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Meeting report

New Technologies and Expert Meeting (Part 3)

Adjacent fields

Introduction (and welcome address): Time for us to change!

Although the need for innovation remains a mantra in bariatrics, we felt that a different type of organization was requested starting effectively this year 2015, for several reasons:

  • Some trends are moving so fast that sometimes "wait and see" seems the appropriate action, sometimes we have to confirm data that look brilliant and advise caution.
  • New technologies can be divided into three groups: the current surgical techniques and their improvements; the endoscopic field; the adjacent fields (biology, smartsensing, etc.). Each of  them is equally important, since we do not know from where the light will come in the near future. The surgical field is pretty much covered by more traditional meetings, even if a focus on them is necessary every now and then; the endoscopic field is also covered since the initiative of the Spanish leader Gontrand Lopez-Nava; innovations from "outside" require finesse and expertise to be sorted out.

Finally, we broke a deal with our friend Karl Miller who has organizes for a long time the very successful Austrian expert meeting. We agreed to host each other every other year, so that both our meetings represent innovation and state of the art expertise in the same time. This way we shall ensure more industry support, and a long-term capacity to deliver news in a friendly atmosphere and contribute to highlight this more than ever thrilling field... Long live to the International "New Technologies and Expert Meeting"!

Bariatric surgery and telemedicine : Philippe COSTIL and Jean-Marie MOLASOKO (France) have presented the TEO-project, a software platform that coordinates the pre-surgical assessment and the post-operative follow-up in the Paris area in France. Tele-consultations, tele-expertises -between physicians), and tele-monitoring are being developed.

Smartsensing technologies and bariatric short and long-term surveillance : solution with a platform : Frédéric DURAND-SALMON (Bepatient, UK) and Olivier MENAGE (Covidien, Europe)

BEPATIENT Company integrates a comprehensive range of wireless devices into an eHealth platform, to provide effective and valuable remote monitoring services. The following steps are taken into account: patient screening, patient social network, patient education, follow-up, multidisciplinary meetings, care coordination, collecting patient feedback, and data generated on a day-to-day basis. It has a partnership with COVIDIEN to provide the platform to bariatric centers. Likewise, ETHICON ENDOSURGERY has developed a similar project, called "Newlife": connected items are included such as scales, bracelets, watches, etc.

Smartsensing technologies and bariatric short and long-term surveillance: solution with connected clothes : Alain JUTANT (Cityzensciences, France)

Wearable technologies have been introduced by Alain JUTANT (France). The IOT (Internet on Things) market is already estimated a 10 Billion dollars industry, with a 100% increase every year. Many wearable tools exist, that are often too complex and not convenient to use at home. CitizensciencesTM has made an active garment extracting information with a continuous monitoring. Embedded sensors transmit information to a data collecting box and then to a smartphone. The clothes are washable 200 times, they are made of a stretchable textile that is comfortable to wear, most often as an underwear. They contain: an inertial measurement unit, a three axis accelerometer, a 40 Hz GPS, a barometer, a gyroscope. The intention is to get reliable surveillance of post-operative parameters on a short-term basis (cardiac frequency), as well as long-term parameters during physical exercise or daily life activities.

The concept of "second skin" after bariatric surgery, cosmetic management of weight-loss : Patrick BUENOS (France)

The ROSA network in Beziers (France) is a regional collaborative platform in the south of France. It is a matter of debate whether or not bariatric patients should wear compressive garments post-operatively, and if this can minimize the aesthetic consequences of an important weight loss. A whole body compression garment has been made for bariatric candidates, and has an immediate application post-operatively. It includes 3 pieces: sleeve, shorty and thighs. It has to be worn 10 hours a day for 2 years. It allows progressive compression while weight-loss is continuing, therefore achieving a better cosmetic result, and self-image improvement over the time.

Specific food intolerance after bariatric surgery, consequences in terms of patient selection and post-operative follow-up: Katia LURBE PUERTO (France)

Katia LURBE is a sociologist who works in a multi-disciplinary team in Paris, and has presented a study on "New food aversions after bariatric surgery". It can be difficult for patients to make the difference between food intolerance and food aversion, albeit food intolerance can transform itself into aversion because of a negative experience. Taste changes are commonly observed after a bariatric operation. 155 items have been tested in 44 patients, 75% F; 55% had a gastric bypass, 45% a sleeve gastrectomy. Mean age was 44 years. Five main aversions have been identified: "strong flavours", mineral water, sugar food, fried food and fatty food. Aversion for strong flavours and fried food diminished after 6 months, whereas aversion for fatty food increased after 6 months. Some aversions disappear (sea food, fish, veal), some remain unchanged (ham, yoghourt, butter). This study differed from previous international reports, aversions for red meat and poultry being often singled out.

Safety and efficacy of a ketogenic feeding tube diet in the treatment of obesity : Oliver DI PIETRO (USA)

According to the US Department of Health and Human Services, 35.7% of adults and 17% of children in the USA are currently obese. With no American state having an obesity prevalence of <20% and thirteen states having a prevalence rate >= 30%, surgical interventions such as gastric restrictive or diversion bariatric operations are becoming increasingly necessary. Non-surgical therapies like very low calorie diets (VLCD) and low calorie diets (LCD) are limited in potency of nutritional ketosis because carbohydrate-free formulas are not palatable to the patient. The current study therefore sought to evaluate a physician-supervised, outpatient, 10-day ketogenic feeding tube diet as an option for overweight or obese patients using a carbohydrate-free mixture of protein, fats and micronutrients. Methods: This is a retrospective clinic chart review (n=218) of patients who underwent a medically supervised weight loss program using a feeding tube to induce and maintain a state of nutritional ketosis. After medical evaluation, a pediatric feeding tube was inserted through the nose under local anesthesia and a carbohydrate-free ketogenic mixture delivering approximately 600 to 800 kcal/day was administered continuously. Over a 24-month period, 218 patients were treated, and 177 were identified as having verifiable initial and final weights, serial blood chemistries, urinary ketone levels, and fat free mass (FFM) as measured by DEXA. Results: The mean age of patients was 44.7 years (range 20-70 years), 83.1% were female, 65% were Caucasian. The mean BMI was 31.8 kg/m² (SD=5.0); the mean duration of treatment was 8.7 days (range 2-13 days). There was a significant increase in urinary ketones (p<0.001). There was a significant reduction in total body weight of 4.9 kg (SD=2.0, p<0.001) and BMI of 1.95 kg/m² (SD=0.68, p<0.001). The procedure was tolerated well with little or no discomfort by 72.9%; 15.8% removed the feeding tube early due to discomfort or personal reasons; 3.4% did not tolerate the treatment and 6.8% had their feeding tube reinserted during the treatment. There were no serious complications. Conclusion: The ketogenic feeding tube diet induced nutritional ketosis and led to a clinically significant weight loss in the 10-day program. This approach may play a role in the treatment of obesity to initiate weight loss in lifestyle or medication programs, to break through weight loss plateaus, or for preoperative weight loss prior to bariatric surgery. It may also be a useful medical strategy for patients who do not qualify for or refuse bariatric surgery, but are significantly overweight and in need of medical intervention after failing lifestyle modifications.

Optimization of supplementation after bariatric surgery, a randomized controlled trial : Edo AARTS (The Netherlands). An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies on the long-term.

Vitamin and mineral deficiencies are common after Roux-en-Y gastric bypass. An optimal multivitamin supplement (WLS Forte®, FitForMe, Rotterdam, the Netherlands) was developed which was able to reduce the number of iron and vitamin B12 deficiencies after one year. The present study builds on the initial study and evaluates the long-term effectiveness and safety of WLS Forte® after RYGB. A single center prospective trial was conducted comparing WLS Forte®, a standard multivitamin supplement (sMVS), and a group of non-users. A sMVS was defined as an over-the-counter available MVS. In total 137 patients visited the outpatient department for blood withdrawals; 64 (47%) were using WLS Forte®, 45 (33%) a sMVS, and 28 (20%) did not take any kind of MVS. Baseline characteristics were comparable between groups. Serum ferritin levels were different between WLS Forte users and sMVS users, 116 ± 117 μg/L vs. 75 ± 85 μg/L. Significant more patients were diagnosed with an anemia (16% vs 3% [p=0.021]), ferritin (14% vs. 3% [p=0.043]), and zinc (8% vs. 0% [p=0.033]) deficiency in the sMVS group compared to WLS Forte®. Additional, a non-significant difference was found regarding vitamin B12 deficiencies (0% for WLS Forte® vs. 7% for sMVS [p=0.076]). No adverse event occurred which were related to supplement use. Conclusion: On the long-term WLS Forte® is safe and reduces anemia, ferritin, and zinc deficiencies after RYGB. There was an trend towards less vitamin B12 deficiencies when taking WLS Forte® compared to a sMVS.

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