Gastric Restriction Research Articles

BariClip: Outcomes and Complications from a Single-Center Experience.

Laparoscopic BariClip gastroplasty (LBCG) is a new reversible bariatric procedure designed to replicate the restrictive effects of laparoscopic sleeve gastrectomy (LSG) by placing a clip vertically on the stomach. This technique achieves gastric lumen restriction without the need for resection, ensuring organ preservation and reversibility. However, concerns have arisen regarding potential complications such as gastroesophageal reflux disease (GERD), slippage, or erosion of the stomach. The aim of the study is to evaluate the outcomes and complications of LBCG. This is a monocentric retrospective study. We analyzed 149 patients who underwent LBCG procedure between July 2021 and November 2023. A minimum follow-up period of 6months was observed for all patients, recording clinically relevant GERD through GERD-Q score questionnaires. Weight loss was monitored through body mass index (BMI) and % total weight loss (%TWL), registered during follow-up visits. Overall, 149 patients were eligible for this study. Overall complication rate was 8% (12/149). The average BMI went from 40 ± 4.37kg/m2 to 28 ± 4.29kg/m2 (p < 0.05) in 6months, while the mean %TWL was 22.6% after at least 6months of follow-up. Clinically relevant GERD went from 18.1% (27/149) to 10.7% (16/149), p = 0.1262. As expected, also the PPI usage was not altered significantly (17.8% vs 16.4%), p = 0.8714. LBCG remains an experimental procedure that must be approached with caution. Nonetheless, the potential of LBCG to reproduce the effects of LSG while reducing GERD makes it a promising new reversible option for the treatment of morbid obesity.

Prospective, single-arm multicenter, international, observational post-market study to assess the safety and efficacy of a triangulation platform for treating patients requiring endoscopic gastroplasty

Gastric restriction techniques have recently emerged as minimally invasive bariatric procedures. Endoscopic sutured gastroplasty (ESG) with the Endomina (Endo Tools Therapeutics, Gosselies, Belgium) triangulation platform proved to be safe and effective for the treatment of class I and II obesity in prospective studies. In this registry, we aimed to further assess on a larger scale the safety and efficacy of the procedure in routine practice with a dedicated device. This was a multicenter, observational, prospective post-market study including patients with obesity undergoing Endomina ESG. The primary safety outcome was the occurrence of serious adverse device effects (SADEs) at 12 months. The primary efficacy outcome was the technical success defined by completing the procedure without premature abortion owing to technical issues. The rates of procedure-related adverse events, weight loss outcomes, and quality of life changes were collected. A total of 142 patients underwent ESG in 3 centers from July 2020 to March 2023. Of these, 67 (mean body mass index, 38.5 ± 6.3 kg/m2) reached at least 12 months of follow-up up to October 2022. Technical success was 100%. No SADEs occurred. Seven mild procedure-related adverse events were reported overall. Mean percentage of excess weight loss and total body weight loss at 12 months' follow-up were 48.5% ± 38.6 and 15.3% ± 10.6, respectively (n= 67). Improved quality of life was observed following ESG. ESG is safe and effective, thus offering a satisfactory therapeutic option for a wide range of obese patients on a large scale.

Ultrasound Assisted Endoscopic Gastric Bypass (USA-EGB): a potential endoscopic alternative to surgical bypass, a pre-clinical proof of concept study.

Background and study aims Endoscopic weight loss procedures have gained traction as minimally invasive options for the primary treatment of obesity. Thus far, we have developed endoscopic procedures that reliably address gastric restriction but result in significantly less weight loss than surgical gastrointestinal bypass. The goal of this nonsurvival study was to assess the technical feasibility of an endoscopic procedure, that incorporates both gastric restriction and potentially reversible gastrointestinal bypass. Methods Ultrasound-assisted endoscopic gastric bypass (USA-EGB) was performed in three consecutive live swine, followed by euthanasia and necropsy. Procedure steps were: 1) balloon-assisted enteroscopy that determines the length of the bypassed limb; 2) endoscopic ultrasound-guided gastroenterostomy that creates a gastrointestinal anastomosis using a lumen apposing metal stent; 3) endoscopic pyloric exclusion that disrupts transpyloric continuity resulting in complete gastrointestinal bypass; and 4) gastric restriction that reduces gastric volume. Results Complete gastrointestinal bypass and gastric restriction was achieved in all three swine. The mean total procedure time was 131 minutes (range 113-143), mean length of the bypassed limb was 92.5 cm and 180 cm, using short and long overtubes, respectively. There were no significant complications. Conclusions We successfully described USA-EGB in three consecutive live swine. Further studies are needed to access the procedures safety, efficacy, and clinical use.

Prevalence of Postoperative Micronutrient Deficiencies in Bariatric Surgery Patients Who Use Transdermal Patches for Supplementation: A Pilot Study.

BackgroundPatients require vitamin and mineral supplementation after bariatric surgery to prevent the development of micronutrient deficiencies. Consuming oral supplements is challenging due to gastric volume restriction. A transdermal patch dosage form may provide adequate micronutrient supplementation without pill burden. The study aims to determine the percentage of patients who have two or more nutritional deficiencies one year after surgery and to determine serum nutrient concentrations and gastrointestinal symptoms over time.MethodsPatients who planned to undergo bariatric surgery and preferred transdermal patches versus oral supplements were recruited during preoperative office visits. Enrolled patients were instructed to use a transdermal multivitamin patch as per the manufacturer’s instructions. Serum nutrient concentrations and Gastrointestinal Symptom Response Scale scores were determined at baseline and three months, six months, and one year after surgery.ResultsNinety-two participants completed the study protocol. Twenty-five participants had a full panel of study labs one year after surgery. Among these patients, 19% had two or more micronutrient deficiencies. Vitamin D was the most common deficiency followed by vitamin B6; however, median serum concentrations of both nutrients increased over time. Vitamin B1, folate, and zinc deficiencies were also observed. There were no changes in gastrointestinal symptoms.ConclusionsAdditional studies, including randomized controlled trials, are required to determine if the PatchMD Multivitamin Plus patch (Pilot Rd. STE. B, Las Vegas) can provide adequate supplementation of vitamins and minerals. The patch was not associated with changes in gastrointestinal symptoms.

Surgical Treatment of Gallstones in Patients Undergoing Gastric Bypass Surgery as a Treatment of Obesity

Introduction: Sustained weight loss after gastric bypass is achieved by a combination of gastric restriction and a variable degree of malabsortion and has therefore a greater risk for gallstone development than purely restrictive procedures like adjustable gastric banding. Objectives: The main objective of the study is to analyse the surgical treatment of gallstones in patients undergoing gastric bypass surgery as a treatment of obesity. Material and methods: This randomized control trial was conducted in Jinnah Hospital, Lahore during 2021 to 2022. Patients who underwent bariatric surgery for obesity were included in the study. Those who had cholecystectomy before bariatric surgery, those who underwent concomitant cholecystectomy (CC) during bariatric surgery, those with concomittant gall stoness and those who did not attend their follow-up regularly were excluded from the study. Results: The data was collected from 100 patients and we reviewed records from all patients treated for acute biliary pancreatitis. The average age was 36.43±9.52 years and, the ratio of women/men was 151 (81.6%)/34 (18.4%). Mean BMI was determined as 44.16±5.09. When comorbidities were evaluated, 116 (62.7%) patients had comorbidity, while 69 (37.3%) patients did not. Conclusion: It is concluded that prophylactic and selective management can be safely performed and the only significant difference with patients not submitted to concomitant cholecystectomy is mostly observed in operative times that are higher in those who do undergo cholecystectomy.

Evaluation of the Number of Goblet Cells in Crypt of Colonic Mucosa Submitted to Experimental Gastric Restriction

Obesity‐related comorbidity is defined as a condition caused by overweight/obesity or known to contribute to the presence or severity of the condition. These comorbid conditions are expected to improve or go into remission in the presence of effective and sustained weight loss. However, the mechanisms of surgical weight loss and the long‐term consequences of bariatric surgery remain unclear. World Health Organization reports obesity as a rising chronic condition with many devastating health consequences. Gastric reduction procedures are currently employed to treat morbid obesity and there are few reports concerning the consequent effects in large intestine.MethodsExperimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided in three groups: the stomach reduction group (R20), the sham group (SH20), which underwent the same procedure except for the loofah insertion and the control group (C20). Animals were fed and kept in separate cages. Two colon samples were collected 2 cm from the cecum and were individually packed into containers. Samples were submitted to routine histological processing for Alcian Blue, Periodic Acid and Reagent of Schiff (PAS) and High Iron Diamine (HID AB). The sections were analyzed for the length of the crypts and mucous cells. Goblet cells were obtained in all groups as mean, median, minimum, and maximum and were compared between groups using generalized estimation equations (GEE) with normal distribution and identity link function supposing exchangeable correlation matrix between fields. Bonferroni's multiple comparison was applied to identify differences between groups. The results are described by the mean value with respective standard deviation.ResultsThe analysis of PAS and AB Goblet cells count on R20 group indicated a statistically significant reduction and no shallower crypts as compared to the C20. The sialomucins and sulphomucins number cells were found with no enhance. There was not difference regarding on R20 compared to C20 and SH20.ConclusionThese findings might be a result of colonic mucosae atrophy secondary to the effects of gastric restriction in this model. Restriction decreases the content of neutral mucins and total acidic mucins, without interfering with the sulfomucin and sialomucin acid mucin subtypes.

Endoscopic Treatment of Obesity and Nutritional Aspects of Bariatric Endoscopy.

Obesity is a significant problem worldwide. Several serious diseases that decrease patient quality of life and increase mortality (high blood pressure, dyslipidaemia, type 2 diabetes etc.) are associated with obesity. Obesity treatment is a multidisciplinary and complex process that requires maximum patient compliance. Change of lifestyle is fundamental in the treatment of obesity. While pharmacotherapeutic options are available, their efficacy is limited. Surgical treatment though highly effective, carries the risk of complications and is thus indicated mostly in advanced stages of obesity. Endoscopic treatments of obesity are less invasive than surgical options, and are associated with fewer complications and nutritional deficits. Currently, there is a large spectrum of endoscopic methods based on the principles of gastric volume reduction, size restriction and gastric or small bowel bypass being explored with only few available in routine practice. The aim of this publication is to present an up-to-date summary of available endoscopic methods for the treatment of obesity focusing on their efficacy, safety and nutritional aspects.

Recent advances in the mechanisms underlying the beneficial effects of bariatric and metabolic surgery.

Bariatric and metabolic surgery (BMS) is the most effective treatment for obesity, type 2 diabetes and co-morbidities, including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. The beneficial effects of BMS are beyond the primary goal of gastric restriction and nutrients malabsorption. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the 2 most commonly performed procedures of BMS. Both surgeries lead to physiologic changes in gastrointestinal tract; subsequently alter bile acids pool and composition, gut microbial activities, gut hormones, and circulating exosomes; and ultimately contribute to the improved glycemic control, insulin sensitivity, lipid metabolism, energy expenditure, and weight loss. The mechanisms underlying the benefits of BMS likely involve the bile acid-signaling pathway mediated mainly by nuclear farnesoid X receptor and the membrane Takeda G protein-coupled receptor, bile acids-gut microbiota interaction, and exosomes. In this review, we focus on recent advances in potential mechanisms and aim to learn novel insights into the molecular mechanisms underlying metabolic disorders.

Effect Of Peppermint Oil On The Gastric Restriction Model With Phytobezoar In Wistar Rats

Obesity is a public health problem and many patients resort to bariatric surgeries as a form of treatment. However, surgical weight loss mechanisms, histopathological changes and long‐term consequences of bariatric surgery remain unclear. Among the main histopathological changes in the intestine we have increased expression of neutral mucins, acid mucins, caliciform cells and collagen in animals submitted to the gastric restriction model. Currently there is no therapeutic tool to reduce histopathological and oxidative changes promoted by gastric restriction surgeries. Based on these premises, the aim of this work was to investigate whether Peppermint essential oil reduces histopathological and oxidative changes in the experimental gastric restriction model. Adult male Wistar rats weighing between 250 and 400 grams were used. The animals were submitted to surgical gastrostomy and a cylindrical natural sponge (1.5 cm in diameter) was inserted into the stomach. The rats were separated into 3 groups, namely: Control (treated only with saline), Sham (surgical procedure only) and treatment (peppermint oil 100mg/Kg orally). Weight, water and food consumption were measured daily. On the last day all animals were euthanized and had the biological material collected (stomach, duodenum and jejunum) for histopathological evaluation and malondialdehyde (MDA) concentration in tissue. It was found that peppermint oil was able to reduce histopathological changes caused by the phytobenzoar in duodenum and jejunum, as well as to reduce the concentration of MDA in the jejunum (Figure 2). Regarding feed intake, the control group presented lower average consumption (98.7g/animal) when compared with Sham (134g/animal) and treatment groups (132g/animal). Regarding the average weight of the animals, it was observed that there was no statistically significant difference. It was found that peppermint essential oil presented moderate protective effect on phytobenzoar‐induced gastric restriction and reduced the loss of the architecture of intestinal viles.

Temporal behavior of weight loss in a rat model of gastric restriction

BackgroundObesity is a complex and multifactorial disorder and has become a major healthcare burden in some countries. The rising prevalence of overweight and obesity is considered a global pandemic. The current paradigm in obesity treatment has traditionally relied upon lifestyle modifications (diet and exercise) and pharmacological treatments which often lead to modest results. Surgical procedures have been increasingly performed. Bariatric surgery results in superior outcomes in terms of weight loss and weight‐associated comorbidities as compared to non‐surgical interventions. Experiments with animal models have significantly helped to elucidate some of the potential mechanisms underlying bariatric surgery. There is no information about gastric restriction with phytobezoar in animal model and the weight loss.PurposeMeasure the weight loss until 20 days after surgical gastrostomy and phytobezoar insertion and compare to sham and normal groupMethodsExperimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided in three groups: the stomach reduction group (R20), the sham group (SH20), which underwent the same procedure except for the loofah insertion and the control group (C20). Animals were fed and kept in separate cages. They were weighed every 3 days until being sacrificed on day 20. The results were described by the mean value with respective standard deviation. Comparison of multiple groups was performed using analysis of variance (ANOVA) followed by Bonferroni post hoc tests. All tests were applied with 5% significance level.ResultsThere was a mean difference in the behavior of weight changes over the evaluation days between the groups (p Interaction &lt;0.001), and on all evaluated days the experiment group presented a lower average weight change than the other groups (p &lt;0.001). These findings might be a result of post‐ surgical weight loss correlated to a large extent with reduced spontaneous eating. This indicates that in our animal models it seems to recapitulate remarkably well the findings in humans.

Colonic mucosae is affected by experimental gastric restriction

BackgroundObesity‐related comorbidity is defined as a condition caused by overweight/obesity or known to contribute to the presence or severity of the condition. These comorbid conditions are expected to improve or go into remission in the presence of effective and sustained weight loss. World Health Organization reports obesity as a rising chronic condition with many devastating health consequences. Gastric reduction procedures are currently employed to treat morbid obesity and there are few reports concerning the consequent effects in large intestine.MethodsExperimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided in three groups: the stomach reduction group (R20), the sham group (SH20), which underwent the same procedure except for the loofah insertion and the control group (C20). Animals were fed and kept in separate cages. Sections of the colon were obtained and stained with hematoxylin‐eosin and analyzed for the length of the crypts, mucous cells and inflammatory cells.Goblet cells and inflammatory cells were obtained in all groups as mean, median, minimum and maximum and were compared between groups using generalized estimation equations (GEE) with normal distribution and identity link function supposing exchangeable correlation matrix between fields. Bonferroni’s multiple comparison was applied to identify differences between groups. The results are described by the mean value with respective standard deviation.ResultsThe analysis of Goblet cells count on R20 group indicated a statistically significant reduction and shallower crypts as compared to the C20. There was a significant difference regarding inflammatory cells on R20 compared to C20 and SH20. Polymorphonuclear inflammatory cells were increased in all groups when compared to lymphomononuclear cell but with no significant difference among groups.ConclusionThese findings might be a result of colonic mucosae atrophy secondary to the effects of gastric restriction in this model. The increase in neutrophil infiltrate may be related to the presence of bezoar, as well as the greater aggression to the colic epithelium due to lack of short chain fatty acids (CCFA), oxidative stress epithelial damage due to lack of CCFA.

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years.Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years.Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL.Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

Endoscopic Bariatric Therapies: Intragastric Balloons, Tissue Apposition, and Aspiration Therapy.

Endoscopic bariatric therapies (EBTs) have been identified as a group of procedures that can bridge the treatment gap between bariatric surgical procedures and non-procedural treatments such as pharmacotherapy and lifestyle therapy. We will review the recent progress that has been made in this important area in the past several years. Traditional intragastric balloons (IGB) that are both placed and removed endoscopically have been the fixture of IGB therapy. They have been shown to be safe and effective, when kept in place for 6months. Newer IGBs, both currently FDA approved and those in clinical trials, have unique features. The Obalon gastric balloon system is gas filled and does not require endoscopy for placement. The Elipse balloon system that is in clinical trials neither requires endoscopy for placement nor removal. The Spatz3 balloon is in clinical trials and can be adjusted endoscopically by adding or subtracting volume to titrate balloon volume to symptoms and weight loss. In addition to IGBs, several other promising therapies have continued to evolve. Endoscopic sleeve gastroplasty (ESG) is a promising gastric restriction technique that has efficacy and durability. POSE is a gastric plication technique that is available in Europe and in clinical trials in the USA. Aspiration therapy is a novel approach to weight loss that requires patient compliance but can be very effective and used long term. EBTs are an evolving effective and safe approach for patients who do not qualify for or do not want bariatric surgery. There are multiple EBTs currently FDA approved as well as prospective endoscopic therapies in clinical trials that appear promising.

Tissue quantification of neutral and acid mucins in the mucosa of the colon submitted to 10 days of gastric restriction in an animal model

BackgroundObesity and its related comorbidities have detrimental effects for the affected individual and pose a major challenge on public health systems worldwide.However, mechanisms of surgical weight loss and long‐term consequences of bariatric surgery remain unclear. Gastric reduction procedures are currently employed to treat morbid obesity and there are few reports concerning the consequent effects in large intestine.PurposeTo quantify the expression of neutral and acids mucins in mucosa of the colon in animal model and correlate this to gastric restrictionMethodsExperimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided in three groups: the stomach reduction group (R10), the sham group (S10), which underwent the same procedure except for the loofah insertion and the control group (C10). Animals were fed and kept in separate cages. They were weighed every other day until being sacrificed on day 10. The expression of neutral and acid mucins was evaluated using the histochemical techniques of Periodic Acid Schiff and Alcian Blue, respectively and Picrosirius Red. The tissue mucins and collagen expression were quantified by computer‐assisted image analysis software.Goblet cells and protein content were presented by groups as mean, median, minimum and maximum and it was compared between groups using generalized estimation equations (GEE) with normal distribution and identity link function supposing exchangeable correlation matrix between fields. Bonferroni's multiple comparison was applied to identify differences between groups. The results are described by the mean value with respective standard deviation. We used Spearman correlation to verify correlation between weight, height of the crypt and cells quantity. All tests were applied with 5% significance level.ResultsThere was increased expression of neutral mucins and acid mucins as well as Goblet cells in the R10 group. Picrosirius Red enhanced total collagen in restriction group.ConclusionsGastric restriction for 10 days in animal model increased neutral mucins and acid mucins as well as collagen content with trophic maintenance.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Weight losing on gastric restriction in an animal model

BackgroundObesity and its related comorbidities have detrimental effects for the affected individual and pose a major challenge on public health systems worldwide. The number of non‐surgical options to treat obesity are limited and the long‐term success of dietary or life style interventions is minimal Bariatric surgery leads to a long‐term reduction in body weight and in obesity‐related morbidity and is currently the only treatment modality with a proven mortality benefit. In this regard, research with animal models has significantly helped to elucidate some of the potential mechanisms underlying bariatric surgery. There is no information about gastric restriction with phytobezoar in animal model and the weight loss.PurposeMeasure the weight loss until 10 days after surgical gastrostomy and compare to sham and normal groupMethodsExperimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy and a cylindrical loofah is inserted into the stomach. We studied 30 adult male Wistar rats divided in three groups: the stomach reduction group (R10), the sham group (S10), which underwent the same procedure except for the loofah insertion and the control group (C10). Animals were fed and kept in separate cages. They were weighed every other day until being sacrificed on day 10. The results will always be described by the mean value with respective standard deviation. Comparison of multiple groups was performed using analysis of variance (ANOVA) followed by Bonferroni post hoc tests. All tests were applied with 5% significance level.ResultsThe weight decreased significantly 9% in the first three days and then increases 6.2% until the weighing of third day and keep until the tenth.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 2 (Recommendation of macro and micronutrients and Nutritional Therapy)

In order to minimize nutritional complications and create conditions for greater long-term success, it is important to predict, prevent and correct nutritional changes in pre-post surgery, with careful monitoring and nutritional supplementation according to guidelines. Priorities are the nutritional education of the patient/family, aiming at good eating habits, within their lifestyle and socioeconomic and cultural conditions. Nutrients Regular follow-up with a specialized nutritionist is essential to facilitate adequate weight loss and to assess the intake of micronutrients that may be inadequate due to the gastric restriction of the gastric band (BG) and sleeve gastrectomy (GV) techniques; of gastric restriction and dysabsorption in gastric bypass (BGYR) and minor gastric restriction and major dysabsorption in biliopancreatic bypass (BPD) and duodenal switch (BPD-DS). The latter 2 carry greater risk for protein malnutrition and micronutrient deficiencies. In all techniques except BG, there are functional and hormonal changes involved in the control of hunger and appetite, food intake, satiety, metabolic glucose change and changes in intestinal hormones such as ghrelin, GLP-1 and PYY.

Laparoscopic Revision of Failed Bariatric Procedures.

Background:The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications. The objective of revision is to restore the restrictive component and/or add a malabsorptive component.Objectives:To evaluate the effectiveness of revisional laparoscopic bariatric surgery for loss of weight and assess the risks and benefits associated with these technically demanding procedures.Methods:Revision cases performed between 2001 and 2013 were identified and grouped according to the primary procedure and type of revision. A retrospective analysis was carried out for weight loss as well as perioperative morbidity and mortality.Results:The total of 271 patients underwent revisional laparoscopic surgery during the study period and were categorized into four groups. Group 1 (n = 67) had an adjustable gastric band converted to gastric bypass (GBP). Group 2 (n = 128) had a dilated gastric pouch after GBP and underwent pouch reduction. Group 3 (n = 57) had a GBP and underwent pouch reduction and elongation of the biliopancreatic limb. Group 4 (n = 19) had a vertical banded gastroplasty converted to a GBP. The mean total body weight loss for Groups 1 to 4 was 35.3%, 22.9%, 39.4%, and 33.2%, respectively. The average operative times were 185, 75, 142, and 205 minutes; and the average hospitalization was 1.5, 1.0, 2.0, and 2.5 days, respectively. All cases were completed laparoscopically. Concomitant procedures were liver biopsy, cholecystectomy, partial gastrectomy, hiatal, ventral, and internal hernia repairs. Complication rates were 2.9%, 0%, 3.5%, and 5.2% for each of the groups and there were no mortalities.Conclusion:Results of revisional bariatric surgery vary depending on the original procedure and the reasons for revision. In particular, if the main reason for reoperation is inadequate weight loss, then the burden is to demonstrate a surgically correctable deficiency. Revisional procedures incorporating malabsorption result in greater weight loss than gastric restriction alone.

Is the colon mucosa affected by ten days of gastric restriction in an animal model?

Purpose To identify whether the colon mucosa is affected by ten days of gastric restriction in an animal model.Methods An experimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy, and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided into three groups: the stomach restriction group (R10); the sham group (S10), which underwent the same procedure except for the loofah insertion; and the control group (C10). The expression of neutral and acid mucins was evaluated using histochemical techniques. Goblet cells and protein content were compared between groups using generalized estimation equations (GEEs). Bonferroni’s multiple comparison was applied to identify differences between the groups. All tests considered a 5% significance level.Results There was an increased expression of neutral mucins, acid mucins and goblet cells in the R10 group. Collagen was also enhanced in the R10 group.Conclusion The colon mucosa is affected by ten days of gastric restriction in an animal model, increasing neutral mucins, acid mucins and collagen content with trophic maintenance.

Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy Treatments for Obesity: Systematic Review and Meta-Analysis of Short- and Mid-Term Results.

Laparoscopic greater curvature plication (LGP) has recently emerged as a new bariatric procedure. This surgery provides gastric restriction without resection, which could potentially provide a lower risk alternative, with fewer complications. The real benefit of this technique in the short and long term is unknown. This systematic review aims to compare laparoscopic gastric plication and laparoscopic sleeve gastrectomy for obesity treatment. Clinical trials were identified in MEDLINE, Embase, Cochrane, LILACS, BVS, SCOPUS, and CINAHL databases. Comparison of LGP and laparoscopic sleeve gastrectomy (SG) included hospital stay, operative time, loss of hunger feeling, body mass index loss (BMIL), percentage of excess weight loss (%EWL), complications, symptoms in the postoperative period, and comorbidity remission or improvement. This systematic review search included 17,423 records. Eight studies were selected for meta-analysis. There is no difference in operative time, hospital stay, and complications. Patients in the SG group had improved loss of hunger feeling. BMIL was better in the SG group at 12 and 24months [mean difference (MD) - 2.19, 95% confidence interval (CI) - 3.10 to - 1.28, and MD - 4.59, 95% CI - 5.55 to - 3.63, respectively]. SG showed improved %EWL compared with gastric plication in 3, 6, 12, and 24months. However, no difference was found in %EWL long-term results (24 and 36months). Patients who underwent LGP had more sialorrhea. SG showed better results in diabetes remission. SG showed improved weight loss when compared with LGP, with better satiety, fewer symptoms in the postoperative period, and improved diabetes remission.

Endoscopic gastrojejunostomy revision is more effective than medical management alone to address weight regain after RYGB.

Weight regain after bariatric roux-en-y gastric bypass affects up to 30% of individuals. Revisional surgery is risky, and is typically avoided in favor of dietary and psychological management. Endoscopic gastrojejunostomy revision is a low-morbidity, outpatient procedure that may be more effective than medical management alone for regain after gastric bypass. Two patient cohorts were retrospectively assembled. Both groups had gastric bypass, regained weight, and were cleared for revision by their surgeon, dietician, and psychologist. The revision group underwent the procedure, and the no-revision group did not, typically due to insurance issues. Weights from pre-bypass to 2years post-revision, obesity-related comorbidities, and intraoperative factors were collected and analyzed. There were 41 patients included in the revision group and 14 in the no-revision group. Up to the time of revision procedure, body mass index, and % excess weight loss between groups were similar. After revision, the groups diverged over a 2-year period, with improvement seen in the revision group and worsening in the no-revision group. The revision group showed overall improvement in comorbidities compared to the no-revision group. Analysis of intraoperative factors suggests that gastric pouch restriction in addition to stoma diameter reduction may promote weight loss. In this retrospective study, endoscopic revision provided significantly greater weight loss compared to medical management alone. Results show that revision can help resolve obesity-related comorbidities. Analysis of intraoperative factors suggests that pouch reduction at time of stoma revision may improve weight loss.