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Robert M, Poghosyan T, Maucort-Boulch D, Filippello A, Caiazzo R, Sterkers A, Khamphommala L, Reche F, Malherbe V, Torcivia A, Saber T, Delaunay D, Langlois-Jacques C, Suffisseau A, Bin S, Disse E, Pattou F. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study. Lancet Diabetes Endocrinol 2024; 12:267-276. [PMID: 38452784 DOI: 10.1016/s2213-8587(24)00035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The multicentre randomised trial YOMEGA (NCT02139813) comparing the one anastomosis gastric bypass (OAGB) with the Roux-en-Y gastric bypass (RYGB) confirmed the non-inferiority of OAGB on weight loss outcomes at 24 months. We aimed to report weight loss, metabolic, and safety outcomes at 5 years. METHODS YOMEGA is a prospective, open-label, non-inferiority, randomised trial conducted at nine centres in France. Inclusion criteria were BMI of 40 kg/m2 or more, or 35 kg/m2 or more with comorbidities. Key exclusion criteria were severe gastro-oesophageal reflux disease or Barrett's oesophagus and previous bariatric surgery. Patients were randomly assigned (1 :1) to OAGB (one gastrojejunal anastomosis with a 200 cm biliopancreatic limb) or RYGB (with a 150 cm alimentary limb and a 50 cm biliary limb), stratified by centre, with blocks of variable size. The primary endpoint of this extension study was percentage excess BMI loss and was analysed in the per-protocol population, including patients with data who were operated on with the technique randomly assigned to them and excluding patients with major deviations from the protocol during the follow-up (change of surgical technique, death, or withdrawal of consent). Non-inferiority was concluded for the primary endpoint if the upper bound of the CI was less than the non-inferiority limit (7 percentage points). YOMEGA is registered with ClinicalTrials.gov, NCT02139813, and the 5-year follow-up of YOMEGA is registered with ClinicalTrials.gov, NCT05549271. FINDINGS Between May 13, 2014, and March 2, 2016, 253 patients were randomly assigned to OAGB (n=129) or RYGB (n=124), and from these patients 114 in the OAGB group and 118 in the RYGB group were included in the per-protocol analysis. In the per-protocol population, at baseline, mean age was 43·0 years (SD 10·8), mean BMI was 44·0 kg/m2 (5·6), 54 (23%) patients were male and 178 (77%) were female; 55 (27%) of 207 patients had type 2 diabetes. After 5 years, mean percentage excess BMI loss was -75·6% (SD 28·1) in the OAGB group versus -71·4% (SD 29·8) in the RYGB group, confirming non-inferiority (mean difference -4·1% [90% CI -12·0 to 3·7], p=0·0099). Remission of type 2 diabetes was similar in both groups. Nutritional status did not differ; the most common adverse event was clinical gastro-oesophageal reflux disease, occurring in 27 (41%) of 66 patients in the OAGB group versus 14 (18%) of 76 patients in the RYGB group (p=0·0030). Among serious adverse events, ten (8%) of 127 patients converted from OAGB to RYGB. 171 (68%) of 253 patients were followed up. INTERPRETATION OAGB was not inferior to RYGB regarding percentage excess BMI loss at 5 years with similar metabolic outcomes. The high rate of clinical gastro-oesophageal reflux disease after OAGB raises questions about its long-term consequences, which need to be further investigated. FUNDING Medtronic.
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Affiliation(s)
- Maud Robert
- Department of Digestive and Bariatric Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; CarMeN Laboratory INSERM Unit 1060, Lyon 1 University, Lyon, France.
| | - Tigran Poghosyan
- Digestive, Esogastric, and Bariatric Surgery Department, Hôpital Bichat-Claude Bernard, Université Paris Cité, UMRS-INSERM1149, Paris, France
| | - Delphine Maucort-Boulch
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Université Lyon1, Lyon, France
| | | | - Robert Caiazzo
- General and Endocrine Surgery, Université de Lille, Inserm U1190, Centre Hospitalier et Universitaire de Lille, Institut Pasteur de Lille, Lille, France
| | - Adrien Sterkers
- Department of Digestive, Hepatobiliary Surgery, Centre Hospitalier Privé Saint Grégoire, Saint Gregoire, France
| | - Lita Khamphommala
- Department of Digestive, Hepatobiliary Surgery, Centre Hospitalier Privé Saint Grégoire, Saint Gregoire, France
| | - Fabian Reche
- Digestive Surgery Department, CHU Grenoble, Grenoble, France
| | - Vincent Malherbe
- General and Endocrine Surgery Department, Hôpital Privé Drôme et Ardèche, Guilherand-Granges, France
| | - Adriana Torcivia
- Department of Digestive, Hepatobiliary Surgery, Hôpital Pitié Salpétrière, Paris, France
| | - Toufic Saber
- Department of General Surgery, Lebanese American Medical Center, Saint John Hospital, Beyrouth, Lebanon
| | - Dominique Delaunay
- Department of Digestive and Bariatric Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Carole Langlois-Jacques
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Université Lyon1, Lyon, France
| | - Augustin Suffisseau
- Digestive, Esogastric, and Bariatric Surgery Department, Hôpital Bichat-Claude Bernard, Université Paris Cité, UMRS-INSERM1149, Paris, France
| | - Sylvie Bin
- Clinical Research Unit, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Disse
- CarMeN Laboratory INSERM Unit 1060, Lyon 1 University, Lyon, France; Department of Endocrinology, Diabetology and Nutrition, Specialized Center for Obesity Management, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - François Pattou
- General and Endocrine Surgery, Université de Lille, Inserm U1190, Centre Hospitalier et Universitaire de Lille, Institut Pasteur de Lille, Lille, France
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Scicali R, Di Pino A, Platania R, Purrazzo G, Ferrara V, Giannone A, Urbano F, Filippello A, Rapisarda V, Farruggia E, Piro S, Rabuazzo AM, Purrello F. Detecting familial hypercholesterolemia by serum lipid profile screening in a hospital setting: Clinical, genetic and atherosclerotic burden profile. Nutr Metab Cardiovasc Dis 2018; 28:35-43. [PMID: 28958694 DOI: 10.1016/j.numecd.2017.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is underdiagnosed and public cholesterol screening may be useful to find new subjects. In this study, we aim to investigate the prevalence of FH patients in a hospital screening program and evaluate their atherosclerotic burden using intima-media thickness (IMT). METHODS AND RESULTS We screened 1575 lipid profiles and included for genetic analysis adults with a low-density lipoprotein (LDL) cholesterol >190 mg/dL and triglycerides <200 mg/dL and first-degree child relatives with LDL cholesterol >160 mg/dL and triglycerides <200 mg/dL. The diagnosis of FH was presumed by Dutch Lipid Clinic Network (DLCN) criteria and confirmed by the presence of the genetic variant. Mean common carotid intima-media thickness (IMT) was assessed using consensus criteria. After confirming LDL cholesterol value and excluding secondary hypercholesterolemia, 56 subjects with a DLCN ≥4 performed genetic analysis. Of these, 26 had an FH genetic variant. The proportion of patients with a mutation having a DLCN score of 6-8 was 75%; in individuals with a DLCN score >8 it was 100%. Mean IMT was higher in FH patients compared to non FH (0.73 [0.61-0.83] vs 0.71 [0.60-0.75] mm, p < 0.01). Moreover, we detected two mutations not previously described. Finally, simple regression analysis showed a correlation of IMT with LDL cholesterol >190 mg/dL and corneal arcus (p < 0.01 and p < 0.001, respectively). CONCLUSIONS A hospital screening was useful to detect FH subjects with increased atherosclerosis. Also, next-generation sequencing was able to detect new FH mutations.
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Affiliation(s)
- R Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - R Platania
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - G Purrazzo
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - V Ferrara
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Giannone
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - F Urbano
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Filippello
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - V Rapisarda
- Department of Clinical and Experimental Medicine, Section of Occupational Medicine, University of Catania, Italy
| | - E Farruggia
- Occupational Medicine Division, Garibaldi Hospital of Catania, Catania, Italy
| | - S Piro
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A M Rabuazzo
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - F Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Italy.
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Filippello A, Porcheron J, Klein JP, Cottier M, Barabino G. Affinity of Indocyanine Green in the Detection of Colorectal Peritoneal Carcinomatosis. Surg Innov 2016; 24:103-108. [PMID: 27909239 DOI: 10.1177/1553350616681897] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Indocyanine green (ICG) is increasingly being used in digestive oncology. In colorectal cancer, ICG can be used to detect lymph node metastasis and hepatic metastasis on the surface of the liver. In peritoneal carcinomatosis, it was previously suspected that the diffusion of ICG in the tumor mass was due to the enhanced permeability and retention effect; however, this phenomenon has not been clearly demonstrated. Using bevacizumab, an antibody directed against vascular endothelial growth factor that consequently inhibits neoangiogenesis, we sought to confirm the mode of ICG diffusion. We compared the fluorescence of peritoneal carcinomatosis nodules from patients who had previously received bevacizumab during their oncologic treatment with those who did not receive this therapy. The sensitivity of the carcinomatosis nodule fluorescence was higher in the patients who did not receive bevacizumab compared with those who received the drug (76.3% and 65.0%, respectively). The rate of false-negative results was higher in the bevacizumab group than in the group that did not receive the drug (53.8% and 42.9%, respectively). Using bevacizumab, we demonstrate that the enhanced permeability and retention effect causes ICG accumulation in peritoneal carcinomatosis resulting from colorectal cancer.
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Affiliation(s)
- Alexandre Filippello
- 1 University Nord Hospital, Saint Etienne, France.,2 Jean Monnet University of Saint Etienne, Saint Etienne, France
| | | | | | - Michèle Cottier
- 2 Jean Monnet University of Saint Etienne, Saint Etienne, France
| | - Gabriele Barabino
- 1 University Nord Hospital, Saint Etienne, France.,2 Jean Monnet University of Saint Etienne, Saint Etienne, France
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Di Mauro S, Ragusa M, Urbano F, Filippello A, Di Pino A, Scamporrino A, Pulvirenti A, Ferro A, Rabuazzo AM, Purrello M, Purrello F, Piro S. Intracellular and extracellular miRNome deregulation in cellular models of NAFLD or NASH: Clinical implications. Nutr Metab Cardiovasc Dis 2016; 26:1129-1139. [PMID: 27756518 DOI: 10.1016/j.numecd.2016.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) represents the most common chronic liver disease in industrialized countries. NAFLD has the potential to progress through the inflammatory phase of nonalcoholic steatohepatitis (NASH) to fibrosis, cirrhosis, and hepatocellular carcinoma. Identifying patients at risk for this transition is a relevant clinical challenge. The complexity of these phenotypes in vivo made necessary the development of in vitro models in order to dissect the molecular signalling affected in NAFLD and NASH, but also to identify potential circulating biomarkers. METHODS AND RESULTS We profiled the expression of 754 cellular and medium-secreted human miRNAs in HepG2 cells after lipotoxic (Palmitate, model of NASH) or not-lipotoxic stimuli (Oleate-Palmitate, model of NAFLD). Results were validated through Single TaqMan assays. We performed computational analysis of miRNA targets and pathways. Oleate-palmitate treatment induced a variation of 2.8% and 10% of total miRNAs in cells and medium, respectively; palmitate treatment caused 10% and 19% intracellular and extracellular miRNA deregulation, respectively. We validated miR-126, miR-150, miR-223, miR-483-3p, miR-1226*, and miR-1290 deregulation. Through computational analysis, we observed that targets of both intracellular and extracellular DE miRNAs were involved in processes associated with the onset and progression of NAFLD and NASH, such as fatty acid metabolism, apoptosis and inflammation. CONCLUSIONS These data would be useful to elucidate the role of miRNAs in the pathogenesis and progression of the NAFLD spectrum, but they also allow the identification of novel potential biomarkers for differential diagnosis to be tested in vivo.
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Affiliation(s)
- S Di Mauro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - M Ragusa
- Department of BioMedical Sciences and BioTechnology, Section of Biology and Genetics Giovanni Sichel, Unit of BioMolecular, Genome and Complex Systems BioMedicine, Catania, Italy
| | - F Urbano
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - A Filippello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - A Di Pino
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - A Scamporrino
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - A Pulvirenti
- Department of Clinical and Experimental Medicine, Bioinformatics, University of Catania, Catania, Italy
| | - A Ferro
- Department of Clinical and Experimental Medicine, Bioinformatics, University of Catania, Catania, Italy
| | - A M Rabuazzo
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - M Purrello
- Department of BioMedical Sciences and BioTechnology, Section of Biology and Genetics Giovanni Sichel, Unit of BioMolecular, Genome and Complex Systems BioMedicine, Catania, Italy
| | - F Purrello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy.
| | - S Piro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
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