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Schiavon CA. Paired Comment Regarding Early Successful Experiences of Surgical Conversion of Endoscopic Gastric Plication to Roux-en-Y gastric Bypass. Obes Surg 2024:10.1007/s11695-024-07272-8. [PMID: 38743182 DOI: 10.1007/s11695-024-07272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Carlos Aurelio Schiavon
- Center for Obesity and Bariatric Surgery, Hospital BP, A Beneficencia Portuguesa de Sao Paulo, Rua Maestro Cardim, 769, Sao Paulo, SP, 01323-900, Brazil.
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Jirapinyo P, Jaroenlapnopparat A, Zucker SD, Thompson CC. Combination Therapy of Endoscopic Gastric Remodeling with GLP-1RA for the Treatment of MASLD. Obes Surg 2024; 34:1471-1478. [PMID: 38512644 DOI: 10.1007/s11695-024-07178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The mainstay of treatment for metabolic dysfunction-associated steatotic liver disease (MASLD) is weight loss. Endoscopic gastric remodeling (EGR) and glucagon-like peptide-1 receptor agonist (GLP-1RA) are effective weight loss therapies. This study aims to assess the effect of combining EGR with GLP-1RA on liver-related outcomes and weight profile. MATERIALS AND METHODS This is a retrospective study of a prospectively collected registry of patients with MASLD and compensated advanced chronic liver disease (cACLD) who underwent EGR. Patients were categorized as (1) monotherapy: EGR alone and (2) combination therapy: GLP-1RA prescribed within 6 months prior to or after EGR. Outcomes included changes in noninvasive tests of hepatic fibrosis, weight profile, and insulin resistance status at 12 months. RESULTS Thirty patients (body mass index 40.7 ± 9.3 kg/m2) were included. Of these, 12 patients (40%) underwent EGR monotherapy, and 18 patients (60%) underwent EGR + GLP-1RA combination therapy. Combination therapy group experienced greater improvements in fibrosis compared to monotherapy group (alanine aminotransferase: reduction by 55 ± 23% vs 29 ± 22% (p = 0.008), NAFLD fibrosis score: reduction by 181 ± 182% vs 30 ± 83% (p = 0.04), liver stiffness measurement on transient elastography: reduction by 54 ± 12% vs 14 ± 45% (p = 0.05)). There were greater reductions in hemoglobin A1c and homeostatic model assessment for insulin resistance in combination therapy compared to monotherapy (p < 0.05). At 12 months, the combination therapy group experienced 18.2 ± 6.6% TWL, while monotherapy group experienced 9.6 ± 3.3% TWL (p = 0.004). CONCLUSIONS In patients with MASLD and cACLD, combination of EGR with GLP-1RA is associated with greater improvements in hepatic fibrosis, weight profile, and insulin resistance compared to EGR alone.
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Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Aunchalee Jaroenlapnopparat
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Medicine, Mount Auburn Hospital, 330 Mt Auburn St, Cambridge, MA, 02138, USA
| | - Stephen D Zucker
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Pessorrusso F, Mehta SV, Sullivan S. Update on Endoscopic Treatments for Obesity. Curr Obes Rep 2024:10.1007/s13679-024-00551-6. [PMID: 38388770 DOI: 10.1007/s13679-024-00551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Increased morbidity seen with rising obesity rates continues to place an unheralded burden on our health system. Lack of higher bariatric surgery utilization and limitations with lifestyle modification and pharmacotherapy highlights the need for additional therapies for obesity. Endoscopic bariatric and metabolic therapies (EBMT) are effective, safe treatments for obesity. Current FDA-approved EBMT are confined to gastric modalities while small bowel directed therapies are still considered investigational. This review highlights current modalities of EBMT. RECENT FINDINGS Many randomized controlled trials have been performed, including both open label and sham-controlled, which have demonstrated safety and efficacy of EBMT over lifestyle therapy alone. In addition, emerging evidence from clinical experience further supports EBMT for treatment of obesity. Current evidence supports the safety and efficacy of EBMT for obesity treatment in conjunction with lifestyle therapy. They can also be used concurrently with weight loss medications to increase total weight loss.
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Affiliation(s)
- Fernanda Pessorrusso
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Academic Office 1, 12631 E. 17th Ave, Mail Stop B158, Aurora, CO, 80045, USA
| | - Sagar V Mehta
- Division of Gastroenterology, Geisinger Health System, Danville, PA, USA
| | - Shelby Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Academic Office 1, 12631 E. 17th Ave, Mail Stop B158, Aurora, CO, 80045, USA.
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Mauro A, Lusetti F, Scalvini D, Bardone M, De Grazia F, Mazza S, Pozzi L, Ravetta V, Rovedatti L, Sgarlata C, Strada E, Torello Viera F, Veronese L, Olivo Romero DE, Anderloni A. A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going. Medicina (Kaunas) 2023; 59:medicina59030636. [PMID: 36984637 PMCID: PMC10052707 DOI: 10.3390/medicina59030636] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023]
Abstract
Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesca Lusetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Specialization School of Diseases of Digestive System Pavia, University of Pavia, 27100 Pavia, Italy
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Specialization School of Diseases of Digestive System Pavia, University of Pavia, 27100 Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Federico De Grazia
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lodovica Pozzi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Valentina Ravetta
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Laura Rovedatti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Carmelo Sgarlata
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Elena Strada
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesca Torello Viera
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Letizia Veronese
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Daniel Enrique Olivo Romero
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Digestive Endoscopy Unit, Hospital Nacional Zacamil, San Salvador 01120, El Salvador
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Jirapinyo P, Thompson CC. Primary Bariatric Procedures. Dig Dis Sci 2022; 67:1674-87. [PMID: 35348970 DOI: 10.1007/s10620-022-07393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/09/2022]
Abstract
Obesity is pandemic. It is estimated that by 2030, half of the U.S. population will have obesity. Current treatment options for obesity includes lifestyle modification, pharmacotherapy, endoscopic bariatric and metabolic therapy (EBMT) and bariatric surgery. Over the past decades, an increasing number of EBMTs have been developed and become available. As a gastroenterologist, it is therefore important to become familiar with the available EBMTs as well as their safety and efficacy profiles in order to educate and expeditiously refer patients for the appropriate therapy when eligible. This chapter will review currently available and upcoming EBMTs. Details on how the procedures are performed, their mechanisms of action as well as data from pivotal studies will be summarized.
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Singh S, Bazarbashi AN, Khan A, Chowdhry M, Bilal M, de Moura DTH, Jirapinyo P, Thakkar S, Thompson CC. Primary obesity surgery endoluminal ( POSE) for the treatment of obesity: a systematic review and meta-analysis. Surg Endosc 2022; 36:252-266. [PMID: 33523277 PMCID: PMC8389059 DOI: 10.1007/s00464-020-08267-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/22/2020] [Indexed: 02/16/2023]
Abstract
BACKGROUND Primary obesity surgery endoluminal (POSE) utilizes an incision-less operating platform system to create full-thickness plications in the gastric fundus and body (original POSE). Many studies have demonstrated the safety and efficacy of original POSE for the treatment of obesity. OBJECTIVE We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to evaluate the outcomes of original POSE per the ASGE task force thresholds. METHODS Bibliographic databases were systematically searched for studies assessing the outcomes of POSE for the treatment of obesity. All randomized controlled trials (RCTs) and observational studies that assessed outcomes of POSE were included. Studies were included if they reported percent total weight loss (%TWL) or percent excess weight loss (%EWL) and the incidence of serious adverse events (SAE). RESULTS A total of seven studies with 613 patients were included. Two included studies were RCTs, while the remaining were observational studies. Pooled mean %EWL at 3-6 months and 12-15 months were 42.62 (95% CI 37.56-47.68) and 48.86 (95% CI 42.31-55.41), respectively. Pooled mean %TWL at 3-6 months and 12-15 months was 13.45 (95% CI 8.93-17.97) and 12.68 (95% CI 8.13-17.23), respectively. Subgroup analysis of two RCTs showed that weight loss at 1 year was significantly higher in POSE patients (%EWL difference in means 19.45 (95% CI 4.65-34.24, p value = 0.01). The overall incidence of serious adverse events was only 2.84% and included GI bleeding, extra-gastric bleeding, hepatic abscess, severe pain, severe nausea, and severe vomiting. The mean number of total anchors placed in the fundus and body was 13.18 (95% CI 11.77-14.58), and the mean procedure time was 44.55 min (95% CI 36.44-52.65). CONCLUSION POSE, a minimally invasive endoscopic bariatric therapy, is a safe and effective modality for the treatment of obesity. The outcomes of POSE meet and surpass the ASGE joint task force thresholds. Future studies should evaluate newer versions of this procedure that emphasize gastric body plication sparing the fundus.
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Affiliation(s)
- Shailendra Singh
- Division of Gastroenterology and Hepatology, West Virginia University, 5th Floor Suite 5500, Morgantown, WV 26506, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmad Khan
- West Virginia University Health Sciences Center Charleston Division, Charleston, WV, USA
| | - Monica Chowdhry
- West Virginia University Health Sciences Center Charleston Division, Charleston, WV, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Shyam Thakkar
- Division of Gastroenterology and Hepatology, West Virginia University, 5th Floor Suite 5500, Morgantown, WV 26506, USA
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Lopez-Nava G, Laster J, Negi A, Bautista I, Corbelle F, Asokkumar R. Endoscopic gastroplasty: an effective solution in a high-risk patient with morbid obesity. Clin J Gastroenterol 2021; 14:489-493. [PMID: 33428066 DOI: 10.1007/s12328-020-01322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
A 61-year-old man was referred to the bariatric endoscopy unit for the management of morbid obesity (BMI 47 kg/m2). He had multiple obesity-related medical comorbidities. His weight gain started 8 years after suffering smoke inhalation syndrome following an industrial accident. He sustained permanent lung parenchymal injury resulting in impaired pulmonary function. His mobility was restricted to a wheelchair and was dependent on long term oxygen therapy. He tried diet and lifestyle intervention but could not achieve significant weight loss. He was referred for bariatric surgery but was declined because of substantial comorbidities, poor pulmonary function, anesthetic risk (ASA Class 4), and risk of complications. After depleting all of his options, he sought us for endoscopic therapy. Following a successful collaboration with the anesthetist, endocrinologist, and nutritionist, we performed an endoscopic gastroplasty using the modified primary obesity surgery endoluminal procedure (POSE-2) and reduced the gastric volume. He recovered immediately without complications and achieved significant weight loss at 10 months (41 kg). He is now able to walk, the oxygen requirements have decreased, and the comorbidities have significantly improved.
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Affiliation(s)
- Gontrand Lopez-Nava
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - Janese Laster
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain.
| | - Anuradha Negi
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - Inmaculada Bautista
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - Fernando Corbelle
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain
| | - Ravishankar Asokkumar
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, 28050, Madrid, Spain.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
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Khoursheed M, Al-Ali J, Fingerhut A. Laparoscopic sleeve gastrectomy after endoscopic sleeve gastroplasty and primary obesity surgery endoluminal: technical aspects. Surg Obes Relat Dis 2020; 16:1370-1371. [PMID: 32690455 DOI: 10.1016/j.soard.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Mousa Khoursheed
- Department of Surgery, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
| | - Jaber Al-Ali
- Department of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Abe Fingerhut
- Surgical Research Unit Graz, Medical University of Graz, Graz, Austria
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Abstract
BACKGROUND Obesity is one of the main challenges in the first world nowadays. New alternatives are needed and endoscopic endoluminal approaches are gaining importance against the risky surgery and the non-efficient pharmacological treatments. Nevertheless, these techniques seem to be inefficient in obese III patients. The aim of the study is to demonstrate the safety and efficiency of the new reinforced POSE 18-plication protocol. METHODS Mean body mass index (BMI) ≈ 47 kg/m2 obese type III patients were treated in different Spanish centers with the new POSE method consisting of 18 plications in the stomach body. On the other hand, 15 lower body mass patients BMI ≈ 40 kg/m2 were treated with the standard POSE method previously described. RESULTS Three months follow-up shows an overall % total weight loss (TWL) and % excess weight loss (EWL) of 15% and 41% respectively for standard POSE and 17% and 36% for the new reinforced POSE18. Both are equally safe and the endpoint weight loss objectives are reached. Endoluminal procedures have been demonstrated to be useful in overweight and obese type I/II. However, bariatric surgery is recommended for higher BMI > 40 kg/m2. We successfully applied a non-standard POSE protocol and the patients reached 17%TWL in 3 months. CONCLUSIONS Our study shows that reinforced POSE 18 can be successfully applied in obese type III; it is safer than bariatric surgery and there are no associated risks when compared with standard endoscopic surgery.
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Cohen RV, Oliveira da Costa MV, Charry L, Heins E. Endoscopic gastroplasty to treat medically uncontrolled obesity needs more quality data: A systematic review. Surg Obes Relat Dis 2019; 15:1219-1224. [PMID: 31130406 DOI: 10.1016/j.soard.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/26/2018] [Revised: 02/03/2019] [Accepted: 03/10/2019] [Indexed: 02/06/2023]
Abstract
Endoscopic gastroplasty (EG) has been used in clinical practice to treat obesity. This systematic review has the objective of assessing if there is an acceptable level of scientific evidence on the safety and effectiveness of EG. A thorough search strategy was used up to October 2018, including the 2 most common techniques: endoscopic suturing and the primary obesity surgery endolumenal procedure. The quality of the studies was evaluated through the Joanna Briggs Institute Critical Appraisal tools for use in Systematic Reviews-"Checklist for Case Series"-and summarized using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Only 1 randomized controlled trial (moderate GRADE evidence) was found, and the remaining were case reports or small case series (very low GRADE evidence). The literature has low scientific quality. All studies, with 1 exception, are small case series with short follow-up. One of the randomized controlled trials did not meet the primary endpoint for weight loss in both groups (EG × sham) after 1-year follow-up. The case series reported from 16% to 19% total weight loss, but few had more than 6 months of follow-up. Serious adverse events ranged from 2% to 10%. Based on current literature, there is not enough quality scientific evidence regarding long-term weight loss and the procedure's safety to recommend the use of EG in current clinical practice.
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Affiliation(s)
- Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil.
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Movitz BR, Lutfi RE. Endoscopic sleeve gastroplasty: are we burning bridges? Surg Obes Relat Dis 2017; 13:2056-2058. [PMID: 29079382 DOI: 10.1016/j.soard.2017.09.520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/25/2017] [Accepted: 09/09/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Blake R Movitz
- University of Illinois at Chicago, Metropolitan Group Hospitals, Chicago, Illinois.
| | - Rami E Lutfi
- University of Illinois at Chicago, Metropolitan Group Hospitals, Chicago, Illinois; Department of Surgery, Mercy Hospital and Medical Center, Chicago, Illinois; Presence Chicago Institute of Advanced BariatricsChicago, Illinois
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12
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Jirapinyo P, Thompson CC. Endoscopic Bariatric and Metabolic Therapies: Surgical Analogues and Mechanisms of Action. Clin Gastroenterol Hepatol 2017; 15:619-630. [PMID: 27989851 PMCID: PMC5444453 DOI: 10.1016/j.cgh.2016.10.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
Abstract
Obesity is a worsening pandemic with numerous related comorbid illnesses. Conservative management including lifestyle modification and medications have limited efficacy. In contradistinction, bariatric surgery is effective, however, with substantial cost and non-negligible morbidity and mortality. As such, a small percentage of eligible patients undergo surgery. Over the past decade, endoscopic bariatric and metabolic therapies have been introduced as a less invasive option for the treatment of obesity and its related comorbid illnesses. This article reviews major endoscopic bariatric and metabolic therapies, their surgical analogues, and proposed mechanisms of action. Clinical trial data for each device also are discussed.
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Stanek M, Major P, Wierdak M, Pędziwiatr M, Radkowiak D, Zychowicz A, Budzyński A. Laparoscopic gastric resections with per oral specimen extraction in treatment of intramural gastric tumors. Pol Przegl Chir 2017; 89:16-21. [PMID: 28522781 DOI: 10.5604/01.3001.0009.6001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/27/2023]
Abstract
AIM The goal of this work was to present our experiences and results of treatment of gastric tumors using the per oral specimen extraction (POSE) technique. MATERIAL AND METHODS A retrospective analysis a group of patients treated with laparoscopic stomach wedge resection of gastrointestinal stromal tumor (GIST). During that time 50 patients underwent laparoscopy due to the suspicion of GIST. In 12 patients resected material was removed endoscopically per os (POSE). In the remaining 38 subjects it was evacuated through minilaparotomy. Mean age of patients treated using POSE technique was 65.6 years (48-81 years). There were 9 women and 3 men in this group Results: Mean time of the POSE procedure was 92.5 min (40-160 min). Size of removed tumors ranged from 14 mm to 40 mm (mean: 25 mm). The mean length of hospital stay was 3.2 days (2 to 8 days) for patients treated with POSE. One patient (8.3%) required longer hospitalization (8 days) due to the presence of a fluid collection at the site of gastric suture. This patient was treated conservatively. One patient (8.3%) was diagnosed with surgical site infection (navel wound after an optical trocar). Histopathological examination confirmed radical excision in all of our patients (R0). CONCLUSIONS It seems that the POSE technique is the next stage of development of minimally invasive surgery and may constitute a link in evolution of natural orifice translumenal surgery techniques. Removal of excised material through oral cavity is an attractive, effective, and safe method despite its many limitations.
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Affiliation(s)
- Maciej Stanek
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
| | - Piotr Major
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
| | - Mateusz Wierdak
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
| | - Michał Pędziwiatr
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
| | - Dorota Radkowiak
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
| | - Anna Zychowicz
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
| | - Andrzej Budzyński
- Uniwersytet Jagielloński Collegium Medicum; Klinika Chirurgii Endoskopowej, Metabolicznej oraz Nowotworów Tkanek Miękkich II Katedra Chirurgii Ogólnej
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Mills C, Loveridge A, Milligan A, Risius D, Scurr J. Is torso soft tissue motion really an artefact within breast biomechanics research? J Biomech 2014; 47:2606-10. [PMID: 24953261 DOI: 10.1016/j.jbiomech.2014.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/09/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
Abstract
For rigid body POSE estimation, any relative movement of the tracking markers on a segment is often referred to as an artefact; however this may be an important part of the signal within breast biomechanics. This study aimed to quantify differences in breast range of motion when calculated relative to the torso segment using either direct or segment optimised POSE estimation algorithms. Markers on the torso and right nipple were tracked using infrared cameras (200 Hz) during five running gait cycles in three breast support conditions (no bra, everyday bra and sports bra). Multiplanar breast range of motion was calculated relative to the torso segment using two POSE estimation algorithms. First, the torso segment was defined using direct POSE estimation (direct). Second, while standing stationary in the anatomical position; the positional data of the torso markers were used to construct the torso using segment optimised POSE estimation (optimised). The torso segment length defined using direct POSE estimation changed significantly by 3.4 cm compared to that of the segment optimisation POSE estimation in the no bra condition. Subsequently, superioinferior breast range of motion was significantly greater (p<0.017) when calculated using direct POSE estimation, within each of the three breast support conditions. Segment optimisation POSE estimation is recommended to minimise any differences in breast motion associated with intra segment deformation between physical activity types. However, either algorithm is recommended when evaluating different breast support garments, as a correctly fitted bra does not cause the torso markers to move relative to each other.
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Affiliation(s)
- Chris Mills
- Department of Sport and Exercise Sciences, Spinnaker Building, University of Portsmouth, Portsmouth, PO1 2ER, United Kingdom.
| | - Amy Loveridge
- Department of Sport and Exercise Sciences, Spinnaker Building, University of Portsmouth, Portsmouth, PO1 2ER, United Kingdom
| | - Alexandra Milligan
- Department of Sport and Exercise Sciences, Spinnaker Building, University of Portsmouth, Portsmouth, PO1 2ER, United Kingdom
| | - Debbie Risius
- Department of Sport and Exercise Sciences, Spinnaker Building, University of Portsmouth, Portsmouth, PO1 2ER, United Kingdom
| | - Joanna Scurr
- Department of Sport and Exercise Sciences, Spinnaker Building, University of Portsmouth, Portsmouth, PO1 2ER, United Kingdom
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