crossover fashion with 18 subjects. At each clinic visit, subjects were randomized to one of four treatment regimens: 1) no treatment; 2) brushing with denture paste; 3) soaking in Efferdent; 4) brushing followed by soaking in Efferdent. Microbiological sampling for plaque bacteria was made before and after each treatment. Aliquot samples of 10-fold serial dilutions were plated on supplemented Schaedler Agar (for total anaerobes) and on CVE agar (for fusobacteria). Analysis of covariance was performed on the log10 transformed scores at posttreatment using the pre-treatment scores as covariates. Significant treatment effects were: F(3,41) = 81.60, p less than 0.001 for anaerobes and F(3,50) = 104.38, p less than 0.001 for fusobacteria. Pairwise comparisons using Tukey hsd post hoc tests showed that for total anaerobes, treatments 1 and 2 yielded higher scores than treatments 3 and 4. For fusobacteria, treatment 1 greater than 2 greater than 3 or 4; no difference between treatments 3 and 4. The results demonstrated the superior performance of Efferdent over Dentu-Creme.
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Affiliation(s)
- E C Chan
- Faculty of Dentistry, McGill University, Montreal
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Gornitsky M, Clark DC, Siboo R, Amsel R, Iugovaz I, Wooley C, Iuliani N, Chan EC. Clinical documentation and occurrence of putative periodontopathic bacteria in human immunodeficiency virus-associated periodontal disease. J Periodontol 1991; 62:576-85. [PMID: 1682437 DOI: 10.1902/jop.1991.62.9.576] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Human immunodeficiency virus (HIV)-associated gingivitis (HIV-G) and HIV-associated periodontitis (HIV-P) are two intraoral lesions manifested by patients with HIV infection. Periodontal indices were measured for 87 subjects in 5 study groups: HIV-seropositive patients with healthy periodontium (HIV-H), with HIV-G, or with HIV-P; and non-HIV-infected subjects with healthy periodontium (H) or with adult chronic periodontitis (P). The quantitative clinical parameters were compared and statistically significant intergroup differences were noted. The mean scores on PI and PD do not discriminate between HIV-seropositive and non-HIV-infected seronegative cohorts, but a significant difference in the GI between HIV-H and H was noted. When categories of PD and AL are examined, some differences become apparent. Generally, the PD and AL of HIV-P are not as great as those of P. PI correlates well with GI (r = 0.86) in P, but does not (r = 0.33) in HIV-P. In addition, the occurrence of selected putative periodontopathic bacteria (Porphyromonas gingivalis, spirochetes, and motile eubacteria) in these lesions was determined by brightfield (after staining), darkfield and immunofluorescent microscopy. No difference in microbiological profile in the bacterial groups monitored was found between P and HIV-P. Spirochetes were found to be more abundant than P. gingivalis in the lesions of P and HIV-P. In marked contrast, P. gingivalis was found to be in highest numbers in samples from the gingival crevice of H as determined by indirect immunofluorescence.
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Affiliation(s)
- M Gornitsky
- Dental Department, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, PQ
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Abstract
Supravalvular aortic stenosis has a wide range of clinical and morphologic expression. Since 1961, 25 patients (aged 1 to 49 years) with documented supravalvular aortic stenosis have been evaluated. Seven (28%) had Williams' syndrome, 5 (20%) had a familial form of supravalvular aortic stenosis, and 13 (52%) had a sporadic form. A blood pressure difference of greater than 10 mm Hg between the arms was noted in 65% of the patients. Angiographically, 19 (76%) had segmental supravalvular narrowing; 6 (24%) had diffuse narrowing of the ascending aorta. Sixteen patients underwent patch aortoplasty. At surgery, portions of the aortic valve cusps were frequently attached to supravalvular tissue. This "cusp tuck" resulted in distinctive angiographic features and influenced the results of corrective surgery. Three surgical deaths occurred in the early 1960s-2 with diffuse narrowing of the aorta. Of the remaining 12 patients, followed for 1 to 12 years, 10 are asymptomatic, 1 has angina, and 1 died from cancer. All 8 patients who underwent postoperative catheterization had a thick band between the left and right coronary sinus which represented persistent attachment of portions of the aortic valve cusps to residual supravalvular tissue (cusp tuck). This resulted in aortic valvular gradients (23 to 48 mm Hg) in 4 patients and aortic valvular insufficiency in 2 patients. No significant supravalvular gradient was noted. The 20-year experience with supravalvular aortic stenosis reported herein emphasizes a wide range of clinical and morphologic expression, the benefits and limitations of patch aortoplasty, and the importance of postoperative cardiac catheterization, and furthers the understanding of a complex clinical syndrome.
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