Search Results (39)

In the last two decades, metabolic and bariatric surgery (MBS) has become the mainstay of treatment for severe and complex obesity. The majority of patients undergoing MBS are women of childbearing age. Coupled with the dramatic increase in the utilization of MBS, caregivers are likely to encounter patients who have undergone MBS in routine practice. From this perspective, we highlight the different reproductive health challenges and issues encountered throughout the pre-operative, peri-operative, and postoperative phases. Full article

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

Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity, though individual responses vary widely, partly due to genetic predisposition. This study investigates the association of a body mass index (BMI) polygenic score (PGS) with weight loss and metabolic outcomes following surgery. A cohort of 225 patients undergoing MBS was analyzed at baseline (T₀), six (T₆), and twelve (T₁₂) months, with anthropometric and biochemical parameters recorded at each time point. Total weight loss (TWL) and excess weight loss (EWL) percentages were calculated. PGS was computed using the LDpred-grid Bayesian method. The mean age was 45.9 ± 9.4 years. Males had a higher baseline prevalence of type 2 diabetes (T2D) and comorbidities (p < 0.001). Linear regression analysis confirmed an association between PGS and baseline BMI (p = 0.012). Moreover, mediation analysis revealed that baseline BMI mediated the effect of the PGS on %TWL at T₁₂, with an indirect effect (p-value = 0.018). In contrast, high-density lipoprotein-cholesterol (HDL-C) at T₆ and triglycerides (TG) at T₁₂ showed direct associations with the PGS (p-value = 0.004 and p-value = 0.08, respectively), with no significant mediation by BMI. This study showed a BMI-mediated association of PGS with %TWL and a direct association with lipid changes, suggesting its potential integration into personalized obesity treatment. Full article

Metabolomics has emerged as a vital tool for understanding the body’s responses to therapeutic interventions. Metabolic bariatric surgery (MBS) is widely recognized as the most effective treatment modality for severe obesity and its associated comorbidities. This review seeks to analyze the current evidence on the metabolomic profiles of patients with obesity and the impact of various bariatric surgical procedures, with the objective of predicting clinical outcomes, including weight loss and remission of type 2 diabetes (T2D). The data gathered from original studies examining metabolomic changes following MBS have been meticulously compiled and summarized. The findings revealed significant alterations in metabolites across various classes, including amino acids, lipids, energy-related compounds, and substances derived from the gut microbiota. Notably, elevated preoperative levels of specific lipids, such as phospholipids, long-chain fatty acids, and bile acids, were correlated with postoperative remission of T2D. In conclusion, metabolite profiling holds great promise for predicting long-term responses to different bariatric surgery procedures. This innovative approach has the potential to facilitate personalized treatment strategies and optimize the allocation of healthcare resources. Full article

Background: Single-Anastomosis Duodenoileostomy with Sleeve Gastrectomy (SADI-S) has been reported as both a safe and effective surgical procedure. However, these findings have not been directly compared to those of more established and less complex procedures, such as Sleeve Gastrectomy (SG), which remains the most commonly performed technique in Metabolic and Bariatric Surgery (MBS). Objective: This study aimed to assess and contrast the intraoperative and postoperative outcomes between patients who underwent SADI-S and those who underwent SG. Methods: A systematic review and meta-analysis were performed and registered under PROSPERO with the ID CRD42024532504. A comprehensive search strategy was executed on 15 April 2024, covering PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct from the first reports to March 2024. The search strategy incorporated relevant keywords, including: “SADI-S” OR “Single Anastomosis Duodenal-Ileal bypass” and “Sleeve Gastrectomy”. We included studies comparing adult patients (≥18 years old) undergoing SADI-S and SG, reporting at least one clinical outcome of interest. Results: Five studies published between 2019 and 2023, comprising 3593 patients, were included. Of these, 461 patients (12.8%) underwent SADI-S, while 3132 (87.2%) underwent SG. The mean patient age was 42.96 years, with 89.6% female participants. Patients undergoing SADI-S had a significantly higher Body Mass Index (BMI) than those undergoing SG (Mean: 49.73 ± 8.10 vs. 45.64 ± 7.84; Mean Difference [MD]: 3.83, 95% CI: 0.52–7.14; p = 0.02) and an increased risk of hypertension (OR: 1.38, 95% CI: 1.04–1.84; p = 0.03). SADI-S also resulted in longer operative times (125.63 ± 51.91 min vs. 49.67 ± 26.07 min; MD: 65.97 min, 95% CI: 61.71–70.25; p < 0.001) and length of hospital stay (2.30 ± 2.76 days vs. 1.21 ± 0.81 days; MD: 1.03 days, 95% CI: 0.70–1.37; p < 0.001). Moreover, patients who underwent SADI-S demonstrated a significantly higher risk of postoperative complications, such as readmissions and reinterventions (OR: 3.17, 95% CI: 2.15–4.67; p < 0.001), and experienced greater excess weight loss (MD: 12.42%, 95% CI: 0.92–23.92; p = 0.03). No significant differences were observed between the groups regarding age, sex, or the prevalence of obstructive sleep apnea (OSA). Conclusions: SADI-S appears to be a promising surgical technique for facilitating substantial weight loss in individuals with severe obesity. Given the higher risk of postoperative complications associated with SADI-S, careful evaluation and personalized decision-making for patient selection and education are essential to optimize clinical and safety 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

Introduction: Obesity is a chronic disease associated with increased risk for several cancers, including colorectal cancer (CRC), a leading cause of cancer-related mortality. The majority of CRC cases are associated with modifiable risk factors. Metabolic and bariatric surgery (MBS) is a proven, durable, and successful intervention for obesity. This study aimed to evaluate the impact of MBS on CRC risk through measures of association, such as relative risk (RR) and odds ratio (OR). Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted to identify systematic reviews (SR) and meta-analyses examining the relationship between obesity treated with MBS and CRC incidence. The PICO framework guided inclusion criteria, and three independent reviewers screened articles using Rayyan software. Quality assessment was performed using AMSTAR2. Results: Of 1336 screened articles, 10 SR met inclusion criteria, encompassing 53,452,658 patients. Meta-analyses consistently showed a significant reduction in CRC risk following MBS in patients with severe obesity. Risk reductions were reported by Liu et al. (RR: 0.46, 95% CI: 0.32–0.67, p < 0.01), Chierici et al. (RR: 0.46, 95% CI: 0.28–0.75, p = 0.018), Wilson et al. (RR: 0.69, 95% CI: 0.53–0.88, p = 0.003), and Pararas et al. (RR: 0.56, 95% CI: 0.40–0.80, p < 0.001). Sensitivity analyses supported these findings. For colon cancer, Liu and Chierici both reported an RR of 0.75 (95% CI: 0.46–1.21, p = 0.2444) with significant heterogeneity (I² = 89%). A trend towards reduced rectal cancer risk (RR: 0.74, 95% CI: 0.40–1.39, p = 0.3523) was noted but limited by fewer studies. Sex-specific analyses revealed protective effects in both sexes, with a more pronounced impact in females (RR: 0.54, 95% CI: 0.37–0.79, p = 0.0014). Conclusions: This umbrella review synthesizes current evidence on the impact of MBS on CRC risk, highlighting a consistent protective association. The findings also indicate a potential risk reduction for both colon and rectal cancer, with a more pronounced effect observed among females compared to males. Given the profound implications of MBS on cancer incidence, morbidity, and mortality, further high-quality, long-term studies are essential to deepen our understanding and optimize its role in cancer prevention and patient care. Full article

Background: Metabolic and bariatric surgery (MBS) is a well-established treatment for severe obesity, yet its effects in patients with inflammatory bowel disease (IBD) are not well understood. MBS in this population presents unique challenges, including the potential for exacerbating inflammatory disease activity and causing complications such as malnutrition and medication malabsorption. This study aims to assess the long-term outcomes of MBS in IBD patients, focusing on both metabolic outcomes and its impact on the course of IBD. Methods: A retrospective analysis was conducted on 20 patients with IBD who underwent MBS at a tertiary center between 2005 and 2019. Data on baseline characteristics, surgical procedures, complications, weight loss, resolution of obesity-related diseases, and IBD-related outcomes were collected. Results: The cohort, primarily female (65%), had a mean preoperative body mass index (BMI) of 40.8 kg/m². The MBS procedures performed were sleeve gastrectomy (n = 9), Roux-en-Y gastric bypass (n = 6), one-anastomosis gastric bypass (n = 2), and Laparoscopic Adjustable Gastric Banding (n = 3). No major 30-day complications were recorded. At a median follow-up of 91 months, the mean BMI decreased by 9.5 kg/m², with satisfactory outcomes in terms of resolution of obesity-related diseases. IBD activity scores increased postoperatively, particularly in Crohn’s disease (CD) patients, although these changes were not statistically significant. In addition, 30% of patients were hospitalized due to IBD exacerbation, and 15% required surgical intervention for IBD. Conclusions: MBS is an effective treatment for severe obesity and its related diseases in IBD patients. While encountering no major complications or mortality, some long-term complications were observed, with a possible increase in IBD activity, particularly in CD patients. Ongoing challenges, such as the risk of malnutrition, medication malabsorption, and postoperative IBD exacerbations, necessitate careful long-term follow-up. Full article

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients’ management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits. Full article

Background and Objectives: Religious fasting in patients after Metabolic and Bariatric Surgery (MBS) remains a topic with limited clarity. This study aims to present the results of a survey on religious fasting in patients after MBS in Israel. The questionnaire was sent to members of the Israeli Society for Metabolic and Bariatric Surgery (ISMBS). Materials and Methods: An online questionnaire survey was designed and distributed to members of the ISMBS. The survey consisted of 23 questions addressing religious fasting in patients after MBS and was divided into three sections: (1) MBS surgeon clinical experience, (2) clinical considerations regarding religious fasting in MBS patients, and (3) fasting-related complications in MBS patients. Responses were recorded and presented as numbers (percentages), with results analyzed descriptively and/or graphically. Results: The ISMBS has 63 active members, and 37 members (59%) responded to the survey. Most respondents have more than 10 years of MBS experience and perform more than 100 MBS procedures annually (67.5% and 54%, respectively). In general, 81.1% of respondents permit religious fasting in patients after MBS, and 73% think that fasting could be safe at least 12 months after MBS. Most (62.2%) agree that a clinical evaluation should be undertaken prior to permitting religious fasting; 40% of respondents note that there is increased patient admission to emergency rooms during religious fasting, mostly due to dehydration. When asked about fasting risks, most noted hypoglycemia (40.5%) and the evolution of marginal ulcers (16.2%). Conclusions: In conclusion, these national survey results emphasize the variations in MBS surgeons’ opinions regarding religious fasting after MBS. Despite these differences, there were still many similarities in responses such as timing and fasting permission, and this study could aid clinicians in the future when consulted on religious fasting by MBS patients. Full article

Before metabolic and bariatric surgery (MBS), moderate weight loss and liver left lateral section (LLLS) volume reduction are desirable. Low-carb ketogenic diet-induced weight loss before MBS has been shown to have beneficial effects on the reduction in body weight (BW) and LLLS. However, the nutritional protocol of low-carb ketogenic diet may be hard to keep for prolonged periods due to the lack of sweet taste. Furthermore, transitioning to a low-carb ketogenic diet can cause people to crave foods that are restricted in the ketogenic diet, such as cookies, bread, pasta, and bagels. Therefore, many ready-to-eat low-carb ketogenic products (RLCKP) that mimic carbohydrate-rich foods despite a low-carb composition have been provided to make it easier for the patients to adopt a low-carb lifestyle. To date, there are no studies describing the dietary protocol for efficient and safe use of pre-operative RLCKP in terms of weight and LLLS volume reduction in patients with obesity scheduled for MBS. Therefore, the aim of this study was to assess the safety and effectiveness of a 4-week diet using RLCKP in reducing BW and LLLS volume in patients with obesity scheduled for MBS. Patients with obesity (n = 42) with a mean body mass index (BMI) of 42.4 ± 9.2 kg/m² scheduled for MBS underwent a 4-week preoperative RLCKP diet intervention. Their weight, LLLS volume, and biochemical and metabolic parameters were measured before and after the diet. Patient compliance was assessed by the presence of ketonuria and weight loss. Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects. All patients completed the study. We observed highly significant decreases in BW (−6.5%, p < 0.001), and LLLS volume (−22.3%, p < 0.001) and an amelioration of patient clinical status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effects were reported. Based on our findings, we were able to support the hypothesis that a 4-week preoperative RLCKP diet is safe and effective in reducing BW, and LLLS volume in patients with obesity scheduled for MBS. Full article

Background and Objectives: Metabolic and bariatric surgery (MBS) is practiced worldwide. Sugammadex was proven to have multiple benefits in reversing neuromuscular blockade (NMB) for patients with obesity undergoing MBS, but its effects on complications of various systems are not clear and concrete. Materials and Methods: This systematic review and meta-analysis was conducted as per the PRISMA guidelines and registered on the PROSPERO database (CRD42023491171). A systematic search was conducted in multiple databases for studies comparing sugammadex with neostigmine in MBS. Continuous data are reported as mean differences (MDs) and 95% confidence intervals (CIs). Dichotomous data are reported as relative risks (RRs) and 95% CIs. A two-sided p < 0.05 was considered statistically significant. Trial sequential analysis (TSA) was performed to evaluate the reliability of the conclusions. Results: Nine studies with 633 patients met the inclusion criteria. Compared with those from the neostigmine group, patients from the sugammadex group were characterized by a significantly shorter recovery time from the administration of the study drug to a train-of-four (TOF) ratio of ≥90% (MD [95% CI]: −15.40 [−26.64; −4.15]; I² = 96.6%; p = 0.0073; n = 380; random effects model), a lower risk of postoperative residual curarization (PORC) (RR [95% CI]: 0.18 [0.09; 0.38]; p < 0.0001; I² = 27.9%; n = 344; common effect model), postoperative nausea and vomiting (PONV) (RR [95% CI]: 0.67 [0.48; 0.93]; p = 0.0164; I² = 0%; n = 335; common effect model), and cardiovascular complications (RR [95% CI]: 0.48 [0.26; 0.88]; p = 0.0186; I² = 14.7%; n = 178; common effect model). TSA confirmed the conclusions regarding the recovery time and PORC risk. Conclusions: In conclusion, our systemic review and meta-analysis with TSA revealed that sugammadex provided a faster and more reliable choice to reverse NMB in patients with obesity undergoing MBS, with a lower risk of PORC. Sugammadex reduced the risk of cardiovascular complications and postoperative nausea and vomiting. However, the conclusions were not confirmed, and, so, further studies may be necessary. Full article

Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m² at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p < 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types. Full article

Iron is an essential nutrient in living organisms with multiple vital functions. Iron deficiency (ID) can cause long term health consequences beyond iron deficiency anemia (IDA). The high prevalence of ID and its long-term effects in patients with obesity and after metabolic and bariatric surgery (MBS) is recognized. Nevertheless, there is limited knowledge of the optimal route or dose for treatment of patients with obesity and post-MBS, and an evidence-based universal guideline for prevention and treatment of ID in short- and long-term post-MBS (PMBS) is not yet available. ID in the general population is currently treated with oral or parenteral iron, where oral iron treatment is considered the preferred option with parenteral iron as a second-line treatment in case there is intolerance or lack of response to oral iron. In patients with obesity with chronic low-grade inflammation and PMBS patients with altered gut anatomy and function, there are also alterations in the bioavailability and higher risks of side effects of available oral irons. The conclusions of current studies exploring effective treatment of iron deficiency in this population have been inconsistent and further well-planned randomized and prospective studies are needed. This is a narrative review of the literature on the available treatment options and strategies for treatment of ID in PMBS patients to recognize the knowledge gaps and provides topics of future research. Full article

Diets geared to reduce cancer risk in overweight and obese individuals focus on (1) caloric restriction (every day, some days, or most hours of each day); (2) changes in macronutrient intake; or (3) a combination of the prior two strategies. Diets generally fail because of nonadherence or due to limited sustained weight loss. This is in contrast to a diet supplemented with a weight loss medication, so long as the participant continues the medication or after bariatric surgery, in which adherence tends to be much higher. Among individuals who regain weight after surgery, weight loss medications are proving beneficial in maintaining weight loss. Both maximum and sustained weight loss are essential for all forms of effective metabolic improvement, including cancer risk reduction. The focus of this report is to assess the state of research on the consequence of pharmacotherapy use on weight loss and proposed weight loss-independent effects on subsequent cancer risk reduction, including the potential role of medication use in conjunction with metabolic (bariatric) surgery (MBS). Finally, we present Notices of Funding Opportunities (NOFOs) by the National Cancer Institute (NCI) to better understand the mechanism(s) that are driving the efficacy of pharmacotherapy in cancer risk reduction. Full article