Gastric cancer and Roux-en-Y gastric bypass.

Incidence of gastric cancer after Roux-en-Y gastric bypass

Biliary pancreatic diversion and laparoscopic adjustable gastric banding in morbid obesity: their long-term effects on metabolic syndrome and on cardiovascular parameters

<p>Abstract</p> <p>Background</p> <p>Bariatric surgery is able to improve glucose and lipid metabolism, and cardiovascular function in morbid obesity. Aim of this study was to compare the long-term effects of malabsorptive (biliary pancreatic diversion, BPD), and restrictive (laparoscopic gastric banding, LAGB) procedures on metabolic and cardiovascular parameters, as well as on metabolic syndrome in morbidly obese patients.</p> <p>Methods</p> <p>170 patients studied between 1989 and 2001 were called back after a mean period of 65 months. 138 patients undergoing BPD (n = 23) or LAGB (n = 78), and control patients (refusing surgery and treated with diet, n = 37) were analysed for body mass index (BMI), blood glucose, cholesterol, and triglycerides, blood pressure, heart rate, and ECG indexes (QTc, Cornell voltage-duration product, and rate-pressure-product).</p> <p>Results</p> <p>After a mean 65 months period, surgery was more effective than diet on all items under evaluation; diabetes, hypertension, and metabolic syndrome disappeared more in surgery than in control patients, and new cases appeared only in controls. BPD was more effective than LAGB on BMI, on almost all cardiovascular parameters, and on cholesterol, not on triglyceride and blood glucose. Disappearance of diabetes, hypertension, and metabolic syndrome was similar with BPD and with LAGB, and no new cases were observed.</p> <p>Conclusion</p> <p>These data indicate that BPD, likely due to a greater BMI decrease, is more effective than LAGB in improving cardiovascular parameters, and similar to LAGB on metabolic parameters, in obese patients. The greater effect on cholesterol levels is probably due to the different mechanism of action.</p

Restoration of acute insulin response in T2DM subjects 1 month after biliopancreatic diversion

objective: Biliopancreatic diversion (BPD) restores normal glucose tolerance in a few weeks in morbid obese subjects with type 2 diabetes, improving insulin sensitivity. However, there is less known about the effects of BPD on insulin secretion. We tested the early effects of BPD on insulin secretion in obese subjects with and without type 2 diabetes. Methods and Procedures: Twenty-one consecutive morbid obese subjects, 9 with type 2 diabetes (T2DM) and 12 with normal fasting glucose (NFG) were evaluated, just before and 1 month after BPD, by measuring body weight (BW), glucose, adipocitokines, homeostasis model assessment of insulin resistance (HOMA-IR), acute insulin response (AIR) to e.v. glucose and the insulinogenic index adjusted for insulin resistance ([∆I5/∆G5]/HOMA-IR). Results: Preoperatively, those with T2DM differed from those with NFG in showing higher levels of fasting glucose, reduced AIR (57.9 ± 29.5 vs. 644.9 ± 143.1 pmol/l, P &lt; 0.01) and reduced adjusted insulinogenic index (1.0 ± 0.5 vs. 17.6 ± 3.9 1/mmol 2 , P &lt; 0.001). One month following BPD, in both groups BW was reduced (by ~11%), but all subjects were still severely obese; HOMA-IR and leptin decreased significanlty, while high-molecular weight (HMW) adiponectin and adjusted insulinogenic index increased. In the T2DM group, fasting glucose returned to non-diabetic values. AIR did not change in the NFG group, while in the T2DM group it showed a significant increase (from 58.0 ± 29.5 to 273.8 ± 47.2 pmol/l, P &lt; 0.01). In the T2DM group, the AIR percentage variation from baseline was significantly related to changes in fasting glucose (r = 0.70, P = 0.02), suggesting an important relationship exists between impaired AIR and hyperglycaemia. Discussion: BPD is able to restore AIR in T2DM even just 1 month after surgery. AIR restoration is associated with normalization of fasting glucose concentrations

Interdisciplinary European guidelines on surgery of severe obesity

W 2005 roku, dzięki wspólnemu wysiłkowi głównych europejskich towarzystw naukowych aktywnych na polu leczenia otyłości został powołany zespół ekspertów nazwany Bariatryczno-Naukową Grupą Badawczą (BSCG). Towarzystwami, które stworzyły ten zespół i oddelegowały swoich przedstawicieli do prac w opracowaniu wytycznych były: Międzynarodowe Towarzystwo Chirurgicznego Leczenia Otyłości (IFSO), Oddział Europejski Międzynarodowego Towarzystwa Chirurgicznego Leczenia Otyłości (IFSO-EC), Europejskie Towarzystwo Badań nad Otyłością (EASO), Europejska Grupa ds. Otyłości u Dzieci (ECOG) (razem z Międzynarodową Grupą Zwalczania Otyłości). Bariatryczno-Naukowa Grupa Badawcza składała się z władz reprezentujących powyższe towarzystwa (czterech czynnych przewodniczących, dwóch byłych, jeden honorowy, dwóch dyrektorów wykonawczych), a także najwybitniejszych ekspertów w tej dziedzinie. Skład BSCG pozwolił na całościowe objęcie zagadnienia leczenia otyłości olbrzymiej z uwzględnieniem różnorodności geograficznej i etnicznej Europy. Członkowie BSCG odbyli wiele spotkań poświęconych stworzeniu wytycznych, które odzwierciedlałyby współczesną wiedzę i doświadczenie w zakresie leczenia otyłości olbrzymiej.In 2005, for the first time in European history, an extraordinary expert panel named BSCG (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European scientific societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective scientific societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past 2 years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment

Thirty-five years of biliopancreatic diversion: notes on gastrointestinal physiology to complete the published information useful for a better understanding and clinical use of the operation.

none1BACKGROUND: In the attempt to complete the available information on biliopancreatic diversion (BPD) use and mechanisms of action, some data and observations are presented that for different reasons were never published before. METHODS: These pieces of information derive from minute efforts of gastrointestinal physiology research or from rigorous but preliminary and incomplete collection of data, combined with the daily input from clinical use of BPD. RESULT: They essentially regard intestinal limbs, gastric volume, and their interactions in affecting energy and protein intestinal absorption in BPD. CONCLUSION: It is hoped that this new information will help surgeons to increase their knowledge and improve their ability to obtain the best results from the BPD procedure.Scopinaro N.Scopinaro, Nicol