Search Results (164)

Background/Objectives: Gastroesophageal reflux disease (GERD) seems to be a common complaint which persists or develops after metabolic bariatric surgery (MBS). Endoscopic evaluation is vital in both the preoperative and postoperative phases to ensure optimal patient outcomes. The aim of this study was to evaluate the prevalence of GERD after MBS in a 10-year follow-up and analyze the endoscopic outcomes. Methods: This retrospective, multicenter study included 368 patients who underwent single bariatric procedure. The data came from five bariatric centers in Poland, part of the BARI-10-POL project. Data on symptoms of GERD, endoscopic findings, demographics, and surgical outcomes were collected for a 10-year follow-up period. Surgical procedures included SG, Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). Results: Of the 305 patients without symptoms of GERD, 12.3% developed de novo GERD postoperatively. There was no statistical significance regarding the new-onset symptoms and the type of MBS (p = 0.074) and the presence of symptoms of GERD and the type of MBS (p = 0.208). However, SG was associated with a significantly lower likelihood of GERD remission after MBS (p = 0.005). Endoscopic evaluation showed abnormal findings in asymptomatic patients in both preoperative (35.8%) and postoperative (14.1%) examinations (p < 0.001). Conclusions: GERD may be a common issue after MBS. One-quarter of patients after MBS may experience symptoms of GERD, regardless of the type of MBS. SG appears to be associated with a higher risk of persistent symptoms of GERD and a lower likelihood of GERD remission after MBS. Asymptomatic patients both before and after MBS may have abnormal findings in gastroscopy. Full article

Background: Despite being one of the most performed bariatric procedures, there is no consensus regarding optimal limb lengths for Roux-en-Y gastric bypass (RYGB), which may impact weight loss and obesity-related comorbidity resolution. We hypothesize that a ratio-adjusted small bowel to Roux and BP limb lengths in RYGB results in superior outcomes. Objectives: This study aims to define total intestinal length (TIL) and the feasibility of its intraoperative measurement during RYGB. The findings will serve as a foundation for a subsequent randomized trial evaluating different limb length ratios and their effect on postoperative outcomes. Setting: This was a single-center prospective cohort study conducted at Cleveland Clinic Foundation-Main Campus, a tertiary referral center in the United States. Methods: Between January and June 2023, 25 patients with BMI > 40 undergoing RYGB were enrolled. Total small bowel length was measured intraoperatively, and feasibility of measurement was assessed. Patient outcomes, including total weight loss, 30-day complications, and comorbidities at 1 year were captured. Results: Mean preoperative BMI was 47.6 ± 8.0 kg/m². Mean total small bowel length was 592 ± 93.3 cm, with a mean biliopancreatic (BP) limb length of 109 ± 29 cm (18.86% ± 5.84 of total length) and Roux limb length of 103 ± 15 cm (17.71% ± 3.06 of total length). Measurement added an average of 11.5 min to operative time. Measurement feasibility was rated as “moderate” or easier in 80% of cases. One-year postoperative outcomes included a mean total weight loss of 31% and significant reductions in antihypertensive and anti-diabetic medication use. Conclusions: Total small bowel length measurement during RYGB is safe and feasible. High variability in bowel length was observed, with no significant correlation to demographic factors. Establishing individualized limb length ratios may improve weight loss outcomes and comorbidity resolution. Further studies are warranted to evaluate the impact of tailored limb length strategies. Full article

Roux-en-Y gastric bypass (RYGB) surgery induces profound gut microbiota alterations that may impact metabolic outcomes. This study investigated site-specific effects of a multicomponent bovine colostrum-honey-serviceberry (CHJ) complex on post-RYGB microbiome changes in obese rats. Twenty-nine Wistar rats underwent RYGB surgery with CHJ supplementation, followed by mucosal-associated microbiota analysis from five gastrointestinal segments using 16S rRNA sequencing and serum metabolite profiling. RYGB caused regional-specific changes: decreased alpha diversity, systematic Proteobacteria increases (31.2 ± 5.1% in duodenum), and reductions in SCFA-producing bacteria (Romboutsia, Roseburia). CHJ supplementation exhibited dual effects on the microbiome: restoration of beneficial bacteria (Lactobacillus, Bifidobacterium) in distal segments while concurrently promoting Enterobacteriaceae growth in proximal regions. CHJ also maintained alpha diversity levels of the mucosa-associated microbiota comparable to those observed in the control group. Disconnects emerged between predicted microbial functions and systemic metabolites: thiamine pathway activation accompanied 78.5% serum vitamin B1 reduction, indicating severe absorption deficits. Three distinct patterns emerged: pro-inflammatory (proximal), decolonization (widespread Helicobacteraceae loss), and restorative (selective CHJ-mediated recovery). Results demonstrate that post-RYGB dysbiosis exhibits profound regional heterogeneity requiring segment-specific interventions and highlight complex interactions between nutritional supplementation and surgically altered gut ecology in determining metabolic outcomes. Full article

Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: This observational study at University Hospital Mannheim involved 91 patients, aged between 18 and 65 year, who underwent SG or RYGB between 2009 and 2019. Food tolerance was assessed between 25 days and 117 months after surgery using the validated score by Suter et al. (Food Tolerance Score, FTS) and an additional score evaluating tolerance to specific food groups and quality of life. Data on body composition were collected through Bioelectrical Impedance Analysis (BIA) at follow-up visits. Statistical analyses included linear mixed models to analyze the association of food tolerance with body composition changes. Results: The FTS indicated moderate or poor food tolerance in 62.6% of patients, with no significant differences between SG and RYGB. Considering the results of the additional score, food groups such as red meat, wheat products, raw vegetables, carbon dioxide, fatty foods, convenience food, and sweets were the most poorly tolerated food groups. A total of 57 of the participants had a baseline and follow-up BIA measurement. Postoperatively, a significant reduction in body weight and BMI as well as in BIA parameters (fat mass, lean mass, body cell mass, and phase angle) was found. Quality of life improved after bariatric surgery and 76.9% rated their nutritional status as good or excellent, despite possible food intolerances. Conclusions: Bariatric surgery significantly reduces weight and alters food tolerance. Despite moderate or poor food tolerance, patients reported high satisfaction with their nutritional status and quality of life. Detailed food tolerance assessments and personalized dietary follow-ups are essential for the early detection and management of postoperative malnutrition, ensuring sustained weight loss and improved health outcomes. Full article

Background/Objectives: Many patients with obesity require conversion bariatric surgery (CBS) after sleeve gastrectomy (SG). The objective of this study was to assess the evolution of LDL cholesterol and other cardiometabolic parameters in patients who have undergone an SG and require a CBS, as the metabolic effects of such conversion procedures remain insufficiently understood. Methods: A retrospective analysis was conducted in a non-randomized prospective cohort of patients with severe obesity who were previously treated with SG and undergoing CBS. Changes in LDL cholesterol levels after SG were compared to those following CBS using repeated-measures ANOVA. Results: Twenty-eight patients were included (mean age 44.5 ± 7.2 years; 68% female; mean BMI 47.3 ± 7.2 kg/m²). Of these, 57% underwent Roux-en-Y gastric bypass (RYGB), and 43% underwent single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) as conversion procedures. The mean time between SG and CBS was 93.5 ± 45.3 months for RYGB and 31.0 ± 45.2 months for SADI-S. The change in LDL cholesterol pre- vs. post-SG was 3.3 mg/dL (95% CI: −13.6 to 20.1), whereas the change pre- vs. post-CBS was −25.7 mg/dL (95% CI: −37.5 to −13.9) (p < 0.001). Remission of high LDL-C was 18.8% after SG and 73.3% after CBS (p = 0.023). The cardiometabolic profile showed a marked improvement profile during the SG period, followed by maintenance of these improvements during the CBS period. Conclusions: CBS (with either RYGB or SADI-S) results in a reduction in LDL-C, in contrast to the initial surgery with SG. However, CBS does not appear to provide additional benefits over SG in terms of other cardiometabolic parameters. Full article

Background: Despite losing weight, the majority of subjects retained an obese view of themselves. The aim of the study was to evaluate the usefulness of a 3D modeling tool in improving the body image of patients who have undergone bariatric surgery. Methods: Morbidly obese subjects involved in a medico-surgical obesity management program and having undergone a Roux en Y Gastric Bypass (RYGB) or a sleeve gastrectomy (SG) were prospectively included during their usual postoperative medical follow-up. The figure rating scale (FRS), body image questionnaire, and Hospital Anxiety Depression Scale test were performed. The FRS was assessed before and after visualizing their body image using a 3D modeling tool. Distributions between the groups for gender (female vs. male) and type of surgery (gastric bypass vs. sleeve gastrectomy) were tested with a Pearson’s chi² independence test. The significance threshold was p < 0.05. Results: We included 140 adults with sleeve gastrectomy (72.9%; n = 102) or gastric bypass (27.1%; n = 38). The mean time from surgery was 308.3 ± 111.4 days (63–511). Participants were mostly female (77.9%; n = 109). Nearly half of the subjects who had undergone bariatric surgery almost one year before modified their body perception after visualizing their avatar thanks to a 3D modeling tool. One third reduced their FRS score (“perceived body”) after visualizing their avatar. FRS score and body mass index (BMI) following surgery (“real body”) were significantly correlated before and after visualizing the 3D avatar, with a stronger correlation after visualizing the 3D avatar. Conclusions: A 3D modeling tool may improve body perception after weight loss in subjects with bariatric surgery. Being simple, non-invasive, not expansive, and easy to use during a consultation and to understand for the patient, a regular use of this tool may be largely implemented in clinical practice. Its usefulness in improving body image, mood disorders, and eating disorders and the further success of the surgery should be further evaluated. Full article

Background: Food addiction (FA) is prevalent among individuals with severe obesity and has been associated with poorer weight loss (WL) outcomes after dietary interventions. However, its long-term impact after bariatric surgery (BS) remains unclear. Objective: This study aimed to evaluate the effect of preoperative FA on WL and weight regain (WR) three years after different BS techniques. Methods: An ambispective study was conducted in 165 patients undergoing BS (41.1% sleeve gastrectomy [SG], 13.3% Roux-en-Y gastric bypass [RYGB], and 45.6% hypoabsorptive procedures [HA]). FA was assessed preoperatively using the Yale Food Addiction Scale 2.0. WL outcomes were evaluated at 1 and 3 years postoperatively. Mixed-effects models were used to assess longitudinal changes, adjusted for baseline weight, sex, type 2 diabetes (T2D), and height. Results: FA was present in 17.6% of patients. At 3 years, total WL was lower in FA patients compared to those without FA (−27.1% vs. −31.0%; p = 0.023), driven by greater WR from nadir (+8.3% vs. +1.7%; p = 0.03). The effect was particularly pronounced after RYGB and HA, but not after SG. Nevertheless, a substantial proportion of FA patients (58%) were no longer classified as having obesity at 3 years. The presence of FA was not associated with insufficient WL or lower T2D remission rates. Mixed models confirmed a significant interaction between FA and time, indicating a trend toward reduced WL over time in FA patients. Conclusions: Preoperative FA was not associated with a reduced likelihood of achieving satisfactory WL following BS. Our data does not support the use of preoperative FA as a decisive factor in guiding the choice of BS type. Although FA was associated with increased WR over time, clinically meaningful WL was achieved in most patients. Long-term multidisciplinary follow-up remains essential in this subgroup. Full article

This review examines the effectiveness of various surgical and endoscopic bariatric interventions in improving several components of metabolic dysfunction-associated steatotic liver disease (MASLD). Roux-en-Y gastric bypass (RYGB) consistently showed substantial long-term reductions in liver fat, inflammation, and fibrosis, achieving resolution of steatosis in up to 95% of cases. Vertical sleeve gastrectomy (VSG) provided comparable hepatic benefits, significantly reducing liver fibrosis and steatosis in approximately 60% of patients. Adjustable gastric banding (AGB) demonstrated meaningful though comparatively modest hepatic improvements, with steatosis resolution in about 42% of patients. More aggressive procedures like biliopancreatic diversion with duodenal switch (BPD-DS) showed profound metabolic effects, though with increased nutritional risk. Endoscopic therapies, including intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG), offered notable short- to medium-term hepatic improvements, significantly reducing steatosis and fibrosis markers. Newer therapies like duodenal mucosal resurfacing (DMR) and the duodenal-jejunal bypass liner showed promising preliminary results, warranting further investigation. Overall, surgical interventions remain superior for sustained liver health improvements, while endoscopic therapies present viable alternatives for patients requiring less invasive interventions. Full article

Objective: To evaluate the outcomes of a preliminary single-center experience with Robotic Roux-en-Y Gastric Bypass (R-RYGB) using the Hugo™ Robotic-assisted Surgery system, focusing on operative time, perioperative complications, and length of hospital stay. Methods: A retrospective review identified 19 consecutive patients who underwent R-RYGB with the Hugo™ system between January 2023 and January 2024. The baseline data collected were sex, age, and BMI. Key outcomes measured were operative time, docking time, length of hospital stay, conversions to open or laparoscopic surgery, reinterventions, readmissions, and intraoperative and early (<30 days) postoperative complications (bleeding, leak, and stenosis). Results: Nineteen patients underwent R-RYGB using the Hugo™ system. The mean age was 43.5 ± 10 years, and the mean BMI was 39.4 ± 2.9 kg/m². Among these patients, 11 were female (57.9%); 3 had diabetes mellitus (15.8%), 3 had obstructive sleep apnea syndrome (15.8%), and 7 had hypercholesterolemia (36.8%). The mean operative time was 177.8 ± 34.7 min, with a mean docking time of 12.5 ± 4.6 min. The mean length of hospital stay was 3.1 ± 0.2 days. There were no intraoperative complications, conversions, reinterventions, readmissions, or 30-day postoperative complications. All procedures were completed uneventfully. Conclusions: Our preliminary experience suggests that R-RYGB using the Hugo™ Robotic-assisted Surgery system is safe and feasible, with acceptable operative and docking times and no perioperative complications. Full article

Background: Roux-en-Y gastric bypass (RYGB) surgery results in weight reduction and decreased energy intake and can ameliorate type 2 diabetes. These beneficial effects are usually attributed to changes in hunger and satiety and relatively rapid improvements in glycemic control, but these effects may depend on dietary adherence. The aim of this study is to investigate the relatively early effects of RYGB surgery on weight reduction (by focusing on eating patterns) and glycemic control in rats subjected to a healthy maintenance diet or an unhealthy Western-style diet. Methods: Rats were fed a high-fat diet with added sucrose (HF/S) or a low-fat (LF) diet. Body weight, high-resolution tracking of meal-related parameters, and glucose regulation after overnight fasting and during a mixed meal tolerance test (MMTT; 2 mL sweet/condensed milk) were measured before and after RYGB (RYGB+) or sham surgery (RYGB−). Results: HF/S feeding led to an increased body weight just before RYGB surgery, but it also caused enhanced weight loss following RYGB, which led to similar body weights in the HF/S and LF diet groups twenty-four days post-operatively. RYGB surgery and diet dependently and independently influenced meal-related parameter outcomes, where both RYGB+ and HF/S feeding resulted in shorter meal duration (p < 0.01), higher ingestion rates (p < 0.001), and increased satiety ratio (p < 0.05), especially in the HF/S diet group subjected to RYGB. While RYGB surgery generally improved baseline glycemic parameters including HOMA-IR (p < 0.01), it often interacted with diet to affect MMTT-induced hyperglycemia (p < 0.05), beta-cell sensitivity (p < 0.01), and the insulinogenic index (p < 0.01), with the LF rats overall maintaining better glycemic control than the HF/S-fed rats. Conclusions: This study shows the importance of controlling diet after RYGB surgery, as diet type significantly influences ingestive behavior, post-prandial glucose regulation, beta-cell sensitivity, and glucose tolerance after RYGB. Full article

Background: The mechanisms of diabetes remission following bariatric surgery independent of calorie restriction and weight loss remain unclear. Objectives: To undertake a systematic review and meta-analysis to investigate mechanisms underpinning diabetes remission. Methods: We included individuals with type 2 diabetes who have undergone RYGB, SG, and a very low-calorie diet (VLCD). In total, 234 studies were identified (N = 52 for qualitative; N = 40 for quantitative synthesis). Review Manager v5.4 and IBM SPSS for Windows (v28.0.1.1) were used for analysis. Results: Crude annualised diabetes relapse rates for RYGB and SG are as follows: −6.98 ± 16.19 (p = 0.046) and −2.75 ± 4.94 (p = 0.08); crude remission rates for RYGB and SG, respectively, are as follows: 39.59 ± 45.93 (p = 0.000) and 33.36 ± 33.87 SG (p = 0.006). Differences in other metabolic outcomes (standardised mean difference and 95% confidence intervals (CIs)) are BMI: ([RYGB: −2.73, 95%CI: −3.14 to −2.32, p < 0.000001) (SG: −2.82, 95%CI: −5.04 to −0.60, p = 0.01)]; HbA1c: [(RYGB: −1.58, 95%CI: −2.16 to −1.00, p < 0.00001) (SG: −1.42, 95%CI: −1.69 to −1.15, p < 0.00001)]; insulin: [(RYGB: 0.16, 95%CI: −0.19 to −0.50, p = 0.37) (SG: −3.00, 95%CI: −3.17 to −2.82, p = 0.75)]; and fat mass [(RYGB: −2.56, 95%CI: −4.49 to −0.64, p = 0.009) (SG: −1.69, 95%CI: −4.58 to 1.21, p = 0.25)]. RYGB and SG produced a significant improvement in HOMA-B measurements. Adiponectin and the Matsuda index were significantly increased with RYGB. No difference was observed for other metabolic markers (RYGB: GLP-1, GIP, leptin, ghrelin, PYY) (SG: GLP-1 and FGF19) (VLCD: leptin, GLP-1, GIP, and ghrelin). Conclusions: Diabetes remission following RYGB and SG was primarily driven by improvement in beta-cell function, with improvement in insulin resistance markers also observed for RYGB, driven by reductions in fat mass. No other metabolic mechanism explaining diabetes remission was observed based on clinical studies. Full article

Background and Objectives: Bariatric surgery is the most effective method for achieving sustainable weight loss, improving quality of life, and resolving obesity-related comorbidities over the long term. However, data from long-term studies remain scarce and contradictory. Materials and Methods: This study is a retrospective analysis of prospectively collected data over a 7-year follow-up period involving 211 patients diagnosed with morbid obesity who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or mini gastric bypass (MGB) at Samsun University Training and Research Hospital, Department of General Surgery, between 1 January 2014 and 1 January 2018. Changes in weight, remission of associated comorbidities, postoperative complications, re-admission rates, and revision requirements were compared among the patients. Results: Of the 211 patients, 20.4% were male, and 79.6% were female. During the study period, 61.1% of patients underwent SG, 29.4% underwent MGB, and 9.5% underwent RYGB. There was no statistically significant difference among the three surgical techniques in terms of weight change parameters, comorbidity remission, postoperative complications, and readmission rates. However, revision rates were significantly higher among patients who underwent SG (p < 0.05). Conclusions: SG, MGB, and RYGB techniques are comparable and reliable methods in terms of long-term weight loss, surgical outcomes, and complications. After a 7-year follow-up period, all three techniques were found to be similar in terms of HT, T2DM, and GERD remission; however, SG was observed to have a higher revision requirement compared to the other surgical techniques. Full article

Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can lead to severe complications such as anemia, osteoporosis, and neurological disorders. This narrative review examines the prevalence and clinical implications of micronutrient deficiencies in BS patients, as well as evidence-based strategies for their prevention and management. The most common deficiencies include iron, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, E, and K). Procedures with a hypoabsorptive component, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), pose higher risks of deficiencies compared to restrictive procedures like sleeve gastrectomy (SG). Effective strategies involve the preoperative correction of deficiencies, continuous monitoring, and tailored supplementation. However, long-term adherence to supplementation tends to decrease over time, influenced by behavioral and socioeconomic factors. Hence, preventing and managing micronutrient deficiencies are crucial for the long-term success of BS. While current guidelines provide valuable recommendations, many are based on low-certainty evidence, underscoring the need for more robust studies. A multidisciplinary approach, combined with innovative strategies, such as telemedicine, can enhance adherence and achieve sustainable clinical outcomes. Full article

Background and Objectives: Type 2 diabetes (T2D), closely associated with obesity, contributes to increased morbidity and mortality due to complications such as cardiometabolic disease. This review aims to evaluate the effectiveness of metabolic and bariatric surgeries (MBS) and endoscopic bariatric therapies (EBTs) in achieving diabetes remission and to examine key predictors influencing remission outcomes. Materials and Methods: This review synthesizes data from studies on MBS and EBT outcomes, focusing on predictors for diabetes remission such as preoperative insulin use, diabetes duration, HbA1c, and C-peptide levels. Additionally, predictive scoring systems, including the Individualized Metabolic Surgery (IMS), DiaRem, Advanced-DiaRem, ABCD, and Robert et al. scores, were analyzed for their utility in forecasting remission likelihood. Results: Key predictors of T2D remission include shorter diabetes duration, lower HbA1c, and higher C-peptide levels, while prolonged insulin use, and higher insulin doses are associated with lower remission rates. Scoring models like IMS and DiaRem demonstrate that lower scores correlate with a higher likelihood of remission, especially for procedures such as Roux-En-Y gastric bypass (RYGB). RYGB generally shows higher remission rates compared to sleeve gastrectomy (SG), particularly among patients with mild disease severity, while EBTs like ESG and IGBs contribute 5–20% total weight loss (TWL) and moderate glycemic control improvements. Conclusions: Both MBS and EBTs are effective for T2D management, with predictive scoring models aiding in individualized patient selection to optimize remission outcomes. Further research to validate these predictive tools across diverse populations could enhance treatment planning for both surgical and endoscopic interventions. Full article

Background/Objectives: Performing endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered gastrointestinal anatomy remains challenging, frequently necessitating the use of forward-viewing endoscopes. Given the challenge in endoscope selection based on the type of altered anatomy, the aim of this study was to examine ERCP success rates by specific endoscopes for different anatomy types. Methods: This single-center retrospective study examined ERCPs performed in patients with surgically altered gastrointestinal anatomy during an 18-year period. Enteroscopy success, cannulation success, and intervention success rates were compared between the different anatomy and endoscope types. Results: This study included a total of 334 adult patients (665 total ERCPs) with altered anatomy. The pediatric colonoscope was most frequently utilized (32.2%), and the majority of procedures were performed for biliary indications. Enteroscopy success was 82.2% in Roux-en-Y gastric bypass (RYGB), 97% in Billroth II, 91.5% in Whipple, and 93.2% in Roux-en-Y hepaticojejunostomy (RYHJ). Cannulation success was 90.5% in RYGB, 90.5% in Billroth II, 83.6% in Whipple, and 90.6% in RYHJ. Intervention success was 88.2% in Billroth II, 65.1% in RYGB, 81.6% in Whipple, and 87.5% in RYHJ. In patients with RYGB and RYHJ, SBE was utilized most frequently, with rotational enteroscopy having the highest success rates. The overall adverse event rate was 5.1%, with the majority of these being mild in severity. Conclusions: This large retrospective study found ERCP with forward-viewing endoscopes to be safe and effective for a variety of surgically altered anatomy types. Despite recent advances seen with endoscopic ultrasound-guided drainage procedures, this study advocates for ERCP as the initial approach for pancreaticobiliary access in surgically altered anatomy. Full article