Intragastric Balloon Research Articles

IBC-Oxford University2023_BJSPoster_12Outcomes of Intra-Gastric Balloon as a first step before bariatric surgery for the treatment of patients with super obesity (BMI>50)

Abstract Introduction The treatment of super obesity, defined as a body mass index (BMI) ≥ 50 Kg/m2, presents several challenges. The best therapeutic strategy is debatable and dependent on each case. The intragastric balloon (IGB) can be used as a "neoadjuvant" therapy before metabolic/bariatric surgery (MBS). The purpose of this study is to evaluate the outcomes and safety profile of the IGB as a first step before MBS for the treatment of super obese patients. Methods Retrospective study of all patients with BMI ≥ 50 Kg/m2 submitted to intragastric balloon placement before MBS between 2009 and 2023. Several variables were analysed including weight loss outcomes, adverse events, and complications of IGB. Therapeutic failure of IGB was defined as %TWL< 5 or early removal of IGB due to adverse events. Results We identified 74 patients with BMI≥ 50 Kg/m2 that were proposed for intragastric balloon placement prior to bariatric surgery, of which 56 (76%) were women, with a mean age of 43,0 ± 11,8 years. The mean initial BMI was 59,4 ± 5.3 Kg/m2. The intragastric balloon remained in the patient for 7,0 ± 1,4 months. The weight loss up to the moment of subsequent bariatric surgery was 22,5 ± 13,2 Kg and the percentage of total weight loss (%TWL) was 14.4 ± 8.4%. The overall rate of complications was 23% (17), the most frequent being nausea and vomiting, of which 50% (8) led to an emergency service visit and 50% (8) to rehospitalization. Regarding serious complications, 3 were identified: 1 gastric perforation and 2 severe respiratory complications, one of which resulted in mortality. Out of the 74 patients, 9 (12%) did not achieve the pre-established %TWL < 5 and 4 (5%) had to remove the intragastric balloon beforehand. Conclusion This study demonstrates that the intragastric balloon is a possible "neoadjuvant" therapeutic strategy in this particularly difficult group of patients, resulting in satisfactory weight loss. However, it has a non-negligible complication rate that should be considered when planning each patient's therapeutic strategy.

Safety and Efficacy of 12-Month Intra-gastric Balloon-Series of over 1100 Patients.

Intra-gastric balloons (IGB) are a mainstay of endoscopic treatment of overweight and obesity. In recent years, an IGB which can remain in situ for 12 months has been developed. The current study aimed to analyse the safety and efficacy of this 12-month IGB. Consecutive patients receiving the Orbera 365TM IGB (Apollo Endosurgery, TX, USA) between September 2017 and August 2021 were included in a prospective database. Patients received regular follow-up consultations followed by endoscopic removal at 12 months. Demographic data along with weight loss data were collected. All adverse events were recorded. In total, 1149 patients were included in the study. A majority of the patients were female (87.13%). Median body mass index (BMI) prior to insertion was 36.30 kg/m2 (IQR 32.60-40.00 kg/m2). Median absolute weight loss for all patients was 11.36 kg (IQR 6.70-16.82 kg). There was ongoing sustained weight loss until device removal at week 52. For patients with a weight recording at point of IGB removal, median weight loss was greater (15.88 kg, IQR 10.43-21.72) with percentage total body weight loss of 15.38% (IQR 10.99-21.77) and excess weight loss of 53.99% (IQR 32.44-76.30). Increased patient engagement with post-procedural follow-up was associated with increased weight loss (p<0.001). There were 60 total complications (5.22%). Fifty patients required balloon removal due to intolerance. There were eight cases of balloon rupture. There were only two severe complications (0.17%). The current study has confirmed safety of this IGB at 12 months with adverse events comparable to published literature. Weight loss increased up until the point of removal at 12 months.

IBC-Oxford University2023_BJSOral_4Comparison Between Two Different Intragastric Balloon Intervention in Terms of Weight- Loss, Tolerance, and Complications

Abstract Introduction Obesity and its complications have been rising worldwide. Several interventions are available including lifestyle intervention, drug therapy, devices such as intragastric balloon (IGB), and metabolic surgery. This study focuses on two intragastric balloon (IGB) -The Orbera365 and Elipse in terms of weight loss, tolerance, and complications. Methods We performed a retrospective before and after study on patients who underwent IGB intervention in the period between July 2020–November 2021. Data on weight loss, tolerance and complications were recorded from patient’s files. Results A total of 311 patients underwent Elipse intervention and 107 underwent Orbera365 intervention. The average weight and BMI prior to Elipse were 94.7±19.1 kgs and 35.2±5.5 kg/m2 and Orbera365 was 94.6±19.1 kgs and 35.4±3.9 kg/m2. The average weight and BMI decreased significantly in four months post-Elipse and was 83.7±17.4 kgs and 31.3±4.8 kg/m2 while in 12-months post Orbera365, it was 79.8±15.5 kgs and 30.1±4.1 kg/m2. Moreover, maximum weight loss is achieved in the 4-6 months of balloon intervention, which continues at reduced rate till the end of the term. Intolerance rate was higher in Orbera365 (6.5%) as compared to Elipse (2.6 %). Conclusion IGB is effective in terms of weight reduction for short term with acceptable rate of complications and intolerance, however weight regain is observed after IGB removal.

Recent advances in bariatric surgery: a narrative review of weight loss procedures

Bariatric surgery has emerged as a highly effective option for individuals with obesity, offering significant and sustainable weight loss outcomes. This surgical approach involves various procedures that alter the anatomy of the gastrointestinal tract, leading to reduced food intake and nutrient absorption. Established procedures such as sleeve gastrectomy, gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch have proven track records. In contrast, emerging options like intragastric balloons, AspireAssist devices, and endoscopic sleeve gastroplasty show promise but require further investigation. Numerous studies have highlighted the remarkable benefits of bariatric surgery, not only in weight loss but also in the resolution of obesity-related comorbidities and significant improvements in quality of life. However, successful outcomes rely on a multidisciplinary approach, encompassing preoperative evaluation, patient selection, comprehensive postoperative care, nutritional support, and psychological counseling. Regular follow-up and adherence to postsurgical recommendations are crucial for sustained weight loss and positive long-term results. As bariatric surgery continues to evolve, tailored procedures based on individual needs and ongoing research hold the potential for even more refined and effective approaches. Through this ongoing advancement, bariatric surgery is poised to offer improved patient outcomes, transforming lives for those grappling with the challenges of obesity.

IBC-Oxford University2023_BJSPoster_8Intragastric Balloon as a Primary Bariatric Endoscopic Therapy for Overweight and Obese Patients in Guatemala

Abstract Background Intragastric balloon (IGB) is a temporary and minimally invasive option for overweight and obesity treatment, acting as a space occupying device which leads to weight loss reducing gastric capacity and inducing satiety. Objective Review our intragastric balloon usage as a primary therapy for overweight and obese patients in Guatemala. Results The total number of IGB procedures was 70. The mean patient age was 33.8 years, with 84.3% being female. The youngest patient was 16 years old and the oldest was 56 years old. The mean pre procedure BMI was 31.8 kg/m2. The minimum pre procedure BMI was 25.5 kg/m2 and the maximum was 66 kg/m2. The most frequently used balloon was the adjustable fluid-filled balloon Spatz3 totalling 46 implants (66%). This was followed by nonadjustable fluid-filled balloons Silimed (17%) and Orbera (8.5%). The Helioscopie air-filled balloon was used in 8.5% of cases. The overall mean percentage of total body weight loss (TBWL) at 12 months was 14.55% + 8.47%. The minimum percent of TBWL was 3% and the maximum was 34.2%. The failure rate (defined as TBWL &amp;lt;10%) was 6.87% + 2.34%. No serious adverse events were reported. The early removal rate due to intolerance was 4.2% (3/70). Conclusions Intragastric balloon as a primary endoscopic bariatric treatment for overweight and obese patients at a one-year period is a safe and effective procedure as compared to the data in the literature.

IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management—an International Delphi Study

IntroductionThis survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity.MethodsA three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement.ResultsConsensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease.ConclusionsIn this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.Graphical

Meta-analysis: Impact of intragastric balloon therapy on NAFLD-related parameters in patients with obesity.

Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease affecting approximately 25% of adults in the western world. Intragastric balloon (IGB) is an endoscopic bariatric therapy -a therapeutic endoscopic tool that has shown promise in inducing weight loss. Its role in the treatment of NAFLD is yet to be established. To evaluate the effect of IGB as a treatment option in NAFLD. We searched MEDLINE (PubMed) and EMBASE from inception to September 2022. We included studies evaluating the impact of IGB on obesity with the assessment of one or more liver-related outcomes and studies primarily evaluating the impact of IGB on NAFLD. We included comparative and non-comparative studies; primary outcomes were liver-related NAFLD surrogates. We included 19 studies with 911 patients. IGB demonstrated an effect on NAFLD parameters including NAFLD activity score (NAS): mean difference (MD): -3.0 [95% CI: -2.41 to -3.59], ALT: MD: -10.40 U/L [95% CI: -7.31 to -13.49], liver volume: MD -397.9 [95% CI: -212.78 to 1008.58] and liver steatosis: MD: -37.76 dB/m [95% CI: -21.59 to -53.92]. There were significant reductions in non-liver-related outcomes of body weight, BMI, glycated haemoglobin and HOMA-IR. Intragastric balloons may play an important role in addressing the treatment gap in NAFLD management.

BS P03 The burden of bariatric tourism on the Health and Social Care System in Northern Ireland: a descriptive analysis

Abstract Background The lack of public bariatric surgical services in Northern Ireland has favoured the growth of bariatric tourism. This retrospective study aimed to analyse the data extracted from the records of bariatric patients who presented with complications to Belfast Health and Social Care Trust following their surgery abroad and investigate the costs associated with managing these complications. It also aimed to explore other factors, such as emotional trauma, that may be associated with bariatric tourism. Methods This was a retrospective study including all patients, who had their bariatric procedure abroad, presenting acutely to our hospital between August 2016 and February 2023. Data were collected from hospital records and included demographic characteristics, type of surgery, nature of complications, and costs associated with managing these complications. Descriptive statistics were used to analyse the data. Results 42 patients included in the study. Majority were female (n=35, 83.3%) with a mean age of 46.6 years. Sleeve gastrectomy was the most common surgery (n=22,52.3%), followed by AGB (n=11,26.1%), Gastric bypass (n=6,14.2%) and Gastric balloon (3,7.1%). Operations were performed in 7 countries, majority were done in Turkey (n= 22). The most common complication was leak (n=14), followed by band erosion (n=7) and nutritional failure (n=7). The total cost was estimated to be (£737,126), which includes hospital-stay costs (£553,179), non-surgical intervention (£55,607), scans (£41,728), and surgical intervention (£75,413). The total cost of dietetic inputs were about £17,390,including 410 hours. Conclusions Most patients experienced emotional trauma related to lack of adequate perioperative care, and difficulties in communication with their overseas surgeons. The results of this study highlight significant costs associated with managing such complications in Northern Ireland. The findings suggest investing in public bariatric surgical services may be more cost-effective than relying on bariatric tourism. Furthermore, Bariatric care is delivered by MDTs which are actively involved in management of these patients throughout their care-pathway. The study highlights lack of perioperative care and follow up needed to minimize complications and associated costs, as well as addressing the emotional trauma of those patients.

Intragastric Balloon Impacted in the Esophagus After Vomiting

Intragastric Balloon Impacted in the Esophagus After Vomiting

Genetic variant panel allows predicting both obesity risk, and efficacy of procedures and diet in weight loss.

Obesity is a multifactorial condition with a relevant genetic correlation. Recent advances in genomic research have identified several single nucleotide polymorphisms (SNPs) in genes such as FTO, MCM6, HLA, and MC4R, associated with obesity. This study aimed to evaluate the association of 102 SNPs with BMI and weight loss treatment response in a multi-ethnic population. The study analyzed 9,372 patients for the correlation between SNPs and BMI (dataset A). The correlation between SNP and weight loss was accessed in 474 patients undergoing different treatments (dataset B). Patients in dataset B were further divided into 3 categories based on the type of intervention: dietary therapy, intragastric balloon procedures, or surgeries. SNP association analysis and multiple models of inheritance were performed. In dataset A, ten SNPs, including rs9939609 (FTO), rs4988235 (MCM6), and rs2395182 (HLA), were significantly associated with increased BMI. Additionally, other four SNPs, rs7903146 (TCF7L2), (rs6511720), rs5400 (SLC2A2), and rs7498665 (SH2B1), showed sex-specific correlation. For dataset B, SNPs rs2016520 (PPAR-Delta) and rs2419621 (ACSL5) demonstrated significant correlation with weight loss for all treatment types. In patients who adhered to dietary therapy, SNPs rs6544713 (ABCG8) and rs762551 (CYP1A2) were strongly correlated with weight loss. Patients undergoing surgical or endoscopic procedures exhibited differential correlations with several SNPs, including rs1801725 (CASR) and rs12970134 (MC4R), and weight loss. This study provides valuable insights into the genetic factors influencing BMI and weight loss response to different treatments. The findings highlight the potential for personalized weight management approaches based on individual genetic profiles.

Sleeve gastrectomy versus endoscopic intragastric balloon in decreasing weight and associated comorbidities in Erbil city: A comparative study

Background: Surgical obesity treatment is difficult for both surgeons and patients. The three main categories of bariatric surgery procedures are malabsorptive, restrictive, or both in combination. Intragastric balloon (IB) is an easily applicable restrictive interventional and nonsurgical strategy for obese patients, and the surgical procedure known as laparoscopic sleeve gastrectomy (LSG) is frequently used to help obese patients decrease weight.&#x0D; Objective: To assess and compare these two restrictive approaches.&#x0D; Patients and Methods: A prospective study of 138 LSG patients was conducted, (n=82) and IB (n=56) between 1st January 2016 to 31st December 2021 in private hospitals in Erbil, Iraq. The study retrospectively evaluates patients' demographic information, changes in total body weight (TBW), changes in body mass index (BMI), and percentage of excess weight loss (%EWL), morbidities and change of comorbidities during a year of follow-up, at months 1, 3, 6, and 12 after surgery. Comparative analysis was undertaken for the follow-up results after 6 and 12 months.&#x0D; Results: In the IB group, 12 patients did not tolerate insertion, leaving 56; in the LSG group, 82 patients completed treatment. In terms of age (p=0.121), gender (p=0.242), and BMI (p=0.078), there were no statistical differences between the IB and LSG groups. The LSG group achieved statistically significant superior treatment outcomes in terms of changes in TBW, BMI, and %EWL.&#x0D; Conclusion: Both LSG and IB are beneficial in the short term for helping obese patients lose weight. IB has the benefit of being performed as an outpatient procedure with less complications, but it is less successful in helping people lose weight than LSG. The best options for various patient groups in terms of clinical outcomes and health system effectiveness must be determined through prospective, randomized control studies.&#x0D;

Sleeve gastrectomy versus endoscopic intragastric balloon in decreasing weight and associated comorbidities in Erbil city: A comparative study

Background: Surgical obesity treatment is difficult for both surgeons and patients. The three main categories of bariatric surgery procedures are malabsorptive, restrictive, or both in combination. Intragastric balloon (IB) is an easily applicable restrictive interventional and nonsurgical strategy for obese patients, and the surgical procedure known as laparoscopic sleeve gastrectomy (LSG) is frequently used to help obese patients decrease weight. Objective: To assess and compare these two restrictive approaches. Patients and Methods: A prospective study of 138 LSG patients was conducted, (n=82) and IB (n=56) between 1st January 2016 to 31st December 2021 in private hospitals in Erbil, Iraq. The study retrospectively evaluates patients' demographic information, changes in total body weight (TBW), changes in body mass index (BMI), and percentage of excess weight loss (%EWL), morbidities and change of comorbidities during a year of follow-up, at months 1, 3, 6, and 12 after surgery. Comparative analysis was undertaken for the follow-up results after 6 and 12 months. Results: In the IB group, 12 patients did not tolerate insertion, leaving 56; in the LSG group, 82 patients completed treatment. In terms of age (p=0.121), gender (p=0.242), and BMI (p=0.078), there were no statistical differences between the IB and LSG groups. The LSG group achieved statistically significant superior treatment outcomes in terms of changes in TBW, BMI, and %EWL. Conclusion: Both LSG and IB are beneficial in the short term for helping obese patients lose weight. IB has the benefit of being performed as an outpatient procedure with less complications, but it is less successful in helping people lose weight than LSG. The best options for various patient groups in terms of clinical outcomes and health system effectiveness must be determined through prospective, randomized control studies.

Expression characteristics of peripheral lymphocyte programmed death 1 and FoxP3+ Tregs in gastric cancer during surgery and chemotherapy.

Programmed death 1 (PD-1) and CD4+CD25+FoxP3+ expression in peripheral blood T-cells has been previously reported in various types of cancer. However, the specific variation tendency during surgery and chemotherapy, as well as their relationship in gastric cancer patients, still remain unclear. Understanding this aspect may provide some novel insights for future studies on tumor recurrence and tumor immune escape, and also serve as a reference for determining the optimal timing and dose of clinical anti-PD-1 antibodies. To observe and analyze the expression characteristics of peripheral lymphocyte PD-1 and FoxP3+ regulatory T cells (FoxP3+ Tregs) before and after surgery or chemotherapy in gastric cancer patients. Twenty-nine stomach cancer patients undergoing chemotherapy after a D2 gastrectomy provided 10 mL peripheral blood samples at each phase of the perioperative period and during chemotherapy. This study also included 29 age-matched healthy donors as a control group. PD-1 expression was detected on lymphocytes, including CD4+CD8+CD45RO+, CD4+CD45RO+, and CD8+CD45RO+ lymphocytes as well as regulatory T cells. We observed a significant increase of PD-1 expression on immune subsets and a larger number of FoxP3+ Tregs in gastric cancer patients (P < 0.05). Following D2 gastrectomy, peripheral lymphocytes PD-1 expression and the number of FoxP3+ Tregs notably decrease (P < 0.05). However, during postoperative chemotherapy, we only observed a decrease in PD-1 expression on lymphocytes in the CD8+CD45RO+ and CD8+CD45RO+ populations. Additionally, linear correlation analysis indicated a positive correlation between PD-1 expression and the number of CD4+CD45RO+FoxP3high activated Tregs (aTregs) on the total peripheral lymphocytes (r = 0.5622, P < 0.0001). The observed alterations in PD-1 expression and the activation of regulatory T cells during gastric cancer treatment may offer novel insights for future investigations into tumor immune evasion and the clinical application of anti-PD-1 antibodies in gastric cancer.

Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment.

Comprehensive genomic analysis has shown that small bowel adenocarcinoma (SBA) has different genomic profiles from gastric and colorectal cancers. Hence, it is essential to establish chemotherapeutic regimens based on SBA characteristics. The expression of programmed cell death-ligand 1 (PD-L1) and programmed cell death-ligand 2 (PD-L2) in SBA is not fully understood. Anti-PD-L1/PD-1 therapy uses tumor-infiltrating lymphocytes (TILs); therefore, the status of TILs in the tumor microenvironment (TME) may influence their efficacy. The ratio of FoxP3+ to CD8+ T cells has been reported to be useful in predicting the prognosis of digestive system cancers. To investigate the clinicopathological significance of PD-L1/2 expression according to the status of TILs in SBA tissues. We performed immunohistochemical analysis for PD-L1, PD-L2, CD8, FoxP3, and DNA mismatch repair (MMR) proteins using formalin-fixed, paraffin-embedded tissues from 50 patients diagnosed with primary SBA. The immunoreactivities of PD-L1 and PD-L2 were determined separately in tumor cells and tumor-infiltrating immune cells throughout the tumor center and invasive margins, and finally evaluated using the combined positive score (CPS). We assessed CD8+ and FoxP3+ T cells in the intratumoral and tumor-surrounding stroma. Subsequently, we calculated and summed the ratio of FoxP3 to CD8+ T cell counts. Immune-related cell densities were graded as low or high. Immunohistochemical results were compared with clinicopathological factors and patient prognosis. The distribution of cancer-specific survival (CSS) was estimated using the Kaplan-Meier method, and the log-rank test was used to test for significant differences in CSS. A Cox proportional hazard model was also used to assess the effect of tumor variables on CSS. PD-L1 expression was positive in 34% in tumor cells (T-PD-L1) and 54% in tumor-infiltrating immune cells (I-PD-L1) of the cases examined. T-PD-L2 was positive in 34% and I-PD-L2 was positive in 42% of the cases. PD-L1 CPS ≥ 10 and PD-L2 CPS ≥ 10 were observed in 50% and 56% of the cases, respectively. Deficient MMR (dMMR) was 14% of the cases. T-PD-L1, I-PD-L1 and PD-L1 CPS ≥ 10 were all significantly associated with dMMR (P = 0.037, P = 0.009, and P = 0.005, respectively). T-PD-L1, I-PD-L1, and PD-L1 CPS ≥ 10 were all associated with deeper depth of invasion (P = 0.001, P = 0.024, and P = 0.002, respectively). I-PD-L2 expression and PD-L2 CPS ≥ 10 were significantly higher in the differentiated histological type (P = 0.015 and P = 0.030, respectively). The I-PD-L1 and I-PD-L2 levels were significantly associated with better CSS (P = 0.037 and P = 0.015, respectively). CD8-high was significantly associated with less lymph node metastasis (P = 0.047), less distant metastasis (P = 0.024), less peritoneal dissemination (P = 0.034), and earlier TNM stage (P = 0.047). The CD8-high group had better prognosis than the CD8-low group (P = 0.018). FoxP3 expression was not associated with any clinicopathological factors or prognosis. We found that patients with PD-L2 CPS ≥ 10 tended to have worse prognosis in the FoxP3/CD8-low group (P = 0.088). The clinicopathological significance of PD-L1/2 expression may differ depending on the TME status. Immune checkpoint inhibitors may improve the prognosis of SBA patients with low FoxP3/CD8 ratio and PD-L2 expression.

Roles of phosphatidylinositol-3-kinases signaling pathway in inflammation-related cancer: Impact of rs10889677 variant and buparlisib in colitis-associated cancer.

Phosphatidylinositol-3-kinases (PI3K) is a well-known route in inflammation-related cancer. Recent discovery on PI3K-related genes revealed a potential variant that links ulcerative colitis (UC) and colorectal cancer (CRC) with colitis-associated cancer (CAC). PI3K/AKT pathway has been recommended as a potential additional therapeutic option for CRC due to its substantial role in modifying cellular processes. Buparlisib is a pan-class I PI3K inhibitor previously shown to reduce tumor growth. To investigate the regulation of rs10889677 and the role of buparlisib in the PI3K signaling pathway in CAC pathogenesis. Genomic DNA from 32 colonic samples, including CAC (n = 7), UC (n = 10) and CRC (n = 15), was sequenced for the rs10889677 mutation. The mutant and wildtype fragments were amplified and cloned in the pmirGLO vector. The luciferase activity of cloned vectors was assessed after transfection into the HT29 cell line. CAC mice were induced by a mixture of a single azoxymethane injection and three cycles of dextran sulphate sodium, then buparlisib was administered after 14 d. The excised colon was subjected to immunohistochemistry for Ki67 and Cleaved-caspase-3 markers and quantitative real-time polymerase chain reaction analysis for Pdk1 and Sgk2. Luciferase activity decreased by 2.07-fold in the rs10889677 mutant, confirming the hypothesis that the variant disrupted miRNA binding sites, which led to an increase in IL23R expression and the activation of the PI3K signaling pathway. Furthermore, CAC-induced mice had a significantly higher disease activity index (P < 0.05). Buparlisib treatment significantly decreased mean weight loss in CAC-induced mice (P < 0.05), reduced the percentage of proliferating cells by 5%, and increased the number of apoptotic cells. The treatment also caused a downward trend of Pdk1 expression and significantly decreased Sgk2 expression. Our findings suggested that the rs10889677 variant as a critical initiator of the PI3K signaling pathway, and buparlisib had the ability to prevent PI3K-non-AKT activation in the pathophysiology of CAC.

Pancreatitis After Placement of the Bariatric Intragastric Balloon Is Not Related to Off-Protocol Use: An Analysis of 39 Cases

Pancreatitis After Placement of the Bariatric Intragastric Balloon Is Not Related to Off-Protocol Use: An Analysis of 39 Cases

Metabolic-Dysfunction-Associated Steatotic Liver Disease-Its Pathophysiology, Association with Atherosclerosis and Cardiovascular Disease, and Treatments.

Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a chronic liver disease that affects more than a quarter of the global population and whose prevalence is increasing worldwide due to the pandemic of obesity. Obesity, impaired glucose metabolism, high blood pressure and atherogenic dyslipidemia are risk factors for MASLD. Therefore, insulin resistance may be closely associated with the development and progression of MASLD. Hepatic entry of increased fatty acids released from adipose tissue, increase in fatty acid synthesis and reduced fatty acid oxidation in the liver and hepatic overproduction of triglyceride-rich lipoproteins may induce the development of MASLD. Since insulin resistance also induces atherosclerosis, the leading cause for death in MASLD patients is cardiovascular disease. Considering that the development of cardiovascular diseases determines the prognosis of MASLD patients, the therapeutic interventions for MASLD should reduce body weight and improve coronary risk factors, in addition to an improving in liver function. Lifestyle modifications, such as improved diet and increased exercise, and surgical interventions, such as bariatric surgery and intragastric balloons, have shown to improve MASLD by reducing body weight. Sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to improve coronary risk factors and to suppress the occurrence of cardiovascular diseases. Both SGLT2i and GLP-1 have been reported to improve liver enzymes, hepatic steatosis and fibrosis. We recently reported that the selective peroxisome proliferator-activated receptor-alpha (PPARα) modulator pemafibrate improved liver function. PPARα agonists have multiple anti-atherogenic properties. Here, we consider the pathophysiology of MASLD and the mechanisms of action of such drugs and whether such drugs and the combination therapy of such drugs could be the treatments for MASLD.

Acute pancreatitis secondary to migration and impaction of the intragastric balloon

Acute pancreatitis secondary to migration and impaction of the intragastric balloon

Early safety and efficacy comparison of endoscopic bariatric interventions.

Intragastric balloon (IGB) placement and endoscopic sleeve gastroplasty (ESG) are the 2 primary endoscopic bariatric therapies currently performed in the United States. Procedural selection is often based primarily on patient preference. There is a paucity of comparative data between these interventions. The aim of this study is to compare the short-term safety and efficacy of IGB to ESG in the largest, direct comparative analysis to date. Accredited bariatric centers across the United States and Canada. We retrospectively analyzed patients who underwent IGB or ESG from 2016 to 2020 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. IGB patients were propensity matched (1:1) to ESG patients. We compared readmissions, reinterventions, serious adverse events (SAE), weight loss, procedure time, and length of stay between the 2 interventions. All outcomes were measured within 30 days of the initial procedure. A total of 1998 pairs of patients who underwent IGB and ESG were propensity matched with no difference in baseline characteristics. Patients who underwent ESG had more readmissions within 30 days. Patients who underwent IGB had more outpatient treatments for dehydration and re-interventions, with 3.7% of patients undergoing early balloon removal less than 30 days from implantation. Both procedures had similarly low rates of SAE (P > .05). ESG led to greater total body weight loss at 30 days. ESG and IGB are both safe procedures with comparably low rates of SAE. Higher rates of dehydration and re-interventions after IGB suggest that ESG is perhaps better tolerated.

S3404 Delayed Intragastric Balloon Retrieval, Favorable Gastric Environment, and Balloon Permeability Promote Spontaneous Intragastric Balloon Hyperinflation

S3404 Delayed Intragastric Balloon Retrieval, Favorable Gastric Environment, and Balloon Permeability Promote Spontaneous Intragastric Balloon Hyperinflation