Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures.Over the last decade,significant progress in endoscopic techniques and technologies has improved the safety,eff...Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures.Over the last decade,significant progress in endoscopic techniques and technologies has improved the safety,efficacy,and accessibility of these procedures.Current methods,such as intragastric balloons,endoscopic sleeve gastroplasty,and endoscopic-assisted gastrojejunostomy,have promoted weight loss,improving the metabolic health of obese individuals,with emerging evidence suggesting that their combination with pharmacological agents could further maximize their benefit.Emerging technologies,such as robotic-assisted endoscopic devices,advanced imaging systems,and biodegradable implants,could enhance procedural precision,minimize complications,and provide more personalized treatment options.In contrast,novel approaches such as microbiome modulation and tissue regeneration could have an adjunct role in improving patient outcomes.This review provides a brief overview of the current status of endoscopic bariatrics,highlighting the most common procedures and emerging technologies.It also discusses the challenges and future directions for the field,emphasizing the importance of multidisciplinary collaboration,patient selection,and research priorities to establish the long-term benefit and effectiveness of the available endoscopic bariatric interventions.展开更多
The obesity epidemic in the USA and worldwide is well documented and continues to grow.Endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention.This article will revie...The obesity epidemic in the USA and worldwide is well documented and continues to grow.Endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention.This article will review advances in endobariatrics over the last several decades,addressing the past and current state of bariatric and metabolic endoscopy.Food and Drug Administration-cleared devices and interventions currently under investigation are described including gastric devices,gastric remodeling procedures,small-bowel devices,duodenal ablation,as well as procedures to address weight regain after bariatric surgery.Future studies evaluating gastric and duodenal combination therapy,adjunctive pharmacotherapy,as well as individualized precision-health algorithms are underway.展开更多
BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While th...BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While the efficacy of revisional EBTs has been documented,no studies to date have examined how these procedures impact quality of life(QOL)and internalized weight bias(IWB).AIM To understand how endoscopic revisional therapies impact QOL,IWB,and dumping syndrome.METHODS Analysis included 19 participants treated for post-MBS recurrent weight gain and/or dumping syndrome.The short-form 36 survey,weight bias internalization scale,and the Sigstad scoring system were used to measure QOL,IWB,and dumping syndrome pre-and≥4 weeks post-EBT.RESULTS At 6-months,total body weight loss was 8.6%±7.15%(n=16),at 12-months was 13.4%±7.46%(n=16).Short-form 36 scores for all 8 scales significantly increased from pre-to post-procedure with the greatest improvement in the scales related to emotional(mean improvement=59.6,P<0.05)and physical health(mean improvement=31.1,P<0.05).Both total Sigstad score(mean difference=4.947,P<0.05)and total weight bias internalization score(mean difference=0.761,P<0.05)significantly decreased from pre-to post-procedure.CONCLUSION Findings suggest that revisional EBT may improve post-MBS QOL across a broad spectrum of outcomes beyond optimizing body weight.As early EBT results indicate positive mental and physical health outcomes,further research is needed to evaluate the relationship between these improvements,body weight and interdisciplinary post-MBS care.展开更多
Metabolic dysfunction-associated fatty liver disease(MAFLD)is currently the leading cause of end-stage liver disease and liver cancer in the world because of the obesity pandemic.Insulin resistance resulting from abdo...Metabolic dysfunction-associated fatty liver disease(MAFLD)is currently the leading cause of end-stage liver disease and liver cancer in the world because of the obesity pandemic.Insulin resistance resulting from abdominal adiposity is the main cause of MAFLD and type 2 diabetes mellitus among these patients.Although very common,therapeutic options for MAFLD are currently limited.Metabolic and bariatric surgery is the best treatment option for weight loss that can also improve MAFLD in a very high proportion of patients.However,surgical interventions are expensive,technically challenging,and carry significant immediate and long-term postoperative risks.Duodenal mucosal ablation,a malabsorptive endoscopic bariatric intervention,has shown beneficial effects in the management of obesity with an improvement of insulin resistance.It alters the duodenal mucosal lining,which helps maintain cellular homeostasis and better intestinal endocrine function.This process helps reduce lipid deposition in the liver,maintain serum lipid levels,and promote weight loss,especially in patients with type 2 diabetes mellitus-related MAFLD.However,some of these effects were independent of weight loss and food intake.As a minimally invasive procedure,it is beneficial for patients who have not had success with drug therapy alone,though this approach needs to be tested and further developed in future clinical trials.A basic study by Yu et al in the recent issue of the World Journal of Gastroenterology on duodenal mucosal ablation using irreversible electroporation,when experimented on rats,has shown fewer complications compared to other metabolic surgeries.This editorial describes the minimally invasive endoscopic bariatric strategies for the management of obesity and MAFLD in light of this experimental study.展开更多
Currently,the worldwide prevalence of morbid obesity has increased.1 The National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention revealed that the prevalence of obesity in ...Currently,the worldwide prevalence of morbid obesity has increased.1 The National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention revealed that the prevalence of obesity in the adult population between 20 and 74 years old had more than doubled from 13.3%to 31.1%from 1960 to 2002.2 Metabolic and bariatric surgery(MBS)is now suggested for patients with a body mass index(BMI)of more than 35 kg/m2,comorbidities or no comorbidities.Furthermore,MBS should be offered to people with metabolic disease and a BMI of 30e34.9 kg/m2 who have failed to gain a meaningful amount of weight or have failed to keep it off with non-surgical management.However,the BMI cutoff points should be modified for the Asian population.展开更多
BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report ...BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.展开更多
Obesity is a significant global health concern, often leading to comorbidities such as cardiovascular diseases, diabetes, and hypertension. Bariatric surgery, including sleeve gastrectomy (SG), is a proven treatment f...Obesity is a significant global health concern, often leading to comorbidities such as cardiovascular diseases, diabetes, and hypertension. Bariatric surgery, including sleeve gastrectomy (SG), is a proven treatment for morbid obesity, offering substantial weight loss and resolution of comorbidities. However, post-surgical complications, particularly anorectal disorders such as hemorrhoids and anal fissures, remain underexplored, especially in Saudi Arabia. This retrospective cohort study aimed to assess the prevalence, risk factors, and impact of anal complications following SG at Almoosa Specialist Hospital in Alhassa, Saudi Arabia. A total of 205 patients who underwent SG between January 2020 and December 2021 were surveyed, with 148 eligible participants included in the final analysis. Results indicated that 8.8% of patients experienced anal complications, with anal fissures (53.8%) and hemorrhoids (38.5%) being the most common. These complications typically occurred 2 - 6 months post-surgery. Lifestyle factors such as physical activity and fluid intake were found to significantly reduce the likelihood of anal issues. Moreover, 69.2% of patients with anal problems reported a negative impact on their quality of life. The study highlights the importance of targeted post-operative care, including lifestyle modifications, to mitigate the impact of anal complications. The findings suggest that ongoing education and comprehensive support for bariatric surgery patients, particularly regarding physical activity and hydration, are critical for improving long-term health outcomes. Further research is needed to explore the long-term progression of anal complications and effective interventions for enhancing patient satisfaction and quality of life.展开更多
Traditionally,liver retraction for laparoscopic gastrectomy is done via manual methods,such as the placement of retractors through the accessory ports and using a Nathanson retractor.However,these techniques often pos...Traditionally,liver retraction for laparoscopic gastrectomy is done via manual methods,such as the placement of retractors through the accessory ports and using a Nathanson retractor.However,these techniques often posed issues including extra abdominal incisions,risk of liver injury or ischaemia,and the potential for compromised visualization.Over the years,the development of innovative liver retraction techniques has significantly improved the safety and efficacy of laparoscopic gastrectomy and similar other hiatal procedures.This editorial will comment on the article by Lin et al,and compare this to the other liver retractor techniques available for surgeons and highlight the pros and cons of each technique of liver retraction.展开更多
BACKGROUND Type 2 diabetes(T2D)remission has been widely reported after bariatric surgery,but rarely reported after esophagectomy.AIM To explore the incidence and predictors of T2D remission 1 year after esophagectomy...BACKGROUND Type 2 diabetes(T2D)remission has been widely reported after bariatric surgery,but rarely reported after esophagectomy.AIM To explore the incidence and predictors of T2D remission 1 year after esophagectomy with gastric conduit reconstruction.METHODS In this prospective study,consecutive patients from 2 tertiary hospitals who had esophageal cancer and T2D and underwent esophagectomy with gastric conduit reconstruction were studied preoperatively and at 3 months,6 months,and 12 months postoperatively.Remission of T2D is defined as glycated hemoglobin(HbA1c)values below 6.5%without glucose-lowering medications.Related clinical information were recorded and analyzed.RESULTS A total of 187 patients were included.Of these patients,24(12.8%)discontinued antidiabetic drugs and maintained HbA1c values below 6.5%1 year after surgery.At baseline,patients with T2D remission were younger(63.0±5.2 years vs 67.0±6.1 years,P=0.002),had higher body mass index values(body weight 68.6±11.1 kg vs 61.2±9.3 kg,P=0.001;body mass index 25.5±2.4 kg/m2 vs 23.8±3 kg/m2,P=0.011),shorter duration of T2D(4.9±3.9 years vs 7.1±3.7 years,P=0.008)and higher preoperative HbA1c(8.5%±1.7%vs 7.7%±1.3%,P=0.042).Multivariate logistic regression analysis showed that younger age and greater body weight were independent predictors of T2D remission after surgery.CONCLUSION This study reveals a significant incidence of T2D remission after esophagectomy with gastric conduit reconstruction,and remission is more frequent in patients with younger age and greater body weight.展开更多
Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of ...Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.展开更多
Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating se...Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.展开更多
BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postopera...BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postoperative weight loss remains controversial.AIM To evaluate the effect of RGV on weight loss and body mass index(BMI)changes in patients undergoing sleeve gastrectomy.METHODS This retrospective study included 49 patients.Preoperative and postoperative body weight and BMI(at 6 months and 12 months after surgery)were recorded.RGV was calculated using the ellipsoid formula based on the specimen’s length,width,and thickness measurements.Statistical analyses included parametric tests,repeated-measures one-way analysis of variance,Bonferroni post-hoc tests,and Pearson correlation analysis.RESULTS Both body weight and BMI significantly decreased over time(weight:F=951.34,P<0.01,η^(2)=0.95;BMI:F=345.97,P<0.01,η^(2)=0.88).A positive and statistically significant correlation was found between preoperative body weight and RGV(r=0.285,P<0.05).However,no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.CONCLUSION RGV correlated with preoperative weight but not with postoperative outcomes,indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal,metabolic,and lifestyle factors.展开更多
The increasing prevalence of pediatric obesity has raised numerous questions about its health implications,particularly regarding renal transplant outcomes.These complications often hinder medical interventions in the...The increasing prevalence of pediatric obesity has raised numerous questions about its health implications,particularly regarding renal transplant outcomes.These complications often hinder medical interventions in these children.While kidney transplants are often viewed from an organocentric perspective,the overall health of the patient is critical to the success of the procedure.Current discussions make it clear that childhood obesity poses significant problems not only for graft survival,but also for long-term overall health.Childhood obesity can lead to many metabolic disorders such as diabetes and hypertension.These conditions can significantly affect a child's suitability for a transplant or make the process more difficult.A child's weight can affect the pharmacokinetics of drugs used to prevent organ rejection.Obesity impacts the individual and sets in motion a cascade of effects that can jeopardize transplant success and recovery,so understanding is needed.Research on graft survival rates is both optimistic and concerning.Clinical studies show that obese children often have an increased risk of post-transplant complications,which affects transplant longevity.The likelihood of rejection may increase due to the metabolic status of an obese child.Due to the allocation of healthcare resources for the treatment of obesity-related diseases,availability for the transplant itself may be limited.Many children maintain an adequate quality of life after a kidney transplant,but excessive weight can significantly affect their health and chances of survival.The main target is looking for highly successful strategies to give all children who need a transplant a better future,regardless of their weight.展开更多
BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their gly...BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.展开更多
BACKGROUND Malabsorptive bariatric surgery,including Roux-en-Y gastric bypass and duodenal switch,are known to be more metabolically effective than restrictive surgery.However,the permanent alteration of gastrointesti...BACKGROUND Malabsorptive bariatric surgery,including Roux-en-Y gastric bypass and duodenal switch,are known to be more metabolically effective than restrictive surgery.However,the permanent alteration of gastrointestinal anatomy from these operations has been shown to alter the kinetics of drug absorption and may make subsequent surgeries more technically challenging.AIM To evaluate perioperative liver transplant outcomes and rates of acute cellular rejection in recipients with prior malabsorptive bariatric surgery.METHODS Patients who underwent liver transplantation at a single institution between 2005-2024 with a history of malabsorptive bariatric surgery were identified.Matched controls were selected based on age,sex,listing model for end-stage liver disease(MELD),and primary liver diagnosis.RESULTS A total of 12 liver transplant patients with prior malabsorptive surgery and 25 controls were included.The mean age in the malabsorptive group was 50.5 years at the time of transplant and 92%were female.The mean MELD at the time of transplant was 27.6 and mean body mass index was 28.There were no significant differences in length of stay,post operative complications,or 1 year survival between the controls and malabsorptive patients.However,the malabsorptive group was significantly more likely to experience biopsy-proven and clinically treated acute cellular rejection than the controls(24%vs 66.7%,P=0.012),more frequent rejection episodes(0.28±0.53 vs 1.0±0.91,P=0.006),and earlier time to first rejection episode(P=0.002).CONCLUSION Previous malabsorptive bariatric surgery in liver transplant recipients did not increase the risk of perioperative complications or mortality but significantly increased the rate and frequency of acute cellular rejection.展开更多
BACKGROUND Distal small bowel resection with preservation of the terminal ileum(DBRPI)significantly improves glucose metabolism in rats.AIM To explore the underlying mechanisms of DBRPI in improving glucose metabolism...BACKGROUND Distal small bowel resection with preservation of the terminal ileum(DBRPI)significantly improves glucose metabolism in rats.AIM To explore the underlying mechanisms of DBRPI in improving glucose metabolism.METHODS Following 8 weeks of a high-fat diet,the rats were randomly divided into the DBRPI group and the sham operation group.After surgery,body weight and glucose tolerance were monitored.At 6 weeks post-surgery,the composition of intestinal microbiota,bile acid levels,and the expression of farnesoid X receptor(FXR),Takeda G protein-coupled receptor 5,and glucagon-like peptide-1(GLP-1)in the ileum were examined.Additionally,the gene expression of key enzymes involved in gluconeogenesis in the liver was evaluated.RESULTS DBRPI reduced body weight and improved glucose tolerance.At 6 weeks postsurgery,the abundance of Prevotellaceae_NK3B31_group and the level of 7-ketolithocholic acid(7-KLCA)were significantly increased,while the abundance of Desulfovibrio fairfieldensis and the level ofα-muricholic acid were significantly decreased.The expression of FXR and GLP-1 in the terminal ileum was significantly upregulated.Furthermore,the expression of key gluconeogenic enzyme genes,glucose-6-phosphatase(G6PC)and phosphoenolpyruvate carboxykinase 1(PCK1),was significantly downregulated.Correlation analysis showed that the Prevotellaceae_NK3B31_group was positively correlated with 7-KLCA and FXR,and negatively correlated with glucose tolerance,α-muricholic acid,G6PC,and PCK1.CONCLUSION DBRPI inhibits hepatic gluconeogenesis and improves glucose metabolism.The mechanism may be related to activation of the 7-KLCA-FXR signaling pathway mediated by the Prevotellaceae_NK3B31_group.展开更多
BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestina...BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.展开更多
Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced...Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.展开更多
BACKGROUND Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders.Indeed,numerous maladaptive eating behaviors and eating disorders ...BACKGROUND Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders.Indeed,numerous maladaptive eating behaviors and eating disorders have been described following bariatric surgery.However,the differentiation of pathologic eating patterns from expected dietary changes following bariatric surgery can sometimes be difficult to discern.CASE SUMMARY A female in her early 40s presented for medical stabilization of severe protein calorie malnutrition after losing 52.3 kg over the last six months after Roux-en-Y gastric bypass,with subsequent development of cyclic nausea and vomiting.Fear of these aversive physical symptoms led to further restriction of nutritional intake and weight loss.The patient was diagnosed with avoidant/restrictive food intake disorder,which has not been previously reported after bariatric surgery.CONCLUSION Improvement in the diagnostic nomenclature for feeding and eating disorders is warranted for patients who have undergone bariatric surgery.展开更多
Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission.However,the reliability of glycated hemoglobin(HbA1c)as a type 2 diabetes biomarker post-surgery can be confounded by...Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission.However,the reliability of glycated hemoglobin(HbA1c)as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications.Hence,we explored the use of alter-native biomarkers such as glycated albumin(GA),1,5-anhydroglucitol(1,5-AG),and insulin-like growth factor binding protein-1(IGFBP-1)to monitor glycemic control more effectively in post-bariatric surgery patients.Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c,especially under non-fasting conditions.GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring.IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normal-ization.However,challenges in assay standardization and cost remain significant barriers to their clinical adoption.Although these biomarkers could offer a more personalized approach to glucose monitoring(thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients),this would require overcoming technical,logistical,and cost-related challenges.While using GA,1,5-AG,and IGFBP-1 shows promise for glycemic monitoring,further research and validation are crucial for their routine clinical implementation,espe-cially in the context of diabetes management post-bariatric surgery.展开更多
文摘Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures.Over the last decade,significant progress in endoscopic techniques and technologies has improved the safety,efficacy,and accessibility of these procedures.Current methods,such as intragastric balloons,endoscopic sleeve gastroplasty,and endoscopic-assisted gastrojejunostomy,have promoted weight loss,improving the metabolic health of obese individuals,with emerging evidence suggesting that their combination with pharmacological agents could further maximize their benefit.Emerging technologies,such as robotic-assisted endoscopic devices,advanced imaging systems,and biodegradable implants,could enhance procedural precision,minimize complications,and provide more personalized treatment options.In contrast,novel approaches such as microbiome modulation and tissue regeneration could have an adjunct role in improving patient outcomes.This review provides a brief overview of the current status of endoscopic bariatrics,highlighting the most common procedures and emerging technologies.It also discusses the challenges and future directions for the field,emphasizing the importance of multidisciplinary collaboration,patient selection,and research priorities to establish the long-term benefit and effectiveness of the available endoscopic bariatric interventions.
文摘The obesity epidemic in the USA and worldwide is well documented and continues to grow.Endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention.This article will review advances in endobariatrics over the last several decades,addressing the past and current state of bariatric and metabolic endoscopy.Food and Drug Administration-cleared devices and interventions currently under investigation are described including gastric devices,gastric remodeling procedures,small-bowel devices,duodenal ablation,as well as procedures to address weight regain after bariatric surgery.Future studies evaluating gastric and duodenal combination therapy,adjunctive pharmacotherapy,as well as individualized precision-health algorithms are underway.
文摘BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While the efficacy of revisional EBTs has been documented,no studies to date have examined how these procedures impact quality of life(QOL)and internalized weight bias(IWB).AIM To understand how endoscopic revisional therapies impact QOL,IWB,and dumping syndrome.METHODS Analysis included 19 participants treated for post-MBS recurrent weight gain and/or dumping syndrome.The short-form 36 survey,weight bias internalization scale,and the Sigstad scoring system were used to measure QOL,IWB,and dumping syndrome pre-and≥4 weeks post-EBT.RESULTS At 6-months,total body weight loss was 8.6%±7.15%(n=16),at 12-months was 13.4%±7.46%(n=16).Short-form 36 scores for all 8 scales significantly increased from pre-to post-procedure with the greatest improvement in the scales related to emotional(mean improvement=59.6,P<0.05)and physical health(mean improvement=31.1,P<0.05).Both total Sigstad score(mean difference=4.947,P<0.05)and total weight bias internalization score(mean difference=0.761,P<0.05)significantly decreased from pre-to post-procedure.CONCLUSION Findings suggest that revisional EBT may improve post-MBS QOL across a broad spectrum of outcomes beyond optimizing body weight.As early EBT results indicate positive mental and physical health outcomes,further research is needed to evaluate the relationship between these improvements,body weight and interdisciplinary post-MBS care.
文摘Metabolic dysfunction-associated fatty liver disease(MAFLD)is currently the leading cause of end-stage liver disease and liver cancer in the world because of the obesity pandemic.Insulin resistance resulting from abdominal adiposity is the main cause of MAFLD and type 2 diabetes mellitus among these patients.Although very common,therapeutic options for MAFLD are currently limited.Metabolic and bariatric surgery is the best treatment option for weight loss that can also improve MAFLD in a very high proportion of patients.However,surgical interventions are expensive,technically challenging,and carry significant immediate and long-term postoperative risks.Duodenal mucosal ablation,a malabsorptive endoscopic bariatric intervention,has shown beneficial effects in the management of obesity with an improvement of insulin resistance.It alters the duodenal mucosal lining,which helps maintain cellular homeostasis and better intestinal endocrine function.This process helps reduce lipid deposition in the liver,maintain serum lipid levels,and promote weight loss,especially in patients with type 2 diabetes mellitus-related MAFLD.However,some of these effects were independent of weight loss and food intake.As a minimally invasive procedure,it is beneficial for patients who have not had success with drug therapy alone,though this approach needs to be tested and further developed in future clinical trials.A basic study by Yu et al in the recent issue of the World Journal of Gastroenterology on duodenal mucosal ablation using irreversible electroporation,when experimented on rats,has shown fewer complications compared to other metabolic surgeries.This editorial describes the minimally invasive endoscopic bariatric strategies for the management of obesity and MAFLD in light of this experimental study.
文摘Currently,the worldwide prevalence of morbid obesity has increased.1 The National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention revealed that the prevalence of obesity in the adult population between 20 and 74 years old had more than doubled from 13.3%to 31.1%from 1960 to 2002.2 Metabolic and bariatric surgery(MBS)is now suggested for patients with a body mass index(BMI)of more than 35 kg/m2,comorbidities or no comorbidities.Furthermore,MBS should be offered to people with metabolic disease and a BMI of 30e34.9 kg/m2 who have failed to gain a meaningful amount of weight or have failed to keep it off with non-surgical management.However,the BMI cutoff points should be modified for the Asian population.
文摘BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.
文摘Obesity is a significant global health concern, often leading to comorbidities such as cardiovascular diseases, diabetes, and hypertension. Bariatric surgery, including sleeve gastrectomy (SG), is a proven treatment for morbid obesity, offering substantial weight loss and resolution of comorbidities. However, post-surgical complications, particularly anorectal disorders such as hemorrhoids and anal fissures, remain underexplored, especially in Saudi Arabia. This retrospective cohort study aimed to assess the prevalence, risk factors, and impact of anal complications following SG at Almoosa Specialist Hospital in Alhassa, Saudi Arabia. A total of 205 patients who underwent SG between January 2020 and December 2021 were surveyed, with 148 eligible participants included in the final analysis. Results indicated that 8.8% of patients experienced anal complications, with anal fissures (53.8%) and hemorrhoids (38.5%) being the most common. These complications typically occurred 2 - 6 months post-surgery. Lifestyle factors such as physical activity and fluid intake were found to significantly reduce the likelihood of anal issues. Moreover, 69.2% of patients with anal problems reported a negative impact on their quality of life. The study highlights the importance of targeted post-operative care, including lifestyle modifications, to mitigate the impact of anal complications. The findings suggest that ongoing education and comprehensive support for bariatric surgery patients, particularly regarding physical activity and hydration, are critical for improving long-term health outcomes. Further research is needed to explore the long-term progression of anal complications and effective interventions for enhancing patient satisfaction and quality of life.
文摘Traditionally,liver retraction for laparoscopic gastrectomy is done via manual methods,such as the placement of retractors through the accessory ports and using a Nathanson retractor.However,these techniques often posed issues including extra abdominal incisions,risk of liver injury or ischaemia,and the potential for compromised visualization.Over the years,the development of innovative liver retraction techniques has significantly improved the safety and efficacy of laparoscopic gastrectomy and similar other hiatal procedures.This editorial will comment on the article by Lin et al,and compare this to the other liver retractor techniques available for surgeons and highlight the pros and cons of each technique of liver retraction.
基金Supported by the Technological innovation project of Shapingba District,No.2024111the Research Promotion Fund of Chongqing University Cancer Hospital,No.2023nlts008.
文摘BACKGROUND Type 2 diabetes(T2D)remission has been widely reported after bariatric surgery,but rarely reported after esophagectomy.AIM To explore the incidence and predictors of T2D remission 1 year after esophagectomy with gastric conduit reconstruction.METHODS In this prospective study,consecutive patients from 2 tertiary hospitals who had esophageal cancer and T2D and underwent esophagectomy with gastric conduit reconstruction were studied preoperatively and at 3 months,6 months,and 12 months postoperatively.Remission of T2D is defined as glycated hemoglobin(HbA1c)values below 6.5%without glucose-lowering medications.Related clinical information were recorded and analyzed.RESULTS A total of 187 patients were included.Of these patients,24(12.8%)discontinued antidiabetic drugs and maintained HbA1c values below 6.5%1 year after surgery.At baseline,patients with T2D remission were younger(63.0±5.2 years vs 67.0±6.1 years,P=0.002),had higher body mass index values(body weight 68.6±11.1 kg vs 61.2±9.3 kg,P=0.001;body mass index 25.5±2.4 kg/m2 vs 23.8±3 kg/m2,P=0.011),shorter duration of T2D(4.9±3.9 years vs 7.1±3.7 years,P=0.008)and higher preoperative HbA1c(8.5%±1.7%vs 7.7%±1.3%,P=0.042).Multivariate logistic regression analysis showed that younger age and greater body weight were independent predictors of T2D remission after surgery.CONCLUSION This study reveals a significant incidence of T2D remission after esophagectomy with gastric conduit reconstruction,and remission is more frequent in patients with younger age and greater body weight.
文摘Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.
文摘Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.
文摘BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postoperative weight loss remains controversial.AIM To evaluate the effect of RGV on weight loss and body mass index(BMI)changes in patients undergoing sleeve gastrectomy.METHODS This retrospective study included 49 patients.Preoperative and postoperative body weight and BMI(at 6 months and 12 months after surgery)were recorded.RGV was calculated using the ellipsoid formula based on the specimen’s length,width,and thickness measurements.Statistical analyses included parametric tests,repeated-measures one-way analysis of variance,Bonferroni post-hoc tests,and Pearson correlation analysis.RESULTS Both body weight and BMI significantly decreased over time(weight:F=951.34,P<0.01,η^(2)=0.95;BMI:F=345.97,P<0.01,η^(2)=0.88).A positive and statistically significant correlation was found between preoperative body weight and RGV(r=0.285,P<0.05).However,no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.CONCLUSION RGV correlated with preoperative weight but not with postoperative outcomes,indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal,metabolic,and lifestyle factors.
文摘The increasing prevalence of pediatric obesity has raised numerous questions about its health implications,particularly regarding renal transplant outcomes.These complications often hinder medical interventions in these children.While kidney transplants are often viewed from an organocentric perspective,the overall health of the patient is critical to the success of the procedure.Current discussions make it clear that childhood obesity poses significant problems not only for graft survival,but also for long-term overall health.Childhood obesity can lead to many metabolic disorders such as diabetes and hypertension.These conditions can significantly affect a child's suitability for a transplant or make the process more difficult.A child's weight can affect the pharmacokinetics of drugs used to prevent organ rejection.Obesity impacts the individual and sets in motion a cascade of effects that can jeopardize transplant success and recovery,so understanding is needed.Research on graft survival rates is both optimistic and concerning.Clinical studies show that obese children often have an increased risk of post-transplant complications,which affects transplant longevity.The likelihood of rejection may increase due to the metabolic status of an obese child.Due to the allocation of healthcare resources for the treatment of obesity-related diseases,availability for the transplant itself may be limited.Many children maintain an adequate quality of life after a kidney transplant,but excessive weight can significantly affect their health and chances of survival.The main target is looking for highly successful strategies to give all children who need a transplant a better future,regardless of their weight.
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.SKJP220225830.
文摘BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.
文摘BACKGROUND Malabsorptive bariatric surgery,including Roux-en-Y gastric bypass and duodenal switch,are known to be more metabolically effective than restrictive surgery.However,the permanent alteration of gastrointestinal anatomy from these operations has been shown to alter the kinetics of drug absorption and may make subsequent surgeries more technically challenging.AIM To evaluate perioperative liver transplant outcomes and rates of acute cellular rejection in recipients with prior malabsorptive bariatric surgery.METHODS Patients who underwent liver transplantation at a single institution between 2005-2024 with a history of malabsorptive bariatric surgery were identified.Matched controls were selected based on age,sex,listing model for end-stage liver disease(MELD),and primary liver diagnosis.RESULTS A total of 12 liver transplant patients with prior malabsorptive surgery and 25 controls were included.The mean age in the malabsorptive group was 50.5 years at the time of transplant and 92%were female.The mean MELD at the time of transplant was 27.6 and mean body mass index was 28.There were no significant differences in length of stay,post operative complications,or 1 year survival between the controls and malabsorptive patients.However,the malabsorptive group was significantly more likely to experience biopsy-proven and clinically treated acute cellular rejection than the controls(24%vs 66.7%,P=0.012),more frequent rejection episodes(0.28±0.53 vs 1.0±0.91,P=0.006),and earlier time to first rejection episode(P=0.002).CONCLUSION Previous malabsorptive bariatric surgery in liver transplant recipients did not increase the risk of perioperative complications or mortality but significantly increased the rate and frequency of acute cellular rejection.
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.202310024.
文摘BACKGROUND Distal small bowel resection with preservation of the terminal ileum(DBRPI)significantly improves glucose metabolism in rats.AIM To explore the underlying mechanisms of DBRPI in improving glucose metabolism.METHODS Following 8 weeks of a high-fat diet,the rats were randomly divided into the DBRPI group and the sham operation group.After surgery,body weight and glucose tolerance were monitored.At 6 weeks post-surgery,the composition of intestinal microbiota,bile acid levels,and the expression of farnesoid X receptor(FXR),Takeda G protein-coupled receptor 5,and glucagon-like peptide-1(GLP-1)in the ileum were examined.Additionally,the gene expression of key enzymes involved in gluconeogenesis in the liver was evaluated.RESULTS DBRPI reduced body weight and improved glucose tolerance.At 6 weeks postsurgery,the abundance of Prevotellaceae_NK3B31_group and the level of 7-ketolithocholic acid(7-KLCA)were significantly increased,while the abundance of Desulfovibrio fairfieldensis and the level ofα-muricholic acid were significantly decreased.The expression of FXR and GLP-1 in the terminal ileum was significantly upregulated.Furthermore,the expression of key gluconeogenic enzyme genes,glucose-6-phosphatase(G6PC)and phosphoenolpyruvate carboxykinase 1(PCK1),was significantly downregulated.Correlation analysis showed that the Prevotellaceae_NK3B31_group was positively correlated with 7-KLCA and FXR,and negatively correlated with glucose tolerance,α-muricholic acid,G6PC,and PCK1.CONCLUSION DBRPI inhibits hepatic gluconeogenesis and improves glucose metabolism.The mechanism may be related to activation of the 7-KLCA-FXR signaling pathway mediated by the Prevotellaceae_NK3B31_group.
文摘BACKGROUND Laparoscopic one anastomosis gastric bypass(OAGB)has grown in popularity in recent years for the treatment of morbid obesity.Despite routine practice,the utility of early postoperative upper gastrointestinal(UGI)swallow studies to detect complications following OAGB has been questioned.AIM To evaluate the effectiveness and cost-efficiency of performing routine UGI studies on the first postoperative day(POD)after OAGB.METHODS A retrospective cohort analysis of a prospectively collected database was conducted to identify all consecutive patients who underwent OAGB between January 2019 and July 2022.Patient demographics,operative data,and postoperative complication rates were analyzed.Reports from all imaging studies were retrospectively reviewed,and complications were recorded.The institutional review board waived the requirement for informed consent.RESULTS A total of 385 patients were included.All patients had an iodine-based contrast swallow study on the first POD.Abnormal findings were observed in 4 patients(1%),none of which were correlated with postoperative complications.Two patients(0.5%)required reoperation due to complications although both had normal UGI study results.Sensitivity and positive predictive value of UGI studies for detecting complications were 0%,while specificity and negative predictive value were 99%and 98%,respectively.Based on hospital charges the overall cost of all the UGI swallow studies performed in our study was 95865 USD.CONCLUSION The study findings showed that performing routine UGI swallow studies on the first POD after laparoscopic OAGB is ineffective in detecting complications and is not cost effective.Normal UGI studies might mislead clinicians in the postoperative period and thus should be omitted in favor of close clinical monitoring.
基金Supported by the National Natural Science Foundation of China,No.82471616,No.82170418 and No.82271618Natural Science Foundation of Hubei Province,No.2022CFA015+2 种基金Central Guiding Local Science and Technology Development Project,No.2022BGE237Key Research and Development Program of Hubei Province,No.2022BCE001 and No.2023BCB139Hubei Provincial Health Commission Project,No.WJ2023M151。
文摘Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.
文摘BACKGROUND Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders.Indeed,numerous maladaptive eating behaviors and eating disorders have been described following bariatric surgery.However,the differentiation of pathologic eating patterns from expected dietary changes following bariatric surgery can sometimes be difficult to discern.CASE SUMMARY A female in her early 40s presented for medical stabilization of severe protein calorie malnutrition after losing 52.3 kg over the last six months after Roux-en-Y gastric bypass,with subsequent development of cyclic nausea and vomiting.Fear of these aversive physical symptoms led to further restriction of nutritional intake and weight loss.The patient was diagnosed with avoidant/restrictive food intake disorder,which has not been previously reported after bariatric surgery.CONCLUSION Improvement in the diagnostic nomenclature for feeding and eating disorders is warranted for patients who have undergone bariatric surgery.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS 2023-00237287.
文摘Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission.However,the reliability of glycated hemoglobin(HbA1c)as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications.Hence,we explored the use of alter-native biomarkers such as glycated albumin(GA),1,5-anhydroglucitol(1,5-AG),and insulin-like growth factor binding protein-1(IGFBP-1)to monitor glycemic control more effectively in post-bariatric surgery patients.Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c,especially under non-fasting conditions.GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring.IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normal-ization.However,challenges in assay standardization and cost remain significant barriers to their clinical adoption.Although these biomarkers could offer a more personalized approach to glucose monitoring(thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients),this would require overcoming technical,logistical,and cost-related challenges.While using GA,1,5-AG,and IGFBP-1 shows promise for glycemic monitoring,further research and validation are crucial for their routine clinical implementation,espe-cially in the context of diabetes management post-bariatric surgery.
