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Obermayer A, Tripolt NJ, Aziz F, Högenauer C, Aberer F, Schreiber F, Eherer A, Sourij C, Stadlbauer V, Svehlikova E, Brunner M, Goswami N, Kojzar H, Pferschy PN, Pieber TR, Sourij H. EndoBarrier™ Implantation Rapidly Improves Insulin Sensitivity in Obese Individuals with Type 2 Diabetes Mellitus. Biomolecules 2021; 11:biom11040574. [PMID: 33919949 PMCID: PMC8070956 DOI: 10.3390/biom11040574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
The EndoBarrier™ medical device is a duodenal-jejunal bypass liner designed to mimic the effects of gastric bypass surgery to induce weight loss and glycaemic improvement. In this study, 10 participants with type 2 diabetes mellitus (T2DM), a mean body mass index (BMI) of 43.3 ± 5.0 (kg/m2) and a mean glycated haemoglobin A1c (HbA1c) of 60.6 ± 8.6 mmol/mol were examined at baseline (before implantation of EndoBarrier™), 4 weeks after implantation, at 36 weeks (right before explantation) and 24 weeks after the removal of the device to explore the short and long-term effects on glucose metabolism. Besides a significant reduction in body weight and fat mass, EndoBarrier™ treatment significantly improved insulin sensitivity during Botnia clamp investigations after four weeks of implantation. The beneficial effects decreased over time but remained significant 24 weeks after removal of the device.
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Affiliation(s)
- Anna Obermayer
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Norbert J. Tripolt
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Faisal Aziz
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Florian Schreiber
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
| | - Andreas Eherer
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
| | - Caren Sourij
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8010 Graz, Austria;
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Eva Svehlikova
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CRC—Clinical Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Martina Brunner
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CRC—Clinical Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Nandu Goswami
- Otto Loewi Research Centre, Physiology Division, Medical University of Graz, 8010 Graz, Austria;
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Peter N. Pferschy
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
- Correspondence:
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Salmaso C, Toniolo I, Fontanella CG, Da Roit P, Albanese A, Polese L, Stefanini C, Foletto M, Carniel EL. Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery. Ann Biomed Eng 2020; 48:2466-2483. [PMID: 32472365 DOI: 10.1007/s10439-020-02542-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/10/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Abstract
Obesity is one of the main health concerns worldwide. Bariatric Surgery (BS) is the gold standard treatment for severe obesity. Nevertheless, unsatisfactory weight loss and complications can occur. The efficacy of BS is mainly defined on experiential bases; therefore, a more rational approach is required. The here reported activities aim to show the strength of experimental and computational biomechanics in evaluating stomach functionality depending on bariatric procedure. The experimental activities consisted in insufflation tests on samples of swine stomach to assess the pressure-volume behaviour both in pre- and post-surgical configurations. The investigation pertained to two main bariatric procedures: adjustable gastric banding (AGB) and laparoscopic sleeve gastrectomy (LSG). Subsequently, a computational model of the stomach was exploited to validate and to integrate results from experimental activities, as well as to broad the investigation to a wider scenario of surgical procedures and techniques. Furthermore, the computational approach allowed analysing stress and strain fields within stomach tissues because of food ingestion. Such fields elicit mechanical stimulation of gastric receptors, contributing to release satiety signals. Pressure-volume curves assessed stomach capacity and stiffness according to the surgical procedure. Both AGB and LSG proved to reduce stomach capacity and to increase stiffness, with markedly greater effect for LSG. At an internal pressure of 5 kPa, outcomes showed that in pre-surgical configuration the inflated volume was about 1000 mL, after AGB the inflated volume was slightly lower, while after LSG it fell significantly, reaching 100 mL. Computational modelling techniques showed the influence of bariatric intervention on mechanical stimulation of gastric receptors due to food ingestion. AGB markedly enhanced the mechanical stimulation within the fundus region, while LSG significantly reduced stress and strain intensities. Further computational investigations revealed the potentialities of hybrid endoscopic procedures to induce both reduction of stomach capacity and enhancement of gastric receptors mechanical stimulation. In conclusion, biomechanics proved to be useful for the investigation of BS effects. Future exploitations of the biomechanical methods may largely improve BS reliability, efficacy and penetration rate.
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Affiliation(s)
- C Salmaso
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - I Toniolo
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy.
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy.
| | - C G Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - P Da Roit
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - A Albanese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - L Polese
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - C Stefanini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - E L Carniel
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
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Abstract
In the current setting of an obesity pandemic, there is an urgent need for minimally invasive, safe, and effective interventions for weight loss. Endoscopic bariatric procedures have been developed as an alternative to more traditional medical and surgical therapies. Multiple options are undergoing evaluation or are already available for clinical use. This review aims to describe these treatments, including their mechanisms of action, efficacy, safety and the knowledge gaps regarding their use.
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Affiliation(s)
- Aoife M Egan
- Division of Endocrinology and Diabetes, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Adrian Vella
- Division of Endocrinology and Diabetes, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Karampinis I, Lion E, Grilli M, Hetjens S, Weiss C, Vassilev G, Seyfried S, Otto M. Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis. Obes Surg 2020; 29:1049-1057. [PMID: 30659465 DOI: 10.1007/s11695-018-03687-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Indexed: 12/17/2022]
Abstract
The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.
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Affiliation(s)
| | - Eliette Lion
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Institute of Medical Statistic and Biomathematics, Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Heidelberg University, Mannheim, Germany
| | | | - Mirko Otto
- Department of Surgery, Heidelberg University, Mannheim, Germany.
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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5
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Abstract
Aspiration therapy is a novel, endoscopic bariatric therapy that allows patients to remove a portion of an ingested meal through a modified percutaneous gastrostomy tube, called an A-Tube. Weight loss results from both fewer calories consumed, and from modifications in lifestyle and mealtime behaviors that patients make as a result of having the device installed. The first commercially available device for aspiration therapy, the AspireAssist (Aspire Bariatrics, King of Prussia, PA), was approved by the Food and Drug Administration in 2016 for weight loss for greater than 6 months duration in patients with a body mass index of 35-55. Multiple studies have demonstrated the effectiveness and safety of aspiration therapy, with low rates of adverse events related to the procedure, including no reported deaths, as well as no evidence of eating disorders developed during therapy. This chapter will describe our experience with aspiration therapy. We will describe how we select appropriate candidates for aspiration therapy, how we perform the procedure including a summary of the equipment used, and how we mitigate and manage complications of the procedure. This article will highlight the effectiveness of aspiration therapy as a novel and safe approach for weight loss in patients in obesity.
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Affiliation(s)
- Eric C Swei
- University of Colorado Anschutz Medical Center, Department of Gastroenterology and Hepatology, Aurora, CO.
| | - Shelby A Sullivan
- University of Colorado Anschutz Medical Center, Department of Gastroenterology and Hepatology, Aurora, CO
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Riedel N, Laubner K, Lautenbach A, Schön G, Schlensak M, Stengel R, Eberl T, Dederichs F, Aberle J, Seufert J. Trends in BMI, Glycemic Control and Obesity-Associated Comorbidities After Explantation of the Duodenal-Jejunal Bypass Liner (DJBL). Obes Surg 2019; 28:2187-2196. [PMID: 29504053 DOI: 10.1007/s11695-018-3144-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND A novel-approach for treatment of obesity and diabetes mellitus type 2 (T2DM) is represented by the endoscopic duodenal-jejunal bypass liner (DJBL). Recent data from the German DJBL registry provide evidence for substantial efficacy of the DJBL during the implantation period in obese patients with T2DM. However, little is known about the trends of glycemic control, BMI, and comorbidities after explantation of the DJBL, which have been investigated in the registry in this report. METHODS Patients were selected from the registry if they had a dataset at implantation, explantation, and at least one time point after explantation of the DJBL (n = 77). We also investigated a subgroup of patients with available data at least 1 year (-2 weeks) after explantation of the DJBL (n = 32). RESULTS For a mean BMI at implantation and a mean follow-up period, an increase of BMI of 2.1 kg/m2 (CI 0.8-3.2; p = 0.013) had to be expected (for HbA1c 0.3% (CI - 0.0-0.7; p = n.s.), respectively). In the subgroup analysis, HbA1c and BMI increased after explantation of the DJBL but stayed significantly below baseline levels. Meanwhile, the mean number of antidiabetic drugs slightly increased. There was deterioration seen for blood pressure and LDL cholesterol over the postexplantation period to approximately baseline levels (or higher). CONCLUSION With this data, we show that improvement of HbA1c and BMI can be partly maintained over a time of nearly 1-year postexplantation of the DJBL. However, for HbA1c, this may be biased by intensified medical treatment and effects deteriorated with time after explantation. These results suggest that implantation of the DJBL needs to be integrated in a long-term weight management program as most of other interventions in obese patients with T2DM. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02731859.
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Affiliation(s)
- Nina Riedel
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Anne Lautenbach
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Schlensak
- Department of Surgery, Schön Klinik Düsseldorf SE & Co. KG, Düsseldorf, Germany
| | | | | | - Frank Dederichs
- Department of Internal Medicine/Gastroenterology, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
- Department of Internal Medicine/Gastroenterology, Kath, Kliniken Hagen, Hagen, Germany
| | - Jens Aberle
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
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Abstract
PURPOSE OF REVIEW Obesity is increasing at an alarming rate and now poses a global threat to humankind. In recent years, we have seen the emergence of medical devices to combat the obesity epidemic. These therapeutic strategies are discussed in this review dividing them into gastric and duodenal therapies. RECENT FINDINGS Traditionally, medical devices for obesity such as the intragastric balloon have focused on reducing gastric size, but more recently there has been a shift towards developing devices that modulate neural and hormonal responses to induce early satiety thus reducing oral intake. Medical devices for obesity treatment may have a role in those patients who are struggling to control their weight despite significant lifestyle modifications such as diet and exercise and who decline or are unfit for bariatric surgery. For the wider adoption and integration of these devices in the obesity treatment paradigm, more long-term efficacy and safety data from randomised controlled trials are required.
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Affiliation(s)
- Aruchuna Ruban
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
| | - Akash Doshi
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Erika Lam
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Julian P. Teare
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
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Holländer SW, Klingen HJ, Hess S, Merscher A, Glanemann M, Birk D. Benefits of Robotic Camera Assistance in Minimally Invasive Bariatric Procedures: Prospective Clinical Trial Using a Joystick-Guided Camera-Holder. Surg Technol Int 2019; 34:87-92. [PMID: 30888669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND While minimally invasive surgery is a growing sector in medicine, camera assistance remains a problem. Especially in bariatric surgery, the assistant holding the camera faces certain challenges. Furthermore, unless the surgeon controls the camera movement themselves, they will be challenged by an unstable image. The aim of this study was to investigate the benefits of a robotic camera assistant (SoloAssist®, AKTORmed GmbH, Barbing, Germany) in bariatric surgery. PATIENTS AND METHODS Three hundred thirty one consecutive laparoscopic bariatric procedures were performed with the assistance of a camera robot, including Roux-en-Y gastric bypass, laparoscopic gastric banding, sleeve gastrectomy, and gastroplication. Failures and aborts were documented and 6 surgeons were interviewed regarding their experiences using a questionnaire. RESULTS In 18 of 331 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of a need for frequent changes of position in narrow spaces and adverse angles. Two short circuits, 4 joystick faliures and one malfunction of the control unit were reported. All of the surgeons preferred robotic to human assistance, mostly because of a steady image and the capacity for self-control. DISCUSSION The SoloAssist® is a reliable system for minimal invasive procedures, especially in bariatric surgery. It provides more comfortable conditions for the surgeon and their assistant by freeing one hand for other purposes. Even in narrow spaces (e.g., between a voluminous stomach and adipose liver), the robot guarantees a steady image. Slight movements of the camera can be precisely controlled, which leads to increased comfort for the surgeon.
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Affiliation(s)
- Sebastian W Holländer
- Department of General Surgery, Vascular, Visceral and Pediatric Surgery, University Hospital of the Saarland, Homburg, Germany
| | - Hans Joachim Klingen
- Department of General Surgery, Vascular, Visceral and Pediatric Surgery, University Hospital of the Saarland, Homburg, Germany
| | - Sarah Hess
- Department of General and Visceral Surgery, Hospital Bietigheim-Vaihingen Bietigheim-Vaihingen, Germany
| | - Anna Merscher
- Department of General and Visceral Surgery, Hospital, Bietigheim-Vaihingen, Bietigheim-Vaihingen, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular, Visceral and Pediatric Surgery University Hospital of the Saarland, Homburg, Germany
| | - Dieter Birk
- Department of General and Visceral Surgery, Hospital Bietigheim-Vaihingen, Bietigheim-Vaihingen, Germany
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Bondugulapati LNR, Ravi S, Kodumuri V, Gourineni VC. Endoscopic bariatric treatments: new toolkit in the armamentarium against obesity. Curr Opin Lipidol 2019; 30:151-153. [PMID: 30844856 DOI: 10.1097/mol.0000000000000585] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Sandeep Ravi
- Cardiology Department, Virginia Tech Carilion School of Medicine, Christiansburg, Virginia
| | - Vamsi Kodumuri
- Cardiology Department, Rush University Medical Centre, Chicago, Illinois
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Betzel B, Cooiman MI, Aarts EO, Janssen IMC, Wahab PJ, Groenen MJM, Drenth JPH, Berends FJ. Clinical follow-up on weight loss, glycemic control, and safety aspects of 24 months of duodenal-jejunal bypass liner implantation. Surg Endosc 2019; 34:209-215. [PMID: 30877567 PMCID: PMC6946747 DOI: 10.1007/s00464-019-06752-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/06/2019] [Indexed: 01/30/2023]
Abstract
Background The duodenal-jejunal bypass liner (DJBL) is an endoscopic device designed to induce weight loss and improve glycemic control. The liner is licensed for a maximum implant duration of 12 months. It might be hypothesized that extension of the dwelling time results in added value. The goals of our study were to determine weight change, change in glycemic control, and safety in patients with an intended 24 months of DJBL dwelling time. Methods Patients were initially selected for a 12-month implantation period. When no physical complaints or adverse events (AEs) occurred, motivated patients who responded well were selected for extension of dwelling time to 24 months. Patients underwent a control endoscopy 12 months after implantation and visited the out-patient clinic every 3 months up to explantation. Patients agreed to remove the DJBL when complaints or AEs occurred that could not be treated conservatively. Results Implantation was extended in 44 patients, and 24 (55%) patients completed the full 24 months. Twenty patients required early removal due to AEs. During dwelling time, body weight decreased significantly (15.9 kg; TBWL 14.6%). HbA1c decreased non-significantly (4.9 mmol/mol). The number of insulin users and daily dose of insulin both decreased significantly. At 24 months after removal, glycemic control had worsened, while body weight was still significantly lower compared to baseline. In total, 68% of the patients experienced at least one AE. Two patients developed a hepatic abscess. Conclusions DJBL treatment results in significant weight loss and improves glycemic control during implantation. The largest beneficial effects occur during the first 9–12 months after implantation. Extension of dwelling time to 24 months results only in stabilization of body weight and glycemic control. After explantation, weight improvements are maintained, but glycemic control worsens. As the cumulative risk of AEs increases with time, a maximal dwelling time of 12 months is advisable. Electronic supplementary material The online version of this article (10.1007/s00464-019-06752-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B Betzel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, Code 455, 6500 HB, Nijmegen, The Netherlands.
| | - M I Cooiman
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - E O Aarts
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - I M C Janssen
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - P J Wahab
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - M J M Groenen
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - J P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, Code 455, 6500 HB, Nijmegen, The Netherlands
| | - F J Berends
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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Abstract
PURPOSE OF REVIEW In this review, we describe the FDA-approved and investigational devices and endoscopic bariatric therapies for the treatment of obesity. We focus on literature published in the past few years and present mechanisms of action as well as efficacy and safety data. RECENT FINDINGS Devices and endoscopic procedures are emerging options to fill the significant treatment gap in the management of obesity. Not only are these devices and procedures minimally invasive and reversible, but they are potentially more effective than antiobesity medications, often safer for poor surgical candidates and possibly less expensive than bariatric surgery. As many patients require a variety of management strategies (medications, devices, procedures, and/or surgery) in addition to lifestyle modifications to achieve clinically significant weight loss, the future of obesity treatment involves a multidisciplinary approach. Combinations of advanced treatment strategies can lead to additive or synergistic weight loss. This is an area that requires further investigation.
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Affiliation(s)
- Katherine H Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, 1165 York Avenue, New York, NY, 10065, USA.
| | - Leon I Igel
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, 1165 York Avenue, New York, NY, 10065, USA
| | - Monica Saumoy
- Divison of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Reem Z Sharaiha
- Divison of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, 1165 York Avenue, New York, NY, 10065, USA
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12
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Abstract
PURPOSE OF REVIEW Obesity is a global epidemic that continues to grow and results in related conditions such as hypertension and diabetes despite established interventions, thus suggesting the importance of new technologies. RECENT FINDINGS Endoscopic interventions are vast in scope and effectiveness. Intra-gastric balloons appear to dominate the field at this time, but a recent FDA-approved technique, the Aspire device, may soon cause a shift in the treatment paradigm. Short-term studies demonstrate optimistic results, yet long-term studies have not been performed. In addition, complications from these procedures are severe, resulting in significant morbidity when they occur. Treatment of bariatric surgery complications with endoscopic techniques is an expanding field that relies heavily on new innovation. The next few years in bariatric endoscopy promise to be turbulent and controversial. Endoscopic procedures for obesity will undoubtedly increase but are anticipated to do so at a slower rate than many projects. Bariatric surgery complications will continue to be treated by endoscopic means, and optimization of these procedures is on the horizon. This review will provide those who treat obesity-related hypertension on the current state of bariatric endoluminal procedures.
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Vyas D, Deshpande K, Pandya Y. Advances in endoscopic balloon therapy for weight loss and its limitations. World J Gastroenterol 2017; 23:7813-7817. [PMID: 29209122 PMCID: PMC5703910 DOI: 10.3748/wjg.v23.i44.7813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023] Open
Abstract
The field of medical and surgical weight loss is undergoing an explosion of new techniques and devices. A lot of these are geared towards endoscopic approaches rather than the conventional and more invasive laparoscopic or open approach. One such recent advance is the introduction of intrgastric balloons. In this article, we discuss the recently Food and Drug Administration approved following balloons for weight loss: the Orbera™ Intragastric Balloon System (Apollo Endosurgery Inc, Austin, TX, United States), the ReShape® Integrated Dual Balloon System (ReShape Medical, Inc., San Clemente, CA, United States), and the Obalon (Obalon® Therapeutics, Inc.). The individual features of each of these balloons, the method of introduction and removal, and the expected weight loss and possible complications are discussed. This review of the various balloons highlights the innovation in the field of weight loss.
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Affiliation(s)
- Dinesh Vyas
- Department of Surgery, Texas Tech University, Odessa, TX 79763, United States
| | - Kaivalya Deshpande
- Department Of Surgery, Michigan State University, Lansing, MI 48912, United States
| | - Yagnik Pandya
- Department of Surgery, MetroWest Medical Center, Natick, MA 01760, United States
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Loureiro M, Ramadan M, Skalli EM, Blanc P, Fabre JM, Nocca D. A multicentric prospective study evaluating the safety and efficacy of Kii ® Fios ® First Entry Trocar in laparoscopic bariatric surgery. Surg Endosc 2017; 31:4680-4687. [PMID: 28389805 DOI: 10.1007/s00464-017-5536-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/25/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Laparoscopic surgery has evolved as an important field of surgery due to its clear benefits when compared to open laparotomy surgery. However, specific complications of laparoscopic surgery have been reported, of which the majority are complications associated with first entry to the abdominal cavity. The emergence of bariatric surgery, combined with the special considerations of the abdominal wall and cavity of obese patients, leads to seeking new modalities of access to the abdominal cavity in this specific population.Kii Fios First Entry Bladeless Trocar (Applied) is a new device that may allow surgeons to facilitate the creation of pneumoperitoneum. This prospective multicenter nonrandomized trial aims to evaluate the safety and efficacy of Kii Fios First Entry Bladeless Trocar in laparoscopic bariatric surgery. METHODS In the period between December 2013 and June 2014, 588 patients were included by 18 surgeons from several French hospitals to undergo laparoscopic surgery using Kii Fios First Entry Trocar as a first-entry trocar. The surgeons filled out a questionnaire assessing the safety and efficacy of the trocar for every patient. RESULTS There were no mortality and no major complications. However, 11 cases (1.87%) of minor complications (liver and greater omentum injuries) were reported. The surgeons reported successful entry in less than 1 min for 70.58% of the cases. CONCLUSIONS Kii Fios First Entry Trocar (Applied) is a safe and efficient method to establish first entry in laparoscopic bariatric surgery when all the recommendations are followed and respected.
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Affiliation(s)
- Marcelo Loureiro
- CHU de Montpellier, Montpellier, France.
- University Montpellier 1, Montpellier, France.
- Universidade Positivo, Rua Angelo Bom 315 casa 1, Curitiba, 81210340, Brazil.
| | | | | | | | - Jean Michel Fabre
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
| | - David Nocca
- CHU de Montpellier, Montpellier, France
- University Montpellier 1, Montpellier, France
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Huberty V, Ibrahim M, Hiernaux M, Chau A, Dugardeyn S, Devière J. Safety and feasibility of an endoluminal-suturing device for endoscopic gastric reduction (with video). Gastrointest Endosc 2017; 85:833-837. [PMID: 27562938 DOI: 10.1016/j.gie.2016.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Received: 03/09/2016] [Accepted: 08/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Obesity is a major pandemic disease. Surgical therapy is highly effective, but its availability will likely be overwhelmed by the burden of the disease. Endoscopic technologies that could reproduce some of the clinical effects of surgery may become part of the treatment armamentarium. A simple transoral restrictive procedure could play a role in first-line surgical management. METHODS We evaluated the safety and feasibility of transmural suturing using a simple triangulation platform for gastric volume reduction through the creation of multiple double plicatures. RESULTS Between May and July 2015, 11 obese (body mass index 34.6 ± 2.1 kg/m2) patients (mean age, 36 ± 10 years) underwent gastroplasty through transmural endoscopic sutures (performed using a triangulation platform and an endoscopic stitcher). The median duration of the procedure was 2.00 hours (range, 1.15-3.15 hours) and dramatically decreased after the first 5 cases. No severe adverse events were observed. Mean (standard deviation) weight loss and percentage of excess weight loss were 5.8 kg (2.7%) and 21% (9%) at 1 month (n = 11), 8.8 kg (4.9%) and 33% (22%) at 3 months (n = 10), and 10.9 kg (7.3%) and 41% (33%) at 6 months (n = 10). CONCLUSIONS Transoral endoscopic gastroplasty performed using a simple triangulation platform and a dedicated suturing device appears to be safe and effective at mid-term follow-up in creating gastric restriction and inducing weight loss in this first-in-humans experience. (Clinical trials registration number: NCT02534662.).
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Affiliation(s)
- Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Mostafa Ibrahim
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Sonia Dugardeyn
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Rohde U. EndoBarrier gastrointestinal liner. Delineation of underlying mechanisms and clinical effects. Dan Med J 2016; 63:B5309. [PMID: 27808040] [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: 06/06/2023]
Abstract
Bariatric surgery (e.g. Roux-en-Y gastric bypass (RYGB)) has proven the most effective way of achieving sustainable weight losses and remission of type 2 diabetes (T2D). Studies indicate that the effectiveness of RYGB is mediated by an altered gastrointestinal tract anatomy, which in particular favours release of the gut incretin hormone glucagon-like peptide-1 (GLP-1). The EndoBarrier gastrointestinal liner or duodenal-jejunal bypass sleeve (DJBS) is an endoscopic deployable minimally invasive and fully reversible technique designed to mimic the bypass component of the RYGB. Not only GLP-1 is released when nutrients enter the gastrointestinal tract. Cholecystokinin (CCK), secreted from duodenal I cells, elicits gallbladder emptying. Traditionally, bile acids are thought of as essential elements for fat absorption. However, growing evidence suggests that bile acids have additional effects in metabolism. Thus, bile acids appear to increase GLP-1 secretion via activation of the TGR5 receptor on the intestinal L cell. Recently FXR receptors were postulated to contribute to GLP-1 secretion too. Furthermore, metformin has been shown to increase circulating GLP-1 levels but although the exact mechanism is not fully elucidated it may involve metformin-induced inhibition of bile acid reuptake from the small intestines. Small-sized studies reported varying degrees of weight loss and, in some, improvement of glucose metabolism. Therefore, the objectives of this thesis were to collect existing information on the DJBS in order to evaluate clinical efficacy and safety (study I and II). Furthermore, since the endocrine impact of the DJBS is not fully elucidated, and DJBS is expected to mimic RYGB, we investigated postprandial metabolic changes following 26 weeks of DJBS treatment in ten obese subjects with normal glucose tolerance (NGT) and nine matched patients with T2D (study III). Finally, we studied the single and combined effects of CCK induced gallbladder emptying and single-dose metformin on human GLP-1 secretion in ten healthy subjects (study IV). We hypothesized that metformin-induced GLP-1 secretion - at least partly - would be dependent on gallbladder emptying and the presence of bile acids in the gut. DJBS appears to lead to moderate weight losses in obese subjects compared to diet or lifestyle modifications (study II). DJBS had insignificant and small effects (compared to diet) on glycaemic regulation. Adverse events consisted mainly of mild-to-moderate transient dyspepsia. Nearly 20% (n = 66) of DJBS treated subjects experienced a serious adverse event (e.g. gastrointestinal bleeding or device migration), which resulted in early device removals. No deaths or liver abscesses were reported following DJBS treatment. In our own study III we found similar, moderate weight losses as in study II. GLP-1 and PYY concentrations increased in patients with T2D (not NGT subjects) after implantation. DJBS had no or minor effects on postprandial levels of glucose, insulin, C-peptide, glucagon, GIP, CCK or gastrin. Food intake decreased in parallel with an increased sensation of satiety in obese NGT subjects, but were transient. Dyspeptic episodes occurred in nearly all participants. Five devices (21%) were explanted early due to abdominal pain, and few changes of on-going antidiabetic medication were made. Finally, study IV showed that both CCK-induced gallbladder emptying and metformin alone elicited significant GLP-1 responses that were additive upon combination. Moreover, we saw significant PYY and short-lasting glucose-dependent insulinotropic polypeptide (GIP) responses following gallbladder emptying. In conclusion, in spite of increased GLP-1 responses in patients with T2D and a modest weight loss, DJBS had no effect on postprandial glucose metabolism, and therefore no patient with T2D achieved disease remission. Based on our results, we cannot recommend DJBS to be implemented as a standard of medical care management of obese patients with T2D. Future larger trials may lead to different conclusions. In addition, the observed gut hormone responses following CCK-induced gallbladder emptying and metformin, make suggest that bile acid release into the small intestines with subsequent TGR5 and FXR involvement contributes to stimulation of GLP-1 secretion and, therefore, that metformin's mode of action encompasses both bile acid-dependent and independent stimulation of gut hormone secretion.
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Abstract
The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.
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Affiliation(s)
- Kartik Sampath
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Gastroenterology Fellow, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Amreen M Dinani
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Richard I Rothstein
- Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Dargent J, Mion F, Costil V, Ecochard R, Pontette F, Mion V, Angella S. Multicenter Randomized Study of Obesity Treatment with Minimally Invasive Injection of Hyaluronic Acid Versus and Combined with Intragastric Balloon. Obes Surg 2016; 25:1842-7. [PMID: 25812529 DOI: 10.1007/s11695-015-1648-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/21/2022]
Abstract
BACKGROUND Research into minimally invasive techniques is worthwhile for greater acceptance in bariatric surgery, a useful first step being to evaluate the combination of these with current procedures. We suggest that intragastric balloon (IGB) can be performed with hyaluronic acid (HA) injections at the level of the gastroesophageal junction. METHODS A submucosal restriction is created by circular injection of an absorbable material within a defined area based on endoscopic anatomy. We included 101 patients in a prospective multicenter randomized trial, with average body mass index (BMI) 33.4 (range 27-44), treated from April 2010 to April 2012 by IGB and/or HA injection, sequentially, and followed for two more years. Patients were divided into group 1 (IGB alone), group 2 (IGB followed by HA at IGB removal, at 6 months), and group 3 (HA and IGB at 6 months). RESULTS BMI loss at 6 months was inferior in the HA group (32 patients) compared with the IGB groups (68 patients) (2.1 ± 0.4 versus 3.4 ± 0.3, p < 0.05). The efficacy of IGB alone compared with combined treatments (groups 2 and 3) was significantly inferior at 18 months only, but the impact of the treatment sequence (HA before or after IGB) on BMI loss was not statistically significant, although in favor of HA first. CONCLUSIONS This study did not demonstrate the efficacy of HA injections as an obesity treatment.
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Affiliation(s)
- Jerome Dargent
- Polyclinique Lyon-Nord, 941 Rue Capitaine Julien, 69140, Rillieux-la-Pape, France,
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Quezada N, Maiz C, Daroch D, Funke R, Sharp A, Boza C, Pimentel F. Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks. Obes Surg 2016; 25:1816-21. [PMID: 25840555 DOI: 10.1007/s11695-015-1622-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 12/17/2022]
Abstract
BACKGROUND Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery. OBJECTIVES The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment. SETTING This study was performed in a University Hospital, (censored). METHODS We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included. RESULTS We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence. CONCLUSIONS SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
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Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery. School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
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Debergh I, Snauwaert C, Dillemans B. New devices for the bariatric patient. MINERVA CHIR 2016; 71:114-123. [PMID: 26923812] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the past years, the global prevalence of obesity has risen dramatically. This generates enormous costs for the health care system, since obesity is associated with hypertension, diabetes mellitus type 2, coronary heart diseases, stroke, dyslipidemia, psychological problems, and cancer. Bariatric surgery has demonstrated to be the most effective and durable treatment option in the morbidly obese patient. Despite its evidence based efficacy, less than 1% of obese patients will undergo surgery. The role of new, less-invasive devices for the bariatric patient needs to be defined. Are they situated in the gap between lifestyle modification and surgery for the obese patient, in the preoperative work-up of the super-obese patient, in patient groups that are currently excluded for surgery, and/or in the routine treatment of obesity as a chronic disease? This review will focus on emerging technologies for the bariatric patient that are currently in clinical practice or in an advanced development stage, with different modes of action: inducing stretch on the gastric wall (space-occupying or stitching devices), vagal neuromodulation, altering the absorption, or exclusion of the duodenum and proximal jejunum. Exploring the evidence and the indication of different therapeutic approaches and innovations will be an interesting field of research in the near future.
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Affiliation(s)
- Isabelle Debergh
- Department of Surgery, AZ Sint-Jan AV Brugge, Oostende, Campus Brugge, Brugge, Belgium -
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Lainas P, Tranchart H, Gaillard M, Ferretti S, Donatelli G, Dagher I. Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:1483-1490. [PMID: 27387688 DOI: 10.1016/j.soard.2016.03.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 01/27/2016] [Revised: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Prompt management of laparoscopic sleeve gastrectomy (LSG) complications is essential in avoiding prolonged hospital stay and associated mortality. The value of routine computed tomography (CT) scan examination in early diagnosis of postoperative complications after LSG has not been studied. OBJECTIVES To prospectively assess the impact of postoperative day (POD) 2 CT scan after LSG. SETTING Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Paris-Saclay University, France. METHODS Data were prospectively gathered for 1000 patients undergoing single-incision LSG and POD 2 CT scan. Complications were identified and treatment modalities decided according to the severity of complications. Sensitivity, specificity, and positive and negative predictive values were calculated for the diagnosis of surgical complications on POD 2 CT scan. RESULTS Mean age was 40.1 years and median BMI 42.6 kg/m². Early postoperative surgical complications occurred in 66 patients (6.6%). Intraabdominal bleeding/hematoma occurred in 38 patients, with 3 requiring emergent reoperation on POD 1. POD 2 CT scan detected this complication in 32 patients (sensitivity: 91.4%). Twenty-four (63.1%) patients were treated with relaparoscopy and drainage while 14 (36.9%) received conservative management. Postoperative transfusion was required in 7 patients. Twenty-eight patients suffered a gastric staple line leak, 13 (sensitivity: 46.4%) detected on POD 2 CT scan. Three patients (10.7%) received pure surgical treatment, 16 (57.1%) combined relaparoscopy and endoscopic treatment, and 9 (32.2%) had pure endoscopic treatment. CONCLUSION POD 2 abdominal CT scan is an efficient diagnostic tool for detecting active bleeding/hematoma, but shows less impressive results with gastric staple line leak detection. A combination of clinical surveillance and early imaging allowed prompt management of complicated cases, avoiding further morbidity.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France
| | - Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France
| | - Stefano Ferretti
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France
| | - Gianfranco Donatelli
- Department of Interventional Endoscopy, Peupliers Private Hospital, Paris, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, Clamart, France; Paris-Saclay University, Orsay, France.
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Brethauer SA, Chang J, Galvao Neto M, Greve JW. Gastrointestinal devices for the treatment of type 2 diabetes. Surg Obes Relat Dis 2016; 12:1256-61. [PMID: 27568475 DOI: 10.1016/j.soard.2016.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity and type 2 diabetes (T2D) continue to be growing epidemics worldwide. Although bariatric surgery remains the most effective and durable treatment for both of these chronic diseases, there is a need for therapies with risk and benefit profiles between medication and standard surgical procedures. Currently there are several endoscopic and minimally invasive therapies available worldwide to treat T2D. OBJECTIVE To review the current evidence regarding the safety and efficacy of medical devices to treat T2D. SETTING Academic practice, international METHODS The published literature was searched for articles evaluating the safety and efficacy of endoluminal and surgical devices used for the treatment of obesity and T2D. RESULTS The current devices in use include intragastric balloons, a duodenal-jejunal liner, gastric content aspiration, and devices that provide neuromodulation to the stomach or vagal nerves. On early phases of first-in-human studies is the duodenal mucosal resurfacing. The current evidence supporting the safety and efficacy of temporary use (6 months) for the intragastric balloon for lower body mass index (BMI) patients is strong and there is growing evidence regarding the effects of the other devices to treat T2D. CONCLUSIONS There is a need for novel therapies to bridge the risk and benefit gap between medical and surgical treatment of T2D. The original indication for many of the current devices was treatment of obesity. Several devices that are currently available are promising but require more study in T2D patient populations.
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Affiliation(s)
- Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Julietta Chang
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manoel Galvao Neto
- Department of Surgery, Herbert Wertheim School of Medicine, Florida International University, Miami, Florida
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Gunkova P, Gunka I, Zonca P, Dostalik J, Ihnat P. Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE). ACTA ACUST UNITED AC 2015; 116:422-5. [PMID: 26286244 DOI: 10.4149/bll_2015_080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE An experience with laparoscopic sleeve gastrectomy using the natural orifice specimen extraction (NOSE) technique. BACKGROUND Bariatric surgery is nowadays the only long term effective obesity treatment method. METHODS Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifice specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m2 or higher than 32 kg/m2 accompanied with relevant comorbidities. RESULTS Among 21 patients in this series, there were three men (14.3%) and 18 women (85.7%). Their mean age was 40.9±10.2 years. Their mean preoperative BMI was 40.4±4.6 kg/m2. No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefit from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22).
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Aarts EO, van Wageningen B, Berends F, Janssen I, Wahab P, Groenen M. Intragastric band erosion: Experiences with gastrointestinal endoscopic removal. World J Gastroenterol 2015; 21:1567-1572. [PMID: 25663775 PMCID: PMC4316098 DOI: 10.3748/wjg.v21.i5.1567] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/11/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To remove the migrated bands using a gastrointestinal endoscopic approach. Little is published on complications that can occur.
METHODS: From June 2006 to June 2010, eight patients developed intragastric band migration. Two patients had received their AGB in a different hospital, the remaining six were operated by the same surgeon. In all patients gastrointestinal endoscopic removal of the band was attempted by two individual gastroenterologists. Clinical signs of band migration were: persisted nausea, abdominal pain, weight gain, recurrent infection of the port and tubing system and hematemesis.
RESULTS: In four patients removal was performed without complications. In two patients extracting the cleaved gastric band into the stomach appeared impossible. The two remaining patients presented with acute hematemesis and melena. One of these patients was readmitted with hematemesis. The other patient started bleeding during the gastroscopy and was converted to a laparoscopy in which one of the branches of the left gastric artery was oversewn.
CONCLUSION: Band migration after gastric banding can be life threatening. Gastrointestinal endoscopic removal is a feasible technique that holds the promise of fast reconvalescence.
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Nikolić M, Sabol M, Kruljac I, Supanc V, Ljubicić N, Nikolić BP, Beslin MB, Mirosević G, Vrkljan M, Nikolac I. A first case of endoscopical removal of an eroded adjustable gastric band in Croatia. Coll Antropol 2014; 38:345-348. [PMID: 24851640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Laparoscopic gastric banding (LAGB) is one of the most common surgical procedures in the treatment of morbid obesity since it provides good long-term outcomes in weight loss and decrease of comorbidities associated with obesity. Although the procedure has low morbidity and almost none-existing mortality, certain complications can occur. Erosion of the band into the gastric wall is one of the rare complications in LAGB. The reported incidence varies from 1 to 11%, however the largest study reported an incidence of 1.6%. This is in accordance with the incidence in our Centre for obesity, where only one case of erosion occurred among 112 operative procedures. The aim of this paper is to present a patient with gastric band erosion and it's removal by using the endoscopic techniques as a minimally invasive management method.
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Murphy P, Colwell C, Pineda G. All you need to know about bariatrics. Anatomical and physiological differences make their care a challenge. EMS World 2014; 43:26-35. [PMID: 24734395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Folini L, Veronelli A, Benetti A, Pozzato C, Cappelletti M, Masci E, Micheletto G, Pontiroli AE. Liver steatosis (LS) evaluated through chemical-shift magnetic resonance imaging liver enzymes in morbid obesity; effect of weight loss obtained with intragastric balloon gastric banding. Acta Diabetol 2014; 51:361-8. [PMID: 24085682 DOI: 10.1007/s00592-013-0516-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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] [Received: 06/27/2013] [Accepted: 09/18/2013] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate in morbid obesity clinical and metabolic effects related to weight loss on liver steatosis (LS), measured through chemical-shift magnetic resonance imaging (MRI) and liver enzymes. Forty obese subjects (8 M/32 W; BMI 42.8 ± 7.12 kg/m(2), mean ± SD) were evaluated for LS through ultrasound (US-LS), chemical-shift MRI (MRI-LS), liver enzymes [aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), alkaline phosphatase (ALP)], anthropometric parameters [weight, BMI, waist circumference (WC)], lipids, insulin, insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), oral glucose tolerance test, and body composition [fat mass (FM) and fat-free mass (FFM) at bio-impedance analysis (BIA)]. Anthropometric measures, MRI-LS, BIA, and biochemical parameters were reevaluated 6 months later in 18 subjects undergoing restrictive bariatric approach, i.e., intragastric balloon (BIB, n = 13) or gastric banding (LAGB, n = 5), and in 13 subjects receiving hypocaloric diet. At baseline, US-LS correlates only with MRI-LS, and the latter correlates with ALT, AST, and GGT. After 6 months, subjects undergoing BIB or LAGB had significant changes of BMI, weight, WC, ALT, AST, GGT, ALP, HbA1c, insulin, HOMA-IR, FM, FFM, and MRI-LS. Diet-treated obese subjects had no significant change of any parameter under study; change of BMI, fat mass, and fat-free mass was significantly greater in LAGB/BIB subjects than in diet-treated subjects. Change of MRI-LS showed a significant correlation with changes in weight, BMI, WC, GGT, ALP, and basal MRI-LS. Significant weight loss after BIB or LAGB is associated with decrease in chemical-shift MRI-LS and with reduction in liver enzymes; chemical-shift MRI and liver enzymes allow monitoring of LS in follow-up studies.
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Affiliation(s)
- Laura Folini
- Divisione di Medicina Generale II, Dipartimento di Scienze della Salute (DISS) Ospedale San Paolo, Università degli Studi di Milano, via antonio di rudinì 8, 20142, Milan, Italy
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Frattini F, Rausei S, Boni L, Rovera F, Marco F, Corrado C, Moalli S, Fraschini A, Dionigi G. Gastric plication: how to decrease the size of the stomach without transection. Surg Technol Int 2013; 23:84-87. [PMID: 24081847] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Gastric plication is an emerging bariatric procedure with the potential for providing safe and significant weight loss and improvement of metabolic parameters without resection, bypass, or implantable device. Laparoscopic plication consists of infolding the greater gastric curvature to reduce stomach volume using running sutures. As a new procedure in bariatric/metabolic surgery very few clinical studies are available. Herein we present technical notes about and evidence from literature.
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Affiliation(s)
| | - Stefano Rausei
- Department of Surgery University of Insubria Varese, Italy
| | - Luigi Boni
- Department of Surgery University of Insubria Varese, Italy
| | | | - Franchin Marco
- Department of Surgery University of Insubria Varese, Italy
| | | | - Stefano Moalli
- Department of Surgery University of Insubria Varese, Italy
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Birkmeyer NJ, Finks JF, English WJ, Carlin AM, Hawasli AA, Genaw JA, Wood MH, Share DA, Birkmeyer JD. Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery. J Hosp Med 2013; 8:173-7. [PMID: 23401464 DOI: 10.1002/jhm.2013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/18/2012] [Accepted: 12/23/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The United States Food and Drug Administration recently issued a warning about adverse events in patients receiving inferior vena cava (IVC) filters. OBJECTIVE To assess relationships between IVC filter insertion and complications while controlling for differences in baseline patient characteristics and medical venous thromboembolism prophylaxis. DESIGN Propensity-matched cohort study. SETTING The prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative. PATIENTS Bariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012. INTERVENTION Prophylactic IVC filter insertion. MEASUREMENTS Outcomes included the occurrence of complications (pulmonary embolism, deep vein thrombosis, and overall combined rates of complications by severity) within 30 days of bariatric surgery. RESULTS There were no significant differences in baseline characteristics among the 1,077 patients with IVC filters and in 1,077 matched control patients. Patients receiving IVC filters had higher rates of pulmonary embolism (0.84% vs 0.46%; odds ratio [OR], 2.0; 95% confidence interval [CI], 0.6-6.5; P=0.232), deep vein thrombosis (1.2% vs 0.37%; OR, 3.3; 95% CI, 1.1-10.1; P=0.039), venous thromboembolism (1.9% vs 0.74%; OR, 2.7; 95% CI, 1.1-6.3, P=0.027), serious complications (5.8% vs 3.8%; OR, 1.6; 95% CI, 1.0-2.4; P=0.031), permanently disabling complications (1.2% vs 0.37%; OR, 4.3; 95% CI, 1.2-15.6; P=0.028), and death (0.7% vs 0.09%; OR, 7.0; 95% CI, 0.9-57.3; P=0.068). Of the 7 deaths among patients with IVC filters, 4 were attributable to pulmonary embolism and 2 to IVC thrombosis/occlusion. CONCLUSIONS We have identified no benefits and significant risks to the use of prophylactic IVC filters among bariatric surgery patients and believe that their use should be discouraged.
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Affiliation(s)
- Nancy J Birkmeyer
- Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Hill-Rom updates TotalCare bariatric beds instructions for use to prevent rare cases of potential instablity during manual handling of patients. Health Devices 2013; 42:70-1. [PMID: 23505661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Majumder S, Birk J. A review of the current status of endoluminal therapy as a primary approach to obesity management. Surg Endosc 2013; 27:2305-11. [PMID: 23344508 DOI: 10.1007/s00464-012-2765-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/04/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Shounak Majumder
- Department of Internal Medicine, University of Connecticut, Farmington, CT, USA.
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Lerner H, Whang J, Nipper R. Benefit-risk paradigm for clinical trial design of obesity devices: FDA proposal. Surg Endosc 2012; 27:702-7. [PMID: 23247746 DOI: 10.1007/s00464-012-2724-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/24/2012] [Indexed: 01/01/2023]
Abstract
Diet and exercise, except in controlled circumstances, have not been shown to provide effective and prolonged weight loss for the majority of those who are obese. Several older drugs intended to reduce weight have been withdrawn from the market, and the new drugs show only modest weight loss. Surgical intervention, specifically procedures that alter the normal gastrointestinal anatomy, does provide prolonged periods of sustained weight loss, with rebound weight gain over time. A variety of medical devices to assist in weight reduction have been studied, but only two are legally marketed devices for obesity. The authors propose a new paradigm for devices intended to treat obesity, based on a benefit-risk determination, with the hope to provide sponsors an a priori tool for systematic assessment of the risks associated with the devices intended for treatment of obesity and to suggest appropriate levels of benefit for devices with different risk levels. The paradigm is not intended to determine the class of a device from a regulatory perspective. This approach was conceived at a Food and Drug Administration (FDA) co-sponsored workshop in October, 2011 and formally presented to an FDA advisory panel for discussion in May 2012.
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Affiliation(s)
- Herbert Lerner
- Center for Devices and Radiological Health, Office of Device Evaluation, US Food and Drug Administration, Silver Spring, MD 20993, USA.
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33
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Markar SR, Penna M, Hashemi M. Robotic bariatric surgery: bypass, band and sleeve. Where are we now? And what is the future? MINERVA GASTROENTERO 2012; 58:181-190. [PMID: 22971629] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Rates of Obesity and Bariatric surgery continue to increase worldwide. Obese patients represent a unique cohort with important anatomical and physiological challenges that can influence operative outcome. The aim of this review is to evaluate the current evidence regarding the role of robotics in bariatric surgery. Robotic surgery confers several technical advantages including better visual field with improved three-dimensional image, seven degrees of freedom and anti-tremor filters to enable more precise manipulations and increased dexterity by downscaling the surgeon's movements. These technical advantages are more likely to confer a benefit in terms of clinical outcome in more complicated minimally invasive procedures especially gastric bypass and in particular with important steps of the procedure such as anastomotic suturing. Despite these advantages robotic bariatric surgery is associated with increased cost and operative time, which may limit its use in less complicated procedures such as gastric band surgery. Future highly powered randomized controlled trials are required to accurately evaluate clinical outcome and cost-effectiveness of robotics both in gastric bypass and in sleeve gastrectomy.
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Affiliation(s)
- S R Markar
- Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospital, UK.
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34
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Abstract
Bariatric surgery provides substantial, sustained weight loss and major improvements in glycaemic control in severely obese individuals with type 2 diabetes. However, uptake of surgery in eligible patients is poor, and the barriers are difficult to surmount. We examine the indications for and efficacy and safety of conventional bariatric surgical procedures and their effect on glycaemic control in type 2 diabetes. How surgical gastrointestinal interventions achieve these changes is of great research interest, and is evolving rapidly. Old classifications about restriction and malabsorption are inadequate, and we explore understanding of putative mechanisms. Some bariatric procedures improve glycaemic control in people with diabetes beyond that expected for weight loss, and understanding this additional effect could provide insights into the pathogenesis of type 2 diabetes and assist in the development of new procedures, devices, and drugs both for obese and non-obese patients.
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Affiliation(s)
- John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
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35
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Lee J. Leading-edge gadgets. ECRI unveils top 10 C-suite Watch List. Mod Healthc 2012; 42:12. [PMID: 22355920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Verdam FJ, Liedorp PR, Geubbels N, Schouten R, Janssen IMC, Koek GH, Greve JW. [EndoBarrier for counteracting obesity and metabolic syndrome]. Ned Tijdschr Geneeskd 2012; 156:A3844. [PMID: 22456287] [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: 05/31/2023]
Abstract
The prevalence of obesity is increasing worldwide. Its primary treatment consists of lifestyle changes. In severely obese (BMI > 40 kg/m2 or ≥ 35 kg/m2 with comorbidity) patients though, bariatric surgery has been found to be the only way to achieve permanent weight loss. Operations such as the placement of a gastric band or a gastric bypass can, however, lead to complications and necessitate secondary interventions. In search of less invasive treatments, placement of the EndoBarrier duodenal jejunal bypass liner appears to be a promising, safe and effective method for facilitating weight loss. The EndoBarrier is a plastic flexible tube which is gastroscopically placed in the duodenal bulb, directly behind the pylorus. It extends from the duodenum to the proximal jejunum. Recent studies have demonstrated significant weight reduction in comparison to control-diet patients. Concomitant positive effects on cardiovascular risk factors including diabetes type 2 were observed. A multicentre trial is currently being executed in order to unravel the mechanism behind these effects.
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Affiliation(s)
- Froukje J Verdam
- Maastricht Universitair Medisch Centrum, afd. Chirurgie, Maastricht, The Netherlands.
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37
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Mathus-Vliegen EMH. [Endobarrier: a unique but still premature concept]. Ned Tijdschr Geneeskd 2012; 156:A4590. [PMID: 22456292] [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: 05/31/2023]
Abstract
The EndoBarrier, an endoscopically delivered duodeno-jejunal bypass device, is a unique concept that starts to ameliorate the symptoms of diabetes mellitus type 2, soon after positioning. Weight-loss results are moderate, with 85% of patients showing a more than 10% excess weight loss in the 12 weeks preoperatively. Sufficient implant training is required, but problems can still occur, e.g., due to a short duodenal bulb length. The stability of the anchors and the tolerability of the device still leave much to be desired. In 25% of patients the EndoBarrier is explanted early, because of migration, physical symptoms, gastrointestinal haemorrhage, rotation and obstruction. Only seven studies on the EndoBarrier are available and these are mostly small in size, short-term and with limited follow-up, and many questions regarding the safety and long-term effects of the device remain. This calls for a large, long-term, randomised, placebo-controlled, double-blind trial. Lessons should have been learned from the disastrous results with intragastric balloon implantation before commercialising another such product.
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Affiliation(s)
- E M H Mathus-Vliegen
- Academisch Medisch Centrum/UvA, afd. Maag-, Darm- en Leverziekten, Amsterdam, The Netherlands.
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38
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Sioulas AD, Polymeros D, Kourikou A, Papanikolaou IS, Triantafyllou K. Intragastric balloon left in the stomach for more than a year: two case reports. Obes Facts 2012; 5:436-9. [PMID: 22797371 DOI: 10.1159/000341134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Received: 11/03/2011] [Accepted: 11/26/2011] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Intragastric balloon (IGB) is often used to achieve short-term weight reduction in morbidly obese patients. It is placed endoscopically for a 6-month-period either in the pre-bariatric surgery setting and also in cases where no bariatric surgery is planned. Prolonged implantation may be accompanied by serious complications. CASE REPORTS We herein report two cases of extraction of intact IGBs long time after their placement. CONCLUSION Although no adverse events were observed, adherence to manufacturers' recommendations is definitely suggested.
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Affiliation(s)
- Athanasios D Sioulas
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Medical School, University of Athens, Haidari, Greece.
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Abstract
PURPOSE To present a case study of a patient with multiple comorbid diseases who undergoes bariatric surgery. DATA SOURCES Recent clinical and research articles, bariatric professional society guidelines, and government sources were culled to provide recommendations for the care of the person who chooses bariatric surgery as the treatment for the comorbid conditions of obesity, type 2 diabetes, obstructive sleep apnea, hypertension, and hyperlipidemia. CONCLUSIONS As surgical management of obesity becomes more prevalent in an attempt to improve health-related quality of life, reduce mortality, and address the comorbidities that are prevalent in this population, nurse practitioners (NPs) need to understand what long-term management these patients will require. IMPLICATIONS FOR PRACTICE NPs are primary care providers for patients with chronic diseases. It is likely that they will make referrals for this surgery and follow the patient after the procedure at some point. Knowledge of what the procedures involve, what changes to expect in the comorbid conditions, and what long-term monitoring and treatment should take place in the care of these patients will provide these patients with optimal care.
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Seki Y, Kasama K. Current status of laparoscopic bariatric surgery. Surg Technol Int 2010; 20:139-144. [PMID: 21082559] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
As the prevalence of obesity has dramatically increased and obesity has become one of the leading public health threats worldwide, the number of bariatric surgeries performed has been exponentially increasing. According to a recent survey, over 90% of bariatric procedures are performed by laparoscopic approach. The most commonly performed procedures are Roux-en-Y gastric bypass (open and laparoscopic), followed by laparoscopic adjustable gastric banding, and sleeve gastrectomy. Definite geographic trends are observable in the specific bariatric procedures being performed. A number of studies have already demonstrated the efficacy of bariatric surgery for the treatment of obesity and its comorbidities, although there are still only a handful of prospective, controlled studies with a high level of evidence. Considering the results derived from a large-scale, prospective, multicenter study and a systematic review, it can be reasonably said that bariatric surgery is a safe and feasible intervention for the treatment of life-threatening morbid obesity under controlled conditions. So far, several studies have shown improved survival rates for patients who undergo bariatric surgery compared with a control cohort of severely obese patients who did not. In addition, bariatric surgery seems to have a positive impact on the economy, although currently only about 1-2% of eligible patients with morbid obesity receive bariatric surgery. In this mini-review article, we summarize bariatric surgery outcomes by quoting some of the recently published landmark articles.
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Affiliation(s)
- Yosuke Seki
- Department of Weight Loss Surgery, Yotsuya Medical Cube, Tokyo, Japan
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Brethauer SA, Chand B, Schauer PR, Thompson CC. Transoral gastric volume reduction for weight management: technique and feasibility in 18 patients. Surg Obes Relat Dis 2010; 6:689-94. [PMID: 20947451 DOI: 10.1016/j.soard.2010.07.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [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: 05/22/2009] [Revised: 07/02/2010] [Accepted: 07/11/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoluminal suturing to reduce the gastric volume might provide an additional option for the treatment of obesity. Potential advantages of a nonoperative endoluminal intervention include less pain, the ability to perform it as an outpatient procedure, and a high level of patient acceptance. The purpose of the present pilot study was to demonstrate the feasibility and procedural safety of transoral gastric volume reduction (TRIM procedure) using the Restore Suturing System in patients with a body mass index of 30-45 kg/m(2). Successful completion of the procedure and adverse events were evaluated at academic/university hospitals. METHODS This was a nonrandomized feasibility study performed at 2 institutions. After institutional review board approval, the patients underwent the TRIM endoluminal gastric plication procedure with the Restore Suturing System (Restore device). Gastric plications were completed to approximate the anterior and posterior gastric walls to achieve restriction of the upper stomach. The number and location of successful plications were recorded, and patients were monitored for complications. The present report described the short-term procedural results (≤ 24 hours after the procedure) of the studied cohort. RESULTS A total of 18 patients were enrolled in the present study. The TRIM procedure was successfully completed in all patients, with placement of 4-8 plications (average 6 per patient). The average procedure time was 125 ± 23 minutes, and no serious or significant procedure-related complications occurred. After the procedure, common patient complaints were nausea, vomiting, and abdominal discomfort. The first 10 patients enrolled were kept overnight according to the study protocol, and the remaining 8 patients were discharged on the day of the procedure. CONCLUSION Endoluminal suturing using the TRIM procedure and the Restore device was technically feasible, and no serious or significant procedure-related complications were reported. Weight loss, co-morbidity improvement, and durability are under assessment.
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Affiliation(s)
- Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Dumonceau JM, François E, Hittelet A, Mehdi AI, Barea M, Deviere J. Single vs repeated treatment with the intragastric balloon: a 5-year weight loss study. Obes Surg 2010; 20:692-7. [PMID: 20352524 DOI: 10.1007/s11695-010-0127-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [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: 12/31/2022]
Abstract
BACKGROUND Saline-filled intragastric balloons (IB) may be inserted for 6 months to promote weight loss. We aimed to assess potential benefits of repeating IB therapy. METHODS One hundred eighteen consecutive subjects (median body mass index, 34.0 kg/m(2); interquartile range [IQR], 31.2-36.9) treated with IB were included in a prospective non-randomized multicenter study. RESULTS Nineteen (16%) subjects had repeat IB therapy at their own request, either to prolong first treatment (n = 8) or after a IB-free interval (n = 11). Higher weight loss 3 months after first IB insertion independently predicted repeat therapy (P = 0.008). Median weight loss in subjects who had repeat therapy was lower with second vs first IB (9.0 vs 14.6 kg; 30.4% vs 49.3% excess weight [EW]; P = 0.003). Compared to subjects with single treatment (n = 99), those with repeat treatment (n = 19) had greater weight loss at first IB extraction (14.6 vs 11.0 kg; 49.3% vs 30.7% EW; P = 0.026) and 1 year later (12.0 vs 6.0 kg; 40.9% vs 20.8% EW; P = 0.008) but the difference became less than 2 kg starting at 3 years. At final follow-up (4.9 years; IQR, 3.4-6.7), the whole subject population had lost a median of 2.0 kg (IQR, -3.0 to 10.3) or 6.2% EW (IQR, -8.1 to 31.6) and identical proportions of subjects with single/repeat treatment had >or=10% baseline weight loss (26%) or bariatric surgery (32%). CONCLUSION Higher weight loss at 3 months independently predicted repeat IB therapy; weight loss with the second IB was lower compared to first IB. Repeat treatment had no effect on proportions of subjects with >or=10% baseline weight loss or bariatric surgery at final follow-up.
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Affiliation(s)
- Jean-Marc Dumonceau
- Service of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest street 24, 1205, Geneva, Switzerland.
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Abstract
BACKGROUND Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. METHODS We studied 40 MO patients (body mass index >35 kg/m(2)) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO(2) achieved during the procedure, were measured. RESULTS Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO(2) post-intubation. CONCLUSION In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions.
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Affiliation(s)
- I Bathory
- Anesthesiology Department, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
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Rodriguez L, Reyes E, Fagalde P, Oltra MS, Saba J, Aylwin CG, Prieto C, Ramos A, Galvao M, Gersin KS, Sorli C. Pilot clinical study of an endoscopic, removable duodenal-jejunal bypass liner for the treatment of type 2 diabetes. Diabetes Technol Ther 2009; 11:725-32. [PMID: 19905889 DOI: 10.1089/dia.2009.0063] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [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: 01/09/2023]
Abstract
BACKGROUND Bariatric surgery is associated with the rapid improvement of type 2 diabetes (T2DM). Here we report an exploratory trial of a completely endoscopic, removable, duodenal-jejunal bypass liner (DJBL) intended to treat T2DM. METHODS Obese T2DM subjects were randomized to receive a DJBL (n = 12) or sham endoscopy (n = 6) in a 24-week study, extended up to 52 weeks. Measurements included weights, hemoglobin A1c (HbA(1c)), meal tolerance testing, fasting glucose, and seven-point glucose profiles. Subjects' diets were adjusted in the first 2 weeks to obtain similar weight loss during this period. RESULTS Subjects had baseline HbA(1c) of 9.1 +/- 1.7% and body mass index of 38.9 +/- 6.1 kg/m(2) (+/- SD). In the completer population by week 1, change in fasting glucose in the DJBL arm was -55 +/- 21 mg/dL versus +42 +/- 30 mg/dL in the sham arm (P < or = 0.05; +/- SE); the seven-point glucose profiles were reduced in the DJBL arm but not in the sham arm. Mean postprandial glucose area under the curve was reduced in the DJBL arm by 20% and increased 17% in the sham arm (P = 0.016). At week 12, HbA(1c) change was -1.3 +/- 0.9% in the DJBL arm and -0.7 +/- 0.4% in the sham arm (P > 0.05), and at 24 weeks, values were -2.4 +/- 0.7% in the DJBL arm and -0.8 +/- 0.4% in the sham arm (P > 0.05). Device migrations required endoscopic removal prior to reaching 52 weeks. CONCLUSIONS The DJBL rapidly normalized glycemic control in obese T2DM subjects, a promising development in the search for novel therapies less invasive than bariatric surgery.
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Affiliation(s)
- Leonardo Rodriguez
- Centro de Cirugía de la Obesidad, Hospital Dipreca, Las Condes, Santiago de Chile, Chile
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Abstract
OBJECTIVE To evaluate the efficacy of Laparoscopic Sleeve Gastrectomy (LSG) as a definitive procedure for morbidly obese patients. DESIGN This constitutes a prospective study carried out in a tertiary care private hospital and included 15 morbidly obese patients who underwent LSG. The operation was performed through two 12 mm and two 5 mm ports, using the Endo-GIA stapler to create a lesser curve gastric tube over a 36-Fr bougie. RESULTS Operative time, complication rates, hospital length of stay, Body Mass Index (BMI), % of Excess Weight Loss (EWL) and appetite were evaluated. There were six females and nine males, aged (mean+/-SD) 40.5+/-10.5 yrs and preoperative BMI 47.8+/-7.5 kg/m2. The operative time was 147.7+/-43.2 min. There was one conversion to open surgery and one gastric leak with haemorrhage that led to gastric tube stenosis, ultimately requiring revision surgery. All patients, except these two, were discharged on the 2nd postoperative day after an upper GI series and the initiation of a clear liquid diet. At the follow-up (7.5+/-4.4 months post operatively), the % EWL was 35.7+/-10.1. Eight patients who received regular postoperative dietician counselling at follow-up did better than the others who did not (% EWL 40.4+/-3.8 vs 30.2+/-4.1, respectively). All patients reported significant loss of appetite. CONCLUSIONS Although the number of patients is relatively small, the data of this study indicate that laparoscopic sleeve gastrectomy is effective in weight reduction, being an acceptable surgical option for morbidly obese patients. A higher number of patients and longer follow-up period will be necessary to evaluate long-term efficacy.
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Tarnoff M, Rodriguez L, Escalona A, Ramos A, Neto M, Alamo M, Reyes E, Pimentel F, Ibanez L. Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc 2008; 23:650-6. [PMID: 19067075 DOI: 10.1007/s00464-008-0125-4] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [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: 05/02/2008] [Revised: 06/20/2008] [Accepted: 07/24/2008] [Indexed: 01/09/2023]
Abstract
BACKGROUND The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endoscopic duodenal exclusion without the need for stapling. This report is the first randomized controlled trial for weight loss. METHODS In a 12-week, prospective, randomized study, subjects received either a low fat diet and the DJBS or a low fat diet control (no device). Twenty-five patients were implanted with the device and 14 received the control. The groups were demographically similar. Both groups received counseling at baseline only, which consisted of a low calorie diet, and exercise/behavior modification advice. No additional counseling occurred in either group. Measurements included starting and monthly body weight and serum blood tests. The device group also had a plain abdominal film post implant, a monthly KUB and a 4-week post explant EGD. RESULTS Twenty device (80%) subjects maintained the DJBS without a significant adverse event for the 12-week duration. At 12 weeks, the mean excess weight loss was 22% and 5% for the device and control groups, respectively (p < 0.001). Five subjects (20%) were endoscopically explanted early secondary to upper GI (UGI) bleeding (n = 3), anchor migration (n = 1) and sleeve obstruction (n = 1). The UGI bleeding occurred at a mean of 13.8 days post implant. EGD was performed in each of these cases with no distinct bleeding source identified. No blood transfusion was required. The migration occurred on day 47 and manifested as abdominal pain. The subject with the sleeve obstruction presented with abdominal pain and vomiting on day 30. Eight subjects (40%) underwent the 4 week post explant EGD at which time mild degrees of residual duodenal inflammation was noted. CONCLUSION The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.
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Affiliation(s)
- M Tarnoff
- Department of Surgery, Tufts-New England Medical Center, Boston, MA, USA.
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Abstract
As bariatric surgery for the treatment of morbid obesity enters its sixth decade, much has been and continues to be learned from the results of several key bariatric operations, particularly the Roux-en-Y gastric bypass. Because of the obesity epidemic and development of the laparoscopic approach, bariatric procedures have increased exponentially in the past decade and are now among the more commonly performed gastrointestinal operations. Emerging data support the role of bariatric surgery as an effective treatment for improvement or remission of type 2 diabetes, hypertension, dyslipidemia, and multiple other comorbid conditions that accompany obesity. The mechanisms involved in the remission of these conditions, however, remain poorly understood and constitute an exciting area of research. This article delineates the current types of bariatric surgery, their respective outcomes, and their impact on obesity-related medical comorbidities.
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Affiliation(s)
- Brian R Smith
- Division of Gastrointestinal Surgery, University of California-Irvine Medical Center, 333 City Boulevard West, Orange, CA 92868, USA
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Murray PJ. Bariatric surgery in adolescents: mechanics, metabolism, and medical care. Adolesc Med State Art Rev 2008; 19:450-ix. [PMID: 19227386] [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: 05/27/2023]
Abstract
Obesity is a serious, lifelong, worldwide health problem. Once obese, few people are able to lose their excess weight. Bariatric surgery is an intervention that has produced substantial and sustained weight loss in adults. It is offered increasingly as an option for extremely obese adolescents. Selection criteria have been proposed by several expert consensus panels. Outcomes and metabolic consequences of bariatric surgery on glucose-insulin interactions, diabetes, sleep architecture, the gastrointestinal tract, asthma, cardiovascular dysfunction, renal parameters, polycystic ovarian syndrome, bone health, nutrition, gynecologic concerns, and mental health are reviewed here.
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Affiliation(s)
- Pamela J Murray
- Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213-2583, USA.
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Logan C. Substantial solutions. Creating safe and sensitive care pathways for bariatric patients. Rehab Manag 2008; 21:23-25. [PMID: 18672820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Madan AK, Taddeucci RJ, Harper JL, Tichansky DS. Initial trocar placement and abdominal insufflation in laparoscopic bariatric surgery. J Surg Res 2007; 148:210-3. [PMID: 18262554 DOI: 10.1016/j.jss.2007.08.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 05/22/2007] [Revised: 08/22/2007] [Accepted: 08/24/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Initial trocar placement and abdominal insufflation in laparoscopic bariatric surgery can be challenging for the novice. One technique is the use of an optical viewing trocar without prior abdominal insufflation. This investigation tests the hypothesis that this technique can be taught to novice surgeons with good results. METHODS Patients undergoing laparoscopic bariatric surgery were included. Novice surgeons (residents/fellows) with 0-50 initial trocar placements placed the initial trocar and insufflated the abdomen in the presence of an expert surgeon (>300 initial trocar placements in morbidly obese patients). Trocar placement time was defined as the time to place the trocar into the peritoneal cavity (including infiltration of local anesthesia and incision). Insufflation time was defined as the time to insufflate the abdomen to a pressure of 10 to 15 mm Hg (including time to place tubing on trocar). Novice times were compared with expert times. RESULTS There were 81 patients (56 by expert and 25 by novice) in this study. No bowel or vessel injury during initial trocar placement was noted. No correlation was seen between times and BMI or waist/hip circumference (P = NS). Mean expert trocar placement time was shorter than the mean novice time (25 +/- 9 versus 54 +/- 27 s; P < 0.0001); although there was no difference in mean insufflation time (expert versus novice: 16 +/- 5 versus 19 +/- 10; P = NS). The mean total time to place the initial trocar and insufflate the abdomen for the novices was 72 +/- 26 s. CONCLUSIONS Initial trocar placement can be taught safely to novices. The technique using an optical viewing trocar without prior abdominal insufflation is effective and efficient in morbidly obese patients.
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Affiliation(s)
- Atul K Madan
- Minimally Invasive Surgery Section, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
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