Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

AIM To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy(VSG).METHODS VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.RESULTS Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients(9.3%) have narrowing of the sleeve with 25(7.1%) having sharp angulation or a spiral while 8(2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients(39%); 10 patients(30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.CONCLUSION Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

IFN-γ Secretion in Gut of Ob/Ob Mice after Vertical Sleeve Gastrectomy and Its Function in Weight Loss Mechanism

Vertical sleeve gastrectomy（VSG） is becoming more and more popular among the world. Despite its dramatic efficacy, however, the mechanism of VSG remains largely undetermined. This study aimed to test interferon（IFN）-γ secretion n of mesenteric lymph nodes in obese mice（ob/ob mice）, a model of VSG, and its relationship with farnesoid X receptor（FXR） expression in the liver and small intestine, and to investigate the weight loss mechanism of VSG. The wild type（WT） mice and ob/ob mice were divided into four groups： A（WT＋Sham）, B（WT＋VSG）, C（ob/ob＋Sham）, and D（ob/ob＋VSG）. Body weight values were monitored. The IFN-γ expression in mesenteric lymph nodes of ob/ob mice pre- and post-operation was detected by flow cytometry（FCM）. The FXR expression in the liver and small intestine was detected by Western blotting. The mouse AML-12 liver cells were stimulated with IFN-γ at different concentrations in vitro. The changes of FXR expression were also examined. The results showed that the body weight of ob/ob mice was significantly declined from（40.6±2.7） g to（27.5±3.8） g on the 30 th day after VSG（P〈0.05）. At the same time, VSG induced a higher level secretion of IFN-γ in mesenteric lymph nodes of ob/ob mice than that pre-operation（P〈0.05）. The FXR expression levels in the liver and small intestine after VSG were respectively 0.97±0.07 and 0.84±0.07 fold of GAPDH, which were significantly higher than pre-operative levels of 0.50±0.06 and 0.48±0.06 respectively（P〈0.05）. After the stimulation of AML-12 liver cells in vitro by different concentrations of IFN-γ（0, 10, 25, 50, 100, and 200 ng/m L）, the relative FXR expression levels were 0.22±0.04, 0.31±0.04, 0.39±0.05, 0.38±0.05, 0.56±0.06, and 0.35±0.05, respectively, suggesting IFN-γ could distinctly promote the FXR expression in a dose-dependent manner in comparison to those cells without IFN-γ stimulation（P〈0.05）. It was concluded that VSG induces a weight loss in ob/ob mice by increasing IFN-γ secretion of mesenteric lymph nodes, which then increases the FXR expression of the liver and small intestine.

Organ-specific alterations in circadian genes by vertical sleeve gastrectomy in an obese diabetic mouse model

Current therapies for obesity and related complications have been shown to have limited benefits,including unsatisfactory weight loss and poor metabolic improvement.With recent developments in bariatric surgery,promising advancements have been made in clinical and scientific research,particularly in the management of obesity and diabetes.Vertical sleeve gastrectomy(VSG)has become increasingly popular due to its safety,simplicity,

Alcohol associated liver disease and bariatric surgery:Current perspectives and future directions

Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity.However,bariatric sur-gery has also been linked to increased alcohol use with up to 30%of these patients developing alcohol use disorder(AUD).The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic,metabolic,and neurohumoral changes associated with post-surgical anatomy.These patients are at increased risk of alcohol associated liver disease and,in some cases,require liver trans-plantation.In this article,we provide a scoping review of epidemiology,patho-physiology,and clinical outcomes of alcohol-related health conditions after bariatric surgery.

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery:A general perspective of current studies?

BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus(T2DM).Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM.There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM,but remission rates of T2DM after metabolic surgery can display great variability.AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy,adjustable gastric banding,Roux-en-Y gastric bypass,and biliopancreatic diversion with duodenal switch.METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures.RESULTS In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patient with T2DM,but further studies are needed to clarify better the rate of diabetes remission.CONCLUSION In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patients with T2DM,but further studies are needed to clarify better the rate of diabetes remission.