Gastric Volume Reduction Research Articles

Comparative study between laparoscopic sleeve gastrectomy and laparoscopic greater curvature gastric plication regarding reduction in gastric volume using computed tomography gastric volumetry

Comparative study between laparoscopic sleeve gastrectomy and laparoscopic greater curvature gastric plication regarding reduction in gastric volume using computed tomography gastric volumetry

Regulation of the RB1 Gene through DNMT1 by SGI-1027 and its Impact on the Growth and Metastasis of Gastric Cancer Cells.

SGI-1027 is a recognized inhibitor of DNA methyltransferase 1 (DNMT1), and earlier investigations have indicated an inverse correlation between dysregulated DNMT1 expression in gastric cancer (GC) and retinoblastoma 1 (RB1) gene expression. Despite this knowledge, the precise mechanisms underlying the action of SGI-1027 in GC cells remain inadequately comprehended. The primary objective of this study is to elucidate the impact of SGI-1027 on the behavior of GC cells, encompassing aspects such as growth and metastatic potential, by intervening in DNMT1, thereby influencing the regulation of RB1 gene expression. The acquisition of the normal gastric mucosal cell line GES-1 and the human gastric cancer cell line MKN45 was followed by employing Western blot (WB) and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) techniques to evaluate the expression levels of RB1 and DNMT1 in these two cell lines. Subsequently, the MKN45 cell line was cultured in medium containing varying concentrations of SGI-1027, and the impact of SGI-1027 on the regulation of RB1 and DNMT1 in GC cells was reassessed using WB and qRT-PCR techniques. To scrutinize the effect of SGI-1027 on GC cells, we utilized the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay to determine cell proliferation and performed Transwell experiments to assess cell migration and invasion capabilities. Throughout this process, we also employed WB to assess the levels of cell cycle-associated proteins (Cyclin D1, Cyclin E1, and Cyclin B1) and proteins related to apoptosis (BCL-2 associated protein X apoptosis regulator (BAX) and B-cell lymphoma 2 apoptosis regulator (BCL-2)). Furthermore, we injected the MKN45 cell line and MKN45 cell line cultured with the optimal concentration of SGI-1027 for 5 days and 10 days into mice subcutaneously and through the tail vein, dividing them into the Model group, Model+SGI-1027 5d group, and Model+SGI-1027 10d group. We monitored changes in tumor size and volume in mice, and tumor tissues as well as lung tissues were collected for hematoxylin and eosin (HE) staining. Finally, DNMT1 expression levels in GC tissues were detected using both WB and immunohistochemistry (IHC) techniques. Additionally, RB1 expression levels in GC tissues were assessed using WB. In contrast to GES-1 cells, MKN45 cells displayed a distinctive profile characterized by increased DNMT1 expression and decreased RB1 expression (p < 0.05). However, upon the introduction of SGI-1027, a notable decrease in DNMT1 levels within GC cells was observed, concomitant with an elevation in RB1 gene expression, with 25 μmol/L SGI-1027 identified as the optimal concentration (p < 0.05). Functional assays demonstrated that SGI-1027-treated GC cells exhibited pronounced features of inhibited proliferation, migration, and invasion when compared to untreated MKN45 cells (p < 0.05). Moreover, in SGI-1027-treated GC cells, the levels of Cyclin D1, Cyclin E1, Cyclin B1, and BCL-2 were significantly reduced, while the expression level of BAX increased (p < 0.05). Notably, the most pronounced impact was observed at 25 μmol/L SGI-1027, further underscoring its regulatory effects on tumor cell behavior (p < 0.05). In animal experiments, the Model group exhibited a substantial increase in tumor volume, with HE staining results indicating extensive necrosis in most gastric tissues and noticeable signs of lung metastasis, accompanied by increased DNMT1 expression and decreased RB1 gene expression. In contrast, the SGI-1027 group displayed a reduction in gastric tumor volume, decreased necrosis, and reduced lung tumor metastasis (p < 0.05). Additionally, the expression of DNMT1 was significantly reduced in SGI-1027-treated GC cells, while RB1 expression increased (p < 0.05), further confirming the inhibitory effects of SGI-1027 on tumor growth and metastasis. SGI-1027 effectively hinders the proliferation and dissemination of GC cells by downregulating DNMT1 and promoting the expression of RB1.

IBC-Oxford University2023_BJSOral_1Dynamic Magnetic Resonance Imaging (Dy-MRI) Evaluation of the Impact of Endoscopic Sleeve Gastroplasty (ESG) on Gastric Structure and Function in Morbid Obese Patients

Abstract Introduction Endoscopic sleeve gastroplasty (ESG) is a restrictive endoluminal bariatric procedure consisting in the application of multiple full-thickness sutures to reduce gastric capacity (GC) and slow down gastric emptying (GE). Although results are promising, a large variation in the weight loss outcomes is reported. Dynamic resonance imaging (Dy-MRI) has been successfully applied for the assessment and analysis of gastrointestinal (GI) function. It permits to acquire large field-of-view, dynamic, high- resolution, three-dimensional (3D) image data with excellent soft-tissue contrast in less than a second3. In addition, our group previously demonstrated a significant correlation between weight loss and gastric anatomy changes assessed by Dy-MRI in laparoscopic sleeve gastrectomy (LSG) patients. The aim of this study is to use Dy-MRI to objectively assess gastric structural and functional changes 6 months after ESG and their impact on weight loss. Material and methods Prospective single centre study. Patients underwent preoperative and postoperative (after 6 months) Dy-MRI to evaluate total GC and GE changes, immediately after the ingestion of 400 ml of liquid meal and over time up to 120 minutes after ingestion (T120). Only patients with a complete follow up at and 6 months (M6) were included. Demographic data, pre- and intra-operative data, and weight loss outcomes were collected. Continuous variables were reported as median and interquartile rank (IQR), while categorical variables as numbers and percentages. Results From July 2021 to June 2023, 16 ESG patients participated in this study. Patients had a median age of 41.5 years (IQR:35-49.7) with a median BMI (kg/m2) of 36.9 (IQR: 34.08-42.18). A median number of 6 (IQR: 5.2-6) purse string sutures were placed during the ESG. There were no complications. At the follow-up gastroscopy at M6 all patients presented an intact ESG with all the suture still present. Dy- MRI showed a median GC reduction of 34.1% of the initial volume (p&amp;lt;0.0001) and GE decreased by 0.43 mL/min (p=0.01). As a whole, the study population had a 16.8% of total weight loss (TWL) at M6 (p&amp;lt;0.0001). Similarly, the median BMI decreased from 36.9 to 29.9 (p=0.01). %TWL varied from 15.5 at M3 to 18.3 at M6. During the same time-elapse, %EWL increased from 46.4 to 57.1. Discussion and Conclusion Dy- MRI is confirmed to be a non-invasive method capable of objectively quantify gastric volume reduction and GE changes after ESG. It is likely that these two factors play a synergic role in the weight loss journey of patients undergoing ESG. Further investigations in a larger sample are needed to support these initial findings and to support an evidence based, patient specific approach to endoscopic gastric remodelling.

Research on the Transitional Care Model-based Health Management Protocol for Patients after Sleeve Gastrectomy

Background: Postoperative care after sleeve gastrectomy is critical to a successful outcome because of the increasing popularity of the procedure in the treatment of obesity and related conditions. Objectives: The purpose of this study was to evaluate the effectiveness of a health intervention plan for sleeve gastrectomy patients based on the Transitional Care Model (TCM). Methods: This study was conducted from January 2021 to January 2022 at Mudanjiang Hospital. The study included a total of 72 patients who underwent sleeve gastric volume reduction. Patients were randomly divided into an intervention group (36 cases) and a control group (36 cases). The intervention group received care based on a health intervention plan, while the control group received routine care. Various assessments were performed on the first day of hospitalization and three months after surgery, such as questionnaires on general information, physical activity, eating behavior, quality of life, and adherence to implementation. Results: After the intervention, the intervention group showed significant improvements in total duration of physical activity, moderate-intensity activity, restrained eating, emotional eating, physical pain, mental health, and social functioning (p&lt;0.05). However, there were no significant differences between groups in activity intensity, walking, external diet, physical functioning, physical role, general health, or vitality (p&gt;0.05). Adherence to the health management protocol was significantly higher in the intervention group (p&lt;0.05). Conclusion: The health intervention plan based on the transitional care model improves physical activity, eating behaviors, quality of life, and compliance in sleeve gastrectomy patients.

Endoscopic management of obesity: Impact of endoscopic sleeve gastroplasty on weight loss and co-morbidities at six months and one year.

Endoscopic sleeve gastroplasty (ESG) is one of the new minimally invasive endoscopic treatments aimed at inducing weight loss. Its effectiveness in terms of weight loss is proven. Gastric volume reduction and delayed gastric emptying are the mechanisms that drive weight loss. However, potential benefits for co-morbidities in relation to weight loss after ESG are still being investigated. This study aims to evaluate the effect of ESG procedures on major obesity-associated co-morbidities, and on some biological parameters. This is a series of consecutive cases from a prospective observational study carried out in a specialized center that follows a standardized care pathway for the multimodal management of obesity. Patients who have undergone ESG with endoscopic and laboratory follow-up at six and twelve months after this intervention were included in the study. Prospectively recorded data on weight loss, co-morbidities and laboratory parameters at six and twelve months after surgery was analyzed retrospectively. Changes in body mass index (BMI), absolute weight loss (AWL), percent of excess weight loss (%EWL) and percent total weight loss (%TWL) were assessed at six and twelve months. Reduction in various obesity-related co-morbidities (arterial hypertension [AHT], type 2 diabetes mellitus [T2DM], gastroesophageal reflux disease [GERD], obstructive sleep apnea syndrome [OSAS] and dyslipidemia was also evaluated at six and twelve months. Changes in blood glucose, liver function tests and lipid blood tests were also analyzed at six and twelve months. From October 2016 to July 2021, 99 of the 227 patients who underwent ESG in our unit (43.6%) subsequently underwent a complete endoscopic and laboratory follow-up at six and twelve months. The initial BMI was 42.7±7.8kg/m2 and age was 45±12.7 years. Seventy-four patients (74.8%) were female. Total weight loss (%TWL) and excess weight loss (%EWL) were 16.6±7.4% and 43.3±21.2%, respectively, at six months, 16.6±9.6% and 42.9±25.6%, respectively, at one year. At six and twelve month follow-up, a statistically significant reduction was observed for the rates of T2DM (30.8 and 32.7%), hypertension (18.4 and 22.1%), GERD (28 and 25.7%), OSAS (15.8 and 25.5%) and dyslipidemia (69.2 and 77.2%) (P<0.001). A statistically significant difference was found in the reduction in blood glucose between the pre-operative period and six months post-operatively (P<0.01) and between the pre-operative period and twelve months post-operatively (P<0.01). The reduction in triglycerides and total cholesterol between the pre-operative values and at six months was statistically significant (P<0.01) as was the reduction at twelve months (P<0.01) (P=0.017). For liver function tests, the reduction in AST was statistically significant at six and twelve months after ESG (P=0.048) (P=0.048) as was ALT (P<0.01) (P<0.01) respectively. From October 2016 to July 2021, of the 227 patients who underwent ESG, 99 (43.6%) had follow-up gastro-duodenoscopy at 6 and 12 months. %TWL and %EWL were respectively 16.6±7.4% and 43.3%±21.2 at 6 months, 16.6±9.6% and 42.9±25.6% at one year. Statistically significant reduction rates at 6 and 12 months were observed in T2DM (30.8 and 32.7%), AHT (18.4 and 22.1%), GERD (28 and 25.7%), OSAS (15.8 and 25.5%) and dyslipidemia (69.2 and 77.2%) (P<0.001). Moreover, glycemic levels were statistically significantly reduced between the pre-operative period and 6 months post-operative (1.11±0.22mg/L vs. 1.01±0.17mg/L, P<0.01), and between the pre-operative period and 12 months post-operative (1.11±0.22mg/L vs. 1.06±0.32mg/L, P<0.01). A statistically significant reduction was also observed in triglycerides and total cholesterol levels at 6 months (1.52±0.74mmol/L vs. 1.14±0.52mmol/L, P<0.01) (1.94±0.4mmol/L vs. 1.85±0.36mmol/L, P<0.01) and at 12 months (1.52±0.74mmol/L vs. 1.18±0.67mmol/L, P<0.01) (1.94±0.4mmol/L vs. 1.82±0.39mmol/L, P=0.017) and in AST (27.2±11.7 IU/L vs. 23.7 IU/L; P=0.048) (27.2±11.7 IU/L vs. 24.7±14.65 IU/L, P=0.048) and ALAT levels (34±21.32 IU/L vs. 22.3±10.4 IU/L, P<0.01 and 34±21.32 IU/L vs. 27.07±25 IU/L, P<0.01) at 6 and 12 months after ESG, respectively. ESG is a well-tolerated and safe surgical procedure that is effective in terms of weight loss and reduction of obesity-related co-morbidities at six months and one year. This procedure could thus be adopted on a broader clinical scale and be more widely promoted as an effective treatment for morbid obesity.

Phenolic acids-rich fraction from Ficus drupacea leaves for the prevention and treatment of ethanol-induced gastric mucosal injury in rats

Bioactivity-guided fractionation of F. drupacea Thunb. extract revealed that the water fraction (FDWF) increased pH of the artificial gastric juice from 1.2 to 5.67 ± 0.015. The gastroprotective effect of FDWF against ulcer induced by ethanol was evaluated in rats. In ulcerogenic rats, increase in the gastric juice volume and ulcer lesions, and decrease in the gastric pH were evident. However, pretreatment with FDWF (100 mg/kg b.wt., p.o.) significantly inhibited lesion index, reduced gastric juice volume by 56.09% and increased gastric pH value. When given after ethanol, the same dose of FDWF led to significant healing of the gastric ulcer, with 75.60% reduction of gastric juice volume, and increase in pH value. In both prophylactic and therapeutic-treated groups, the level of superoxide dismutase and reduced glutathione in gastric homogenate were increased, while that of malondialdehyde was decreased. Also, the levels of succinate dehydrogenase and lactate dehydrogenase were increased, while that of acid phosphatase was decreased. In addition, the inflammatory markers; IL-10 and PGE2 were significantly increased. The histopathological results confirmed the above findings and indicated that the antiulcer effect of FDWF is mediated, at least in part, through antioxidant and anti-inflammatory mechanisms. Twenty-three compounds were tentatively identified in FDWF using UPLC−PDA−ESI–MS/MS and most of them were found to be phenolic acid derivatives. FDWF was standardized to contain 23.66 ± 2.62 mg/g and 8.86 ± 0.29 mg/g of quinic acid and chlorogenic acid, respectively. Accordingly, FDWF is a potential natural product that could increase the healing of gastric mucosal injury and prevents the development of ethanol-induced gastric mucosal injury in rats.

Evolving Technique of Laparoscopic Vertical Gastric Clip Placement.

Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip. All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A). A control group (group B) was designed with patients who underwent previous LBCG technique between May 2017 and June 2019. This is a case-controlled group with patients matched by gender and BMI. We have analyzed the postoperative complications and more notably the slippage. One hundred seventy-six patients (44 male and 132 female) with a mean age of 33years (± 11) underwent evolving technique of LBCG. A control group of 67 patients who underwent previous technique of LBCG was included. All procedures were completed by laparoscopy with no intraoperative complication. For the study group, we have recorded a number of 5 slippages (2.8%). The diagnosis occurred during the first 6months after the operation. The management consisted of repositioning-3 cases-and BariClip removal-2 cases. For the control group, we have recorded a number of 3 slippages (4.3%). All three patients underwent BariClip removal, with no repositioning. We reported a new technique of placement of the BariClip with additional gastric plication anterior, posterior, and volume reduction in the antrum to potentially reduce the rate of slippage and improve weight loss outcomes.

Anti-peptic Ulcer of the N-hexane Fraction from Sanchezia nobilis Hook.F. Leaves and its Isolated Compounds

The n-hexane fraction of the Sanchezia nobilis Hook.f. leaves was evaluated for its effect on the gastric ulcer with pyloric ligation (Shay) rat model, analgesia effect on hot plate model and pain threshold meter, and inhibitory effect on Helicobacter pylori (H.P). The data showed a significant reduction in ulcer score, gastric volume, and total acidity and tended to reduce free acidity and increase gastric pH. In addition, the n-hexane fraction had a central analgesic effect and H.P inhibition. Chemical investigation of the n-hexane fraction resulted in the isolation of the four compounds (1 – 4). By using NMR and ESI-MS spectra, these compounds were identified chemical structures (3β, 5α, 22E)-stigmasta-7,22-dien-3-ol (1), coccinic acid (2), 7-hydroxy-6-methoxy coumarin (3), and betulinic acid (4). All compounds were reported for the first time from the Sanchezia genus.&#x0D; &#x0D; &#x0D;

Three-Dimensional Multi-detector Computed Tomography (3D-MDCT) Gastric Volumetry in Patients with obesity and Normal-Weight Individuals

Obesity is a widely prevalent medical and socioeconomic problem. Bariatric surgery is indicated for patients with clinically severe obesity. Reduction of gastric volume is an important factor that contributes to weight loss after laparscopic sleeve gastrectomy (LSG). The impact of the gastric volume on weight after LSG has been studied. This study was designed to assess the gastric volume in patients with obesity prior to LSG and in the normal-weight patients, using three-dimensional multi-detector computer tomography (3D-MDCT), and to evaluate the potential correlation of the gastric volume with body mass index (BMI). A total of 100 patients were equally enrolled in two groups: one group for patients with obesity scheduled for LSG and another one for normal-weight patients scheduled for non-bariatric surgery. The study patients underwent 3D-MDCT gastric volumetry. The gastric volume ranged from 525 to 1170mL in patients with obesity and from 312 to 676mL in the normal-weight group. Statistically significant difference was found between the two groups. Age, weight, and BMI were found to be predictors for the gastric volume in normal-weight patients only. MDCT gastric volumetry is a feasible method to assess the stomach volume. Higher volumes were evident in patients with obesity. Age, weight, and BMI are predictors for the gastric volume in normal-weight patients with linear regression equations that could help during the preoperative planning of bariatric surgeries.

Amelioration of ethanol-induced gastric ulcer in rats by quercetin: implication of Nrf2/HO1 and HMGB1/TLR4/NF-κB pathways

Gastric ulcer is a serious medical condition that can be developed due to an imbalance in the protective and destructive factors of the gastric system. Available therapies do not provide definite cure, thus, there is an urge to seek for alternative treatments. Quercetin is a natural flavonoid that possesses antioxidant and anti-inflammatory properties. In the current study, the antiulcerogenic effect of quercetin in ethanol-induced gastric ulcer (EI-GU) rat model was compared to Antodine® (a reference drug), to elucidate the potential underlying mechanisms. Quercetin (50 mg/kg) and Antodine® (20 mg/kg) were given orally for one week post ulcer induction by ethanol. EI-GU was associated with downregulation of SOD, CAT, Nrf2 and HO1, and accompanied by upregulation of inflammatory markers (i.e., HMGB1, NF-κB and TNFα) and an increase in Bax/Bcl2 ratio. Administration of quercetin resulted in a significant reduction in gastric volume in the stomach of ulcerative rats by 86% and a significant decrease in gastric lesion count by 3.5- folds, as compared with the ulcerative rats. Moreover, rats treated with quercetin showed upregulation of Nrf2 by 3.3-fold change and in HO1 by 3.5-fold change when compared to ulcerated rats, and decreased HMGB1, TLR4, NF-κB p65 and TNF-α by 50%, 53%, 52.9% and 54.9%, respectively. Treatment of rats with quercetin reduced Bax and Bax/Bcl2 ratio and increased Bcl2 relative to ulcerated rats. Thus, it can be concluded that the ulcerogenic curative properties of quercetin were mediated by antioxidant, anti-inflammatory and antiapoptotic activities.

Impact of Proceduralist Specialty on Outcomes Following Endoscopic Sleeve Gastroplasty.

Endoscopic sleeve gastroplasty (ESG) is a novel minimally invasive weight loss procedure designed to mimic gastric volume reduction of surgical sleeve gastrectomy. Currently, both bariatric surgeons and gastroenterologists perform ESG, and early reports suggest that ESG is safe and effective for weight loss. However, as gastroenterologists and bariatric surgeons have variations in training backgrounds, it is important to evaluate for potential differences in clinical outcomes. To date, there are no studies comparing the impact of proceduralist specialization on outcomes of ESG. This study aims to assess whether proceduralist specialization impacts short-term safety and efficacy after ESG. We retrospectively analyzed over 6,000 patients who underwent ESG from 2016 to 2020 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. ESG patients were stratified into two groups depending on the specialty of the physician performing the procedure, and propensity matched using baseline patient characteristics. We primarily compared adverse events (AE), readmissions, re-operations, and re-interventions within 30days after procedure. Secondary outcomes included procedure time, length of stay (LOS), early weight loss, and emergency department (ED) visits after procedure. There was no difference in AE in ESG performed by gastroenterologists and bariatric surgeons. ESG performed by bariatric surgeons demonstrated a trend towards higher rate of re-operations within 30days. ESG performed by gastroenterologists had more ED visits but did not lead to higher rate of re-intervention. LOS was shorter in ESG performed by gastroenterologists, but procedure time was longer. ESG is safely performed by both gastroenterologists and bariatric surgeons.

Evaluation of antiulcer activity of herbal drugs on experimental animal: Myrica nagi (Myricaceae)

The anti-ulcer activity of Methanolic extract of Myrica nagi (Myricaceae) fruit MEMN was investigated in pylorus ligation and methanol-induced ulcer models in Wistar rats. In both models, the common parameter determined was ulcer index MEMN at doses of 200,400 mg/kg p.o produced significant inhibition of the gastric lesions induced by Aspirin-induced ulcers &amp; pylorus ligation-induced ulcers. The extract (200, 400 mg/kg) showed a significant (P &lt; 0.001) reduction in gastric volume, free acidity and ulcer index as compared to the control. This present study indicates that Myrica nagi fruit extract has potential antiulcer activity in both models. These results may further suggest that methanolic extract was found to possess antiulcer genic as well as ulcer healing properties.

Evaluation of Anti-ulcer activity of Polyherbal preparation in Ulcerogenic Wistar rats

Ulcer is painful open discontinuation or breaking on the skin or mucous membrane that destruct the organ from doing its normal functions. Ayurvedic preparations are in lead because of side effects of allopathic drug. This polyherbal combination was prepared by using previous studies that showing the individual plant have antiulcer activity but there is no polyherbal combination of them. Therefore, the present study was to evaluate the anti-ulcer activity of polyherbal preparation using wistar albino rats against pylorus ligation induced gastric ulcer and ethanol induced gastric ulcer. Rats were treated at the doses of 200mg/kg and 400mg/kg body weight using polyherbal extract and the effect was compared with omeprazole (10mg/kg) as standard drug. The ulcer index was reduced by the extract there was significant difference at dose of 200mg/kg (p˂0.05) and 400mg/kg (p˂0.01) in ethanol induced ulcer model and 200mg/kg (p˂0.05) and 400mg/kg (p˂0.05) in pylorus ligation model when compared to the disease control group animal. The antiulcer activity as seen by reduction in gastric juice volume, percentage of ulcer protection, ulcer index, increase free acidity, total acidity, and pH. This polyherbal preparation shows antiulcer activity because these plants have antioxidant, antisecretory and cytoprotective activity. So, we can conclude that the polyherbal preparation has good antiulcer activity.

Gastroplasty With Endoscopic Myotomy (GEM) for the Treatment of Obesity: Preliminary Efficacy and Physiologic Results

Endoscopic sleeve gastroplasty (ESG) is a commonly performed endoscopic bariatric and metabolic therapy.1,2 The procedure uses endoscopic suturing of the greater curvature with reduction of gastric volume. Mean total weight loss (TWL) is approximately 15.6%, with a 77% response rate (≥10% TWL) at 1 year.3 Proposed mechanisms of ESG include early satiation due to reduced fundal accommodation from gastric shortening and prolonged satiety due to delayed gastric emptying from impeded food breakdown and mixing of chyme secondary to gastric body sutures.

Comparison of distal primary obesity surgery endolumenal techniques for the treatment of obesity (with videos)

Distal primary obesity surgery endolumenal (POSE) procedures involve plication of the gastric body, sparing the fundus. We aim to assess the efficacy of distal POSE procedures and to compare plication techniques (single-helix vs double-helix approaches). This is a prospective registry study of patients who underwent distal POSE procedures using 2 techniques: the single-helix plication technique, in which a single plication with serosa-to-serosa approximation is obtained with each device activation, and the double-helix plication technique, where 2 serosa-to-serosa plications with an internal mucosa-to-mucosa approximation are obtained with each device activation. One hundred ten patients (90 women; mean age, 43 ± 13 years) underwent distal POSE procedures. Baseline body mass index was 38.2 ± 6.1 kg/m2. Technical success was 100%. An average of 21 ± 5 plications were placed per case. The gastric body was shortened by 74%. At 12 months, patients experienced 15.8% ± 8.9% total weight loss (TWL) (P< .0001), with 93% and 61% achieving at least 5% and 10% TWL, respectively. Blood pressure, insulin resistance, and liver enzymes improved. The serious adverse event rate was .9%, including a case of gastric perforation. Of 110 patients, 42 and 68 underwent distal POSE procedures using a single- or double-helix technique, respectively. The double-helix technique resulted in greater reduction in gastric volume (length reduction by 78% vs 65%, P< .0001), weight loss (20.3% ± 8.3% vs 13.4% ± 8.3% TWL, P= .005), and proportion of patients achieving 10% TWL (94.7% vs 58.3%, P= .03) than the single-helix technique. Distal POSE techniques appear to be effective at treating obesity and its related comorbidities. The double-helix technique is associated with greater gastric volume reduction, weight loss, and response rate.

Gastrointestinal effects of Mentha aquatica L. essential oil.

Found in humid regions and waterways and popularly used to treat gastrointestinal problems among other applications, the present study evaluated the M. aquatica essential oil (OEMa) as a therapeutic alternative to treat gastrointestinal disorders. Produced by steam distillation, chemical composition of OEMa was determined by GC-MS analysis. The ethanol-induced ulcer and the dose-repeated acetylsalicylic acid (ASA)-induced gastrointestinal lesions models in rats evaluated, respectively, the prophylactic and curative effects of EOMa on peptic ulcers. The EOMa's effect on gastric secretion, gastric mucus and gastrointestinal motility were evaluated in in vivo models. The curative effect of EOMa on acute colitis was evaluated using the DSS-induced colitis model in mice. Obtained in 0.17% yield (w/w), with carvone (54.82 ± 1.39g/100g oil) as the main constituent, EOMa (at 75mg/kg) showed potent gastroprotective effect (> 90%) mediated by non-protein sulfhydryl compounds (NPSH) and nitric oxide (NO) modulation alongside reduction in gastric secretion volume and total acidity. EOMa did not affect gastric mucus production and gastrointestinal motility. In dose-repeated ASA-induced gastrointestinal lesions model, EOMa (at 25mg/kg) promoted the inflammatory process resolution both in gastric and duodenal walls by modulating NPSH, NO and myeloperoxidase levels. Despite delaying in 2days the clinical symptoms worsening, EOMa (at 25mg/kg) was not able to protect colon tissues from DSS-induced acute colitis as evidenced by macroscopic, biochemical, and histopathological parameters. This is the first report of Mentha aquatica essential oil as a promising herbal medicine for peptic ulcers treatment together with an adjuvant effect in IBD.

Changes of Gastric Secretion after Bolus and Slow Intravenous Administration of Bombesin and Neurotensin

Objectives:The aim of the present study was to evaluate the changes caused by intravenous administration of regulatory peptides, bombesin (BBS) and neurotensin (NT), on gastric secretion, serum gastrin, and plasma levels of bombesin-1ike immunoreactivity (BLI) and neurotensin. Materials and methods: Fourteen dogs underwent an upper gastrointestinal tract operation and a Pavlov pouch for the concentration of gastric fluids was formed. The experimental animals were divided into two groups. Peptides were given one month after the second operation and after fasting for 12 hours. In group A, the effects of BBS were studied after a rapid 1 ìg/kg body weight dose and a slow 30´ 0.5 ìg/kg body weight dose administration intravenously. Correspondingly to group B the effects of NT were studied in the same way. Results:The rapid intravenous infusion of BBS caused a very significant increase in gastrin levels, BLI in plasma, volume and HCl of the gastric fluids. The same results, plus a significant decrease in gastric pH, were observed following slow intravenous infusion of BBS. Concerning the NT, rapid administration caused a significant decrease in the volume of gastric fluids. Slow NT administration of caused a significant reduction in gastric fluid volume and in HCl. On the contrary, pH was significantly increased. Conclusion:Bombesin increases plasma gastrin levels and HCl secretion. Neurotensin administration causes a decrease in HCl secretion without affecting gastrin levels in plasma.

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.

Radiographic Measurement of Gastric Remnant Volume After Laparoscopic Sleeve Gastrectomy: Assessment of Reproducibility and Correlation with Weight Loss

BackgroundAs a restrictive procedure, laparoscopic sleeve gastrectomy (LSG) relies primarily on the reduction of gastric volume. It has been suggested that an immediate postoperative gastric remnant volume (GRV) may influence long-term results of LSG; however, there are no consensus in this matter. The aim of this study was to assess the reproducibility of different radiographic methods of GRV calculation and evaluate their correlation with the weight loss (WL) after surgery.MethodsThis retrospective study evaluated 174 patients who underwent LSG in the period from 2014 to 2017. Using UGI, GRV was measured with 3 different mathematical methods by 2 radiologists. Intraobserver and interobserver calculations were made. Correlation between GRV and WL were estimated with calculations percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL) after 1, 3, 6, 12, 18, and 24 months postoperatively.ResultsDuring analysis of intraobserver similarities, the results of ICC calculation showed that reproducibility was good to excellent for all GRV calculation methods. The intraobserver reproducibility for Reader I was highest for cylinder and truncated cone formula and for Reader II for ellipsoid formula. The interobserver reproducibility was highest for ellipsoid formula. Regarding correlation between GRV and WL, significant negative correlation has been shown on the 12th month after LSG in %TWL and %EWL for every method of GRV calculation, most important for ellipsoid formula (%TWL – r(X,Y) = -0.335, p < 0.001 and %EWL – r(X,Y) = -0.373, p < 0.001).ConclusionRadiographic methods of GRV calculation are characterized by good reproducibility and correlate with the postoperative WL.Graphical

Effects of individualized PEEP obtained by two different titration methods on postoperative atelectasis in obese patients: study protocol for a randomized controlled trial

BackgroundThe incidence of postoperative pulmonary complications (PPCs) is higher in obese patients undergoing general anesthesia and mechanical ventilation due to the reduction of oxygen reserve, functional residual capacity, and lung compliance. Individualized positive end-expiratory pressure (iPEEP) along with other lung-protective strategies is effective in alleviating postoperative atelectasis. Here, we compared the best static lung compliance (Cstat) titration of iPEEP with electrical impedance tomography (EIT) titration to observe their effects on postoperative atelectasis in obese patients undergoing laparoscopic surgery.MethodsA total number of 140 obese patients with BMI ≥ 32.5kg/m2 undergoing elective laparoscopic gastric volume reduction and at moderate to high risk of developing PPCs will be enrolled and randomized into the optimal static lung compliance-directed iPEEP group and EIT titration iPEEP group. The primary endpoint will be pulmonary atelectasis measured and calculated by EIT immediately after extubation and 2 h after surgery. Secondary endpoints will be intraoperative oxygenation index, organ dysfunction, incidence of PPCs, hospital expenses, and length of hospital stay.DiscussionMany iPEEP titration methods effective for normal weight patients may not be appropriate for obese patients. Although EIT-guided iPEEP titration is effective in obese patients, its high price and complexity limit its application in many clinical facilities. This trial will test the efficacy of iPEEP via the optimal static lung compliance-guided titration procedure by comparing it with EIT-guided PEEP titration. The results of this trial will provide a feasible and convenient method for anesthesiologists to set individualized PEEP for obese patients during laparoscopic surgery.Trial registrationClinicalTrials.govChiCTR2000039144. Registered on October 19, 2020