TY  - JOUR
AB  - Background: Due to Covid-19, elective medical procedures were partly postponed to reduce the burden on the medical system. The impact of these effects in bariatric surgery and their individual consequences remain unknown. Materials/Methods: In a retrospective monocentric analysis, all bariatric patients at our centre between 01/2020 and 12/2021 were investigated. All patients with postponed surgery due to pandemic were analysed regarding weight change and metabolic parameters. In addition, we performed a nationwide cohort study of all bariatric patients in 2020 using billing data provided by the Federal Statistical Office. Population adjusted procedure rates of 2020 were compared to 2018/2019. Results: Seventy-four patients (42.5%) out of 174 scheduled for bariatric surgery were postponed due to pandemic-related limitations, and 47 (63.5%) patients waited longer than 3 months. Mean postponement was 147.7 days. Apart from outliers (6.8% of all patients), mean weight (+0.9 kg) and body mass index (+0.3 kg/m2) remained stable. HbA1c increased significantly in patients with a postponement longer than 6 months (p = 0.024) and in diabetic patients (+0.18% vs −0.11 in non-diabetic, p = 0.042). In the Germany-wide cohort, the overall reduction of bariatric procedures in the first lockdown (04-06/2020) was −13.4% (p = 0.589). In the second lockdown (10-12/2020), there was no nationwide detectable reduction (+3.5%, p = 0.843) but inter-state differences. There was a catch-up in the interim months (+24.9%, p = 0.002). Conclusion: For future lockdowns or other healthcare bottleneck circumstances, the impact of postponement in bariatric patients has to be addressed and prioritization of vulnerable patients (e.g. diabetics) should be considered. Graphical Abstract: [Figure not available: see fulltext.]
AU  - Lange, U.G.*
AU  - Uttinger, K.L.*
AU  - Medicke, P.*
AU  - Diers, J.*
AU  - Wiegering, A.*
AU  - Moulla, Y.*
AU  - Steiner, S.
AU  - Dietrich, A.*
C1  - 68452
C2  - 54639
CY  - One New York Plaza, Suite 4600, New York, Ny, United States
SP  - 2375-2383
TI  - Impact of surgical postponements due to Covid-19 on weight and metabolic parameters in bariatric surgery in Germany: Monocentric experiences and considerations in a national context.
JO  - Obes. Surg.
VL  - 33
IS  - 8
PB  - Springer
PY  - 2023
SN  - 0960-8923
ER  - 

TY  - JOUR
AB  - Introduction: Morbid obesity is well known as a risk factor for gastroesophageal reflux disease (GERD) and its related disorders such as Barrett’s esophagus (BE). This study aimed to evaluate the development of BE in patients who underwent bariatric surgery. Materials and Methods: Using a single-center prospectively established database of obese patients who underwent bariatric surgery from 01/2012 to 12/2019, we retrospectively compared the preoperative endoscopic findings of BE to those after 1–2 years and 3–5 years following bariatric surgery. The change of BE was detected endoscopically according to Prague classification and histologically according to the British guidelines of detecting columnar epithelium on the distal esophagus. Results: Among 914 obese patients who underwent bariatric surgery and received a preoperative esophagogastroduodenoscopy (EGD), we found 119 patients (13%) with BE. A follow-up EGD was performed in 74 of the BE patients (62.2%). A total of 37 (50%) patients underwent a follow-up EGD after 1–2 years and 45 (60.8%) patients underwent it after 3–5 years. Among many clinical parameters, the surgical procedure was the only significant factor for the change of BE after bariatric surgery (p < 0.05). A regression of BE was found in 19 patients (n = 54, 35%) after laparoscopic Roux-en-Y- gastric bypass (LRYGB). Furthermore, a progression of BE was detected in six patients (n = 20, 30%) after laparoscopic sleeve gastrectomy (LSG). Conclusion: RYGB should be considered in obese patients with BE. Detecting BE prior to bariatric surgery may have an impact on decision-making regarding the suitable surgical bariatric procedure. Graphical Abstract: [Figure not available: see fulltext.]
AU  - Moulla, Y.*
AU  - Hamadeh, H.*
AU  - Seidemann, L.*
AU  - Mehdorn, M.*
AU  - Blüher, M.
AU  - Feisthammel, J.*
AU  - Hoffmeister, A.*
AU  - Gockel, I.*
AU  - Lange, U.G.*
AU  - Dietrich, A.*
C1  - 68202
C2  - 54821
CY  - One New York Plaza, Suite 4600, New York, Ny, United States
SP  - 3391-3401
TI  - Barrett`s esophagus in bariatric surgery: Regression or progression?
JO  - Obes. Surg.
VL  - 33
IS  - 11
PB  - Springer
PY  - 2023
SN  - 0960-8923
ER  - 

TY  - JOUR
AB  - PURPOSE: People with obesity often develop non-alcoholic fatty liver disease (NAFLD) and are at high risk of progression to non-alcoholic steatohepatitis (NASH). Few therapies are effective other than bariatric surgery. We therefore analyzed data from duodenal-jejunal bypass liner (DJBL) patients regarding steatosis, fibrosis, and NASH. METHODS: Consecutive DJBL patients with type 2 diabetes underwent standardized assessments up to device removal at 48 weeks. These included aspartate and alanine transaminase (AST, ALT), controlled attenuation parameter (CAP, for steatosis), and liver stiffness measurement (LSM, for fibrosis). The NAFLD fibrosis score (NFS), fibrosis-4 score (FIB4), and enhanced liver fibrosis (ELF) test were also used to assess fibrosis and the Fibroscan-AST (FAST) score to assess NASH. Mixed models were used and missing data were accounted for with multiple imputation. RESULTS: Thirty-two patients (18 female, mean age 55.1, mean BMI 40.2 kg/m2) were included. After 48 weeks, the change compared to baseline with 95% CI was a factor 0.74 (0.65 to 0.84) for AST, 0.63 (0.53 to 0.75) for ALT, and a difference of - 0.21 (- 0.28 to - 0.13) for FAST, all with p < 0.001. Fibrosis based on LSM, NFS, and ELF did not change whereas FIB4 exhibited slight improvement. Eight DJBL were explanted early due to device-related complications and eight complications led to hospitalization. CONCLUSIONS: One year of DJBL therapy is associated with relevant improvements in non-invasive markers of steatosis and NASH, but not fibrosis, and is accompanied by a substantial number of complications. Given the lack of alternatives, DJBL deserves further attention.
AU  - Karlas, T.*
AU  - Petroff, D.*
AU  - Feisthammel, J.*
AU  - Beer, S.*
AU  - Blüher, M.
AU  - Schütz, T.*
AU  - Lichtinghagen, R.*
AU  - Hoffmeister, A.*
AU  - Wiegand, J.*
C1  - 65558
C2  - 52740
SP  - 2495-2503
TI  - Endoscopic bariatric treatment with duodenal-jejunal bypass liner improves Non-invasive markers of non-alcoholic steatohepatitis.
JO  - Obes. Surg.
VL  - 32
IS  - 8
PY  - 2022
SN  - 0960-8923
ER  -