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Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis.
Dellon ES, Kohn GP, Morgan DR, Grimm IS
(2009) Dig Dis Sci 54: 1798-803
MeSH Terms: Adult, Anastomosis, Roux-en-Y, Bile Ducts, Bile Ducts, Intrahepatic, Biliary Tract Surgical Procedures, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis, Sclerosing, Feasibility Studies, Female, Gastric Bypass, Humans, Liver, Liver Transplantation, Male, Middle Aged
Show Abstract · Added May 18, 2016
The purpose of this study is to describe the feasibility of using single-balloon enteroscopy (SBE) to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who had a prior Roux-en-Y (RY) anastomosis. This case series describes four patients, one with RY gastric bypass, two with RY due to bile duct injury, and one with RY after liver transplantation, who underwent ERCP with SBE. Cholangiography was successful in three of the four patients. In the procedure that was not successful, the enteroenterostomy site could not be located. The successful procedures ranged from 65-91 min in duration. Medication doses were higher than with typical ERCPs. No procedural complications occurred. SBE for ERCP is a feasible option for endoscopic access to the biliary tree in patients with prior RY anastomoses. Limitations of this technique include the time requirement, delay in identification of the enteroenterostomy site, potential learning curve, and immature technology lacking accessories.
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1 Members
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15 MeSH Terms
Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery.
Fowler SM, Kon V, Ma L, Richards WO, Fogo AB, Hunley TE
(2009) Pediatr Nephrol 24: 851-5
MeSH Terms: Child, Female, Gastric Bypass, Glomerulosclerosis, Focal Segmental, Humans, Obesity, Morbid, Proteinuria, Treatment Outcome
Show Abstract · Added February 25, 2014
Obesity-related glomerulopathy (ORG) is a secondary form of focal and segmental glomerulosclerosis (FSGS) occurring in severely obese patients. A significant percentage of individuals with ORG will develop renal insufficiency or end stage renal disease. We report here a 17-year-old girl with morbid obesity (body mass index 56.8 kg/m(2)) and ORG presenting with nephrotic range proteinuria, who failed to improve following treatment with diet, exercise and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) therapy. Laparoscopic gastric bypass surgery was performed, and within 2 weeks following the surgery, the patient had lost 5.7 kg body weight and showed a remarkable decrease in protein excretion to one tenth of pre-surgery levels. More than 1 year after surgery, the patient's urine protein and kidney function have remained normal while off renin-angiotensin system inhibition therapy. This is the first report of successful use of gastric bypass surgery for obesity-related glomerulopathy in an adolescent. We propose that gastric bypass surgery be considered for patients with ORG.
1 Communities
3 Members
0 Resources
8 MeSH Terms
Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women.
Youssef Y, Richards WO, Sekhar N, Kaiser J, Spagnoli A, Abumrad N, Torquati A
(2007) Surg Endosc 21: 1393-6
MeSH Terms: Adolescent, Adult, Alkaline Phosphatase, Calcium, Female, Gastric Bypass, Humans, Hyperparathyroidism, Secondary, Laparoscopy, Middle Aged, Obesity, Morbid, Parathyroid Hormone, Vitamin D
Show Abstract · Added December 10, 2013
BACKGROUND - Metabolic bone disease is a potential complication of bariatric surgery. The aims of our study were to evaluate the effects of laparoscopic gastric bypass on calcium and vitamin D metabolism, and to identify patients at high risk to develop secondary hyperparathyroidism (HPT).
METHODS - Serum calcium, alkaline phosphatase, intact parathyroid hormone (PTH), and 25-hydroxy (OH) vitamin D were measured at 3, 6, 12, and 24 months after laparoscopic gastric bypass in a cohort of morbidly obese women. Logistic regression was used in both univariate and multivariate models to identify independent preoperative variables associated with secondary HPT.
RESULTS - The study enrolled 193 morbidly obese women. During the 2-year follow-up period, the incidence of elevated PTH levels (>65 pg/ml) was 53.3%. The mean time elapsed between surgery and detection of secondary HPT was 9.1 months (range, 3-24 months). Vitamin D deficiency was observed in 39 patients (20.2%). On univariate analysis, the preoperative factors associated with secondary HPT were race (high PTH levels were detected in 70% of African Americans versus 50% of Caucasians; p < 0.05), preoperative body mass index (BMI; high PTH: 52.5 +/- 10.8 versus normal PTH: 48.9 +/- 7.5 kg/m2; p < 0.01), and age (high PTH: 44.9 +/- 9.2 versus normal PTH: 42.3 +/- 9 years, p < 0.05). Race and age remained independent risk factors for secondary HPT in the multivariate logistic regression model after adjusting for the covariate Roux-limb length. African Americans were at more than 2.5 times greater risk to develop secondary HPT as Caucasian (RR 2.5; 95% CI: 1.03-6.17, p < 0.05). Patients older than 45 years were at 1.8 times higher risk of developing secondary HPT as their younger counterparts (RR 1.8; 95% CI: 1.01-3.32, p < 0.05).
CONCLUSIONS - Morbidly obese women have a high incidence of elevated PTH levels after gastric bypass surgery. Low vitamin D levels did not constitute the only reason behind this finding. African-American women and women older than 45 years of age were at significantly higher risk of developing secondary HPT. In these populations, aggressive supplementation with calcium citrate and vitamin D should be implemented.
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13 MeSH Terms
Weight, dietary and physical activity behaviors two years after gastric bypass.
Silver HJ, Torquati A, Jensen GL, Richards WO
(2006) Obes Surg 16: 859-64
MeSH Terms: Adult, Body Weight, Cross-Sectional Studies, Diet, Diet, Reducing, Energy Intake, Feeding Behavior, Female, Follow-Up Studies, Gastric Bypass, Humans, Male, Middle Aged, Motor Activity, Physical Endurance, Risk Factors, Surveys and Questionnaires, Weight Loss
Show Abstract · Added December 10, 2013
BACKGROUND - This cross-sectional survey was designed to determine the self-reported weight management, dietary and physical activity behaviors of Roux-en-Y gastric bypass (RYGBP) patients who were 1 to 4 years after the RYGBP operation, and to identify gaps in follow-up nutrition-related chronic disease prevention.
METHODS - Questionnaires including behavioral items from the 2003 and 2004 Behavioral Risk Factor Surveillance System (BRFSS) were mailed to all RYGBP patients in a clinically active outpatient database.
RESULTS - Of 212 patients, 140 (66%) returned completed questionnaires. Responders were 24.2 +/- 7.9 months postoperatively. They were older than nonresponders (45.2 +/- 9.9 vs 38.5 +/- 8.9 years, P<.001). Responders had an average weight loss of 55.8 +/- 15.2 kg, and most (81%) reported that they were still trying to lose weight. The most frequently reported dietary behavior for weight loss was decreasing calorie and fat intakes. However, in addition to avoiding sodas and sweet desserts, responders were also excluding nutrient-dense foods high in vitamins and minerals such as milk and dairy products, red meats, breads, cereals and nuts. Remarkably, only 25 (17.9%) engaged in regular exercise activities before surgery, while 116 (82.9%) indicated a moderate level of current physical activity averaging 54.7 +/- 38.5 minutes per episode. Multivariable linear regression analyses identified age, weight at age 21, pre-surgery BMI and time in regular physical activities as the four significant predictors of BMI after weight loss stabilization.
CONCLUSION - Postoperative RYGBP patients engage in various weight management behaviors, some of which could offer greater health benefits with follow-up intervention from dietitians and exercise specialists to prevent adverse outcomes such as weight regain and micronutrient deficiencies.
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1 Members
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18 MeSH Terms
Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients?
Torquati A, Lutfi R, Abumrad N, Richards WO
(2005) J Gastrointest Surg 9: 1112-6; discussion 1117-8
MeSH Terms: Adult, Anastomosis, Roux-en-Y, Blood Glucose, Diabetes Mellitus, Type 2, Female, Gastric Bypass, Glycated Hemoglobin A, Humans, Logistic Models, Male, Obesity, Morbid, Treatment Outcome
Show Abstract · Added December 10, 2013
Type 2 diabetes mellitus (T2DM) has a very strong association with obesity. The aim of our study was to analyze the effects of Roux-en-Y gastric bypass (RYGB) surgery on the glucose metabolism in morbidly obese patients with T2DM. Morbidly obese patients (n = 117) with T2DM underwent measurements of fasting serum glucose and glycosylated hemoglobin (HbA1C) at baseline, 6 months, and 12 months after laparoscopic RYGB surgery. Logistic regression was used in both univariate and multivariate modeling to identify independent variables associated with complete resolution of T2DM. Twelve months after surgery, fasting plasma glucose decreased from a preoperative mean of 164 +/- 55 mg/dL to 101 +/- 38 mg/dL (P = .001) and HbA1C decreased from a preoperative mean of 7.7% +/- 1.5% to 6.0% +/- 1.1% (P = .001). Resolution of T2DM was achieved in 72 patients (74%). All of the remaining 25 patients decreased the daily medication requirements. On univariate analysis, preoperative variables associated with resolution of T2DM were waist circumference, HbA1C, and absence of insulin treatment. Waist circumference (odds ratio 2.4; 95% confidence interval 1.4-4.1; P = .001) and treatment without insulin (odds ratio 42.2; 95% confidence interval 4.3-417.3; P = .002) remained significant predictors of T2DM resolution in the multivariate logistic regression model after adjusting for covariates. Laparoscopic RYGBP resulted in significant resolution of T2DM. Peripheral fat distribution (smaller waist circumference) and absence of insulin treatment were independent and significant predictors of complete resolution of T2DM.
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12 MeSH Terms
Obesity surgery in the United Kingdom: survey of 970 general surgeons.
Owen ER, Cooper MK, Kark AE
(1991) Ann R Coll Surg Engl 73: 36-8
MeSH Terms: Attitude of Health Personnel, Gastric Bypass, Gastroplasty, Humans, Jejunoileal Bypass, Obesity, Morbid, United Kingdom
Show Abstract · Added March 5, 2014
The results of a questionnaire survey on obesity surgery sent to 970 consultant general surgeons working in the United Kingdom National Health Service are presented. The response rate was 37%. There were 38 surgeons actively practising this surgery. The majority were performing a gastric procedure, mostly gastroplasty, but some did gastric bypass or banding. Three were doing the biliopancreatic bypass. Most surgeons were doing less than 10 operations a year. A total of 109 expressed an interest in attending a UK symposium and 59 would participate in a UK Bariatric Register. This practice, though only a small part of UK surgery, is larger than expected.
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7 MeSH Terms