Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including endoscopic gastric pouch plications as a revision procedure, combining JJD1 and GJ-P for RYGB revision, revisional ESG and tirzepatide beat semaglutide in SG patients with weight recidivism, semaglutide could also help people cut down on their alcohol intake and the impact of AI in BMS, and more (please note, log-in maybe required to access the full paper).
Indications and Outcomes of Endoscopic Gastric Pouch Plications After Bariatric Surgery: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database
Endoscopic gastric pouch plications (EGPP) appears to be a relatively safe alternative to surgical revision. However, further research is needed to assess its efficacy and compare it to corresponding surgical revisions, researchers from Case Western Reserve University, Cleveland, OH, have reported.
Writing in Obesity Surgery, their study aims to evaluate the 30-day rate of serious complications and mortality associated with EGPP using the MBSAQIP database. The primary outcomes were 30-day serious complications and mortality.
The study included 1,474 patients with recurrent weight gain the most common indication for EGPP (71.9%), followed by suboptimal initial weight loss (15.1%), dumping syndrome (5.5%), reflux (4.1%), gastrointestinal tract fistula (1.0%) and others (0.9%).
Postoperative complications included 30-day readmissions (3.1%), serious complications (3.3%), 30-day interventions (2.5%), bleeding (0.8%) and reoperations (0.4%), with 0% mortality rate. Multivariable analysis identified GERD as an independent predictor of serious complications (p=0.05) when adjusting for various factors.
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Addressing recurrent weight gain after Roux-en-Y gastric bypass: Efficacy of a dual surgical approach – Short term results of a single center cohort study
Combining jejuno-jejunostomy distalization type 1 (JJD1) and sleeve resection of the gastrojejunostomy and gastric pouch (GJ-P) for RYGB revision is safe and effective, with substantial improvement in weight loss at one year, according to researchers from Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY.
Patients with recurrent weight gain after RYGB that underwent JJD1 with sleeve resection of the GJ-P from 2020 to 2022 were included and studied for one year postoperatively. During the procedure, the total alimentary limb length (TALL) was 350-500cm, a new common channel (CC) 200-350 cm and gastrojejunostomy <2 cm in diameter.
A total of 61 patients underwent this combined revisional procedure, the median new CC was 270cm and the median TALL was 400cm. The median total small bowel length (TSBL) was 580cm and the median BPL/TSBL ratio was 0.32. At one year, the total weight loss (%TWL) was 22.18%. Only three (n=3) patients developed major complications at one-year. After distalisation, the resolution of all obesity-related comorbidities improved, including type 2 diabetes (3.2%), sleep apnoea (13.1%), hypertension (11.4%) and hyperlipidaemia (1.6%).
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Revisional endoscopic sleeve gastroplasty versus semaglutide and tirzepatide for weight recidivism after sleeve gastrectomy
Researchers from the University of California Los Angeles, Los Angeles, CA, have reported revisional endoscopic sleeve gastroplasty (R-ESG) and tirzepatide appear to offer more weight loss than semaglutide in SG patients with weight recidivism although glucose-dependent insulinotropic peptide receptor agonists (GLP1/GIP-RA) were underdosed.
Writing in Obesity Reviews, this retrospective study of 90 patients ≥18 years with prior SG treated with semaglutide, tirzepatide or R-ESG for weight recidivism between January 2019 and 2023 at large academic centre.
In total, 68 patients had prior SG + GLP1/GIP-RA and 22 prior SG + R-ESG. R-ESG resulted in higher TBWL% than GLP1/GIP-RA at 3 (11.2% vs. 4.3%, p<0.001), 6 (13.5% vs. 6.8%, p<0.001) and 12 months (13.4% vs. 9.2%, p=0.07) with no significant difference in AEs or change in metabolic parameters.
Subgroup analysis revealed tirzepatide achieved similar 12-months TBWL% as R-ESG (13.2% vs. 13.4%, p=0.9) and significantly more than semaglutide (13.2% vs. 8.1%, p=0.04). Compared to patients with intact stomach (n = 87), GLP1/GIP-RA achieved significantly lower TBWL% in patients with prior SG at 3 (4.3% vs. 5.7%, p=0.02), 6 (6.8% vs. 9.2%, p=0.02) and 12 months (9.2% vs. 12.7%, p=0.03). Medication refills were difficult in 41.3% of patients.
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Once-Weekly Semaglutide in Adults With Alcohol Use Disorder - A Randomized Clinical Trial
Semaglutide could also help people cut down on their alcohol intake, according to the findings from the ‘Human Laboratory Screening of Semaglutide for Alcohol Use Disorder’ randomised clinical trial.
Investigators from the University of Southern California’s (USC) Institute for Addiction Research, writing in JAMA Psychiatry, sought to evaluate the effects of once-weekly subcutaneous semaglutide on alcohol consumption and craving in adults with alcohol use disorder (AUD).
Although semaglutide treatment did not affect average drinks per calendar day or number of drinking days, but significantly reduced drinks per drinking day (p=0.04) and weekly alcohol craving (p=0.01), also predicting greater reductions in heavy drinking over time relative to placebo (p=0.04). A significant treatment-by-time interaction indicated that semaglutide treatment predicted greater relative reductions in cigarettes per day in a subsample of individuals with current cigarette use (p=0.005).
The results, measured by grams of alcohol consumed and breath alcohol concentration, indicated that semaglutide injections reduced weekly alcohol craving, reduced average drinks on drinking days, and led to greater reductions in heavy drinking days, relative to the placebo.
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Impact of Artificial Intelligence on Metabolic Bariatric Surgery (MBS) and Minimally Invasive Surgery (MIS): A Literature Review
The integration artificial intelligence (AI) in BMS and MIS has the potential to revolutionise surgical outcomes, enhance precision and improve efficiency, according to researchers at Majmaah University, Al Majma’ah, Saudi Arabia, however, addressing interoperability, data security and regulatory barriers will be crucial for widespread adoption.
Their literature review explored AI’s applications, advantages, challenges and future potential in these fields and included 30 studies, including randomised controlled trials, observational studies, literature reviews and meta-analyses, was conducted to examine AI’s impact on surgical precision, workflow efficiency, complications and patient outcomes were synthesised.
They found AI-enabled techniques significantly improved surgical precision, reduced complication rates and optimised workflows. AI applications in preoperative planning, intraoperative assistance and postoperative monitoring demonstrated consistent advantages. However, the authors noted that ethical concerns, data privacy and standardisation issues persist.
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