Endoscopic bariatric treatment (EBT) is an effective method for the treatment of obesity. The principle of weight loss is similar to metabolic bariatric surgery. It can be classified as a food restriction (stomach-targeted) and malabsorption (small intestine-targeted). At present, a lot of EBT devices had been cleared by the US Food and Drug Administration to treat obesity, while the EBT in China lagged behind Western countries. Hence, we reviewed the current stomach-targeted EBT, aiming to provide a reference for the supplement of obesity treatment methods and the development of EBT in China.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
Objective To explore the influencing factors for early complications after laparoscopic sleeve gastrectomy (LSG). Methods A retrospective analysis was conducted for the clinical data of 306 obese patients undergoing LSG at the Weight Reduction and Metabolism Center of Xuzhou Medical University Affiliated Hospital of Lianyungang from January 2020 to September 2022. Early postoperative complications (≤30 d) of LSG were classified according to the Clavien-Dindo classification, and the influencing factors of early postoperative complications were explored. Results There were 27 cases (8.8%) suffered from early complications, including 8 cases of grade Ⅰ (2.6%), 15 cases of grade Ⅱ (4.9%), 4 cases of grade Ⅲ (1.3%), there were no grade Ⅳ and grade Ⅴ complications. The multivariate results showed that BMI≥45 kg/m2 [OR=3.63, 95%CI (1.10, 11.92)], high cholesterol [OR=7.12, 95%CI (2.42, 20.95)], and preoperative GERD [OR=3.69, 95%CI (1.11, 12.23)] were influencing factors for early complications. Conclusions LSG is a safe diagnostic and therapeutic method for treating obesity. Attention should be paid to the impact of BMI, high cholesterol, and preoperative GERD on the occurrence of complications after LSG.
ObjectiveTo investigate the effect of sleeve gastrectomy on preventing adipose infiltration and LOX-1 expression in aortic epithelium of high-fat-diet-induced obese rats. MethodsTwenty-four Wistar rats were randomized into normal chow group (CO group), high-fat diet group (HD group), and high-fat diet combined with sleeve gastrectomy group (SG group). Rats of three groups before operation and CO group after operation were fed with normal diet, rats of HD and SG group were fed with high-fat diet. Body weight of all the rats were examined on day 10, 20, and 30 after operation, respectively. Animals were sacrificed on day 30 after operation and plasma HDL and LDL were detected by ELISA, LOX-1 and LOX-1 mRNA expression in aortic epithelium were measured by Western blot and real-time RT-PCR, respectively. Immunochemical histological Nile red stain was adopted in adipose infiltration examination of aorta. ResultsThe body weights in HD group were much higher than those of other groups （Plt;0.01）. The HDL in CO, HD, and SG groups was (32.9±6.2) mg/dl, (43.4± 4.0) mg/dl, and (37.5± 4.3) mg/dl, respectively. The LDL in CO, HD, and SG groups was (31.8±4.5) mg/dl, (53.3±5.1) mg/dl, and (40.5±3.7 ) mg/dl, respectively. The HDL and LDL values in HD group were higher than those of other two groups (Plt;0.05, Plt;0.01). The LOX-1 protein and mRNA expressions in HD group were much higher than those of other groups (Plt;0.01). Adipose staining in HD group was also ber than that of other groups. ConclusionsHigh-fat diet can induce elevation of LOX-1 protein and mRNA expression in aorta. Sleeve gastrecto my can relieve plasma LDL level, as a result, LOX-1 protein and mRNA expression should be down-regulated.
ObjectiveTo systematically review the efficacy of auricular pressure therapy for simple obesity in adult. MethodsWe electronically searched databases including The Cochrane Library (Issue 4, 2015), PubMed, Web of Science, MEDⅡNE (Ovid), CNKI, VIP, CBM and WanFang Data databases to collect randomized controlled trials (RCTs) of auricular pressure therapy for simple obesity from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 17 RCTs involving 1 246 patients were included. The results of meta-analysis showed that:(1) Compared with the blank control group, the auricular pressure therapy group was superior in weight reduction (MD=-2.50, 95%CI -3.53 to -1.47, P<0.01), BMI reduction (MD=-1.50, 95%CI -2.52 to -0.48, P=0.004), and waist circumference reduction (MD=-3.20, 95%CI -4.38 to -2.02, P<0.01); (2) Compared with the placebo control group, the auricular pressure therapy group was superior in weight reduction (MD=-1.39, 95%CI -1.46 to -1.31, P<0.01), BMI reduction (MD=-0.65, 95%CI -0.91 to -0.38, P<0.01), body fat percentage reduction (MD=-0.58, 95%CI -0.67 to -0.49, P<0.01), and waist circumference reduction (MD=-2.34, 95%CI -4.23 to -0.46, P=0.01); (3) There were no significant differences between the auricular pressure therapy group and the body acupuncture group in weight reduction, BMI reduction, and waist circumference reduction (all P values >0.05); (4) Compared with the body acupuncture group, the auricular pressure combined with body acupuncture group was superior in BMI reduction (MD=-1.67, 95%CI -2.48 to -0.85, P<0.01); (5) Three RCTs reported adverse reactions including cyanotic skin, erythema near auricular pressure etc., and all adverse reactions were mostly mild and recovered after treatment. ConclusionCurrent evidence indicates that auricular pressure therapy for simple obesity is superior to placebo and blank control, but similar to body acupuncture; the auricular pressure combined with body acupuncture is superior to body acupuncture alone in BMI reduction. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
Obesity is a disease state characterized by the accumulation of abnormal or excessive fat that threatens human health. With the rapid development of the economy and society and the change in lifestyle, obesity is highly prevalent in our country and has become an important disease that threatens the health of the population. Different from traditional non-surgical treatments, metabolic and bariatric surgery has a definite curative effect, is not easy to rebound, has good safety, and has sufficient evidence of clinical benefit, which can make many obese patients, especially those with moderate to severe obesity, fully recover. The treatment of obesity has become an important means in the comprehensive treatment of obesity. This article intends to describe the application of bariatric metabolic surgery in the comprehensive treatment of obesity from three aspects: bariatric surgery indications, surgical method selection, and perioperative multidisciplinary intervention.
ObjectiveTo summarize the influence and mechanism of visceral fat on the treatment and prognosis of gastric cancer patients.MethodLiteratures on the correlation and mechanism between visceral fat and treatment and prognosis of gastric cancer were collected and reviewed.ResultsHigh visceral fat may promote the incidence and progress of gastric cancer, and increase the incidence of complication of radical gastrectomy, including surgical site infection, pancreatic fistula, etc., as well as prolong the length of hospital stay. Reducing patients’ visceral fat level before operation could reduce the incidence of surgical complication. However, the persistent decrease of visceral fat level after operation may indicate poor prognosis. The effect of visceral fat on gastric cancer and its treatment was mainly due to the local chronic inflammation caused by excessive visceral fat tissue, the change of adipocytokine secretion, insulin resistance, and other mechanisms.ConclusionWe need to use visceral fat and other indicators to evaluate gastric cancer patients’ weight and body composition, in order to better guide the treatment and prognosis evaluation of gastric cancer.
Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m2. Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.
ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
ObjectiveTo review the current epidemiological status and trends of overweight and obesity globally and in China, and to analyze its hazards, causes, and prevention strategies. MethodsRecent global and Chinese studies and reports on obesity epidemiology were retrieved. Data from the latest World Obesity Federation’s reports and authoritative national statistics were comprehensively analyzed. ResultsThe prevalence of overweight and obesity was rising worldwide. According to the World Obesity Atlas 2025, it was predicted that by 2030, nearly 3 billion adults worldwide (approximately 50% of the adult population) would be affected by overweight or obesity. The overweight rate in youth aged 5–19 increased from 8% in 1990 to 20% in 2022. In China, over half of adults were overweight or obese, totaling over 402 million and ranking first in the world; the overweight/obesity rate in children and adolescents approached 20%. Gaps between urban and rural obesity had narrowed in China, and males and northern regions had higher rates than females and southern regions. Unhealthy diet patterns, reduced physical activity and other lifestyle changes were the main reasons for the prevalence of obesity. Obesity greatly increased the risk of type 2 diabetes, cardiovascular diseases, and other chronic diseases. ConclusionsBoth globally and in China, obesity has become a serious epidemic challenge. Strengthened prevention and control strategies are urgently needed, including comprehensive treatment based on healthy lifestyle intervention, drugs, endoscopy, weight loss surgery, etc, adoption of new weight management therapies and supportive policies are also needed. Special attention should be paid to preventing childhood obesity to curb the rising trend and reduce the associated health burden.