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Journal Watch 15/11/2023

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including side-to-side magnetic duodeno-ileostomy, the profile of fatty acids after primary OAGB and revisional OAGB, evaluating MBS fellows’ training attitudes and duodenal–jejunal bypass improves metabolism, and more (please note, log-in maybe required to access the full paper).

Side-to-Side Magnetic Duodeno-Ileostomy in Adults with Severe Obesity with or without Type 2 Diabetes: Early Outcomes with Prior or Concurrent Sleeve Gastrectomy

The early results of a multi-centre study have shown that using an incisionless, sutureless magnet anastomosis system (MS) formed patent, complication-free anastomoses in side-to-side duodeno-ileostomy (DI) with prior or concurrent sleeve gastrectomy (SG), according to an international team of researchers.

Writing in SOARD, the study evaluated the feasibility, safety and effectiveness of primary and revisional side-to-side DI bipartition using a novel magnetic compression anastomosis device (MS). In 43 patients with a BMI≥35.0–≤50.0 two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating magnet fusion and gradual DI (MagDI). The MagDI-after-SG group had undergone prior sleeve gastrectomy (SG); the MagDI+SG group underwent concurrent SG.

The outcomes showed that the MS met feasibility criteria of magnet device placement, creation of patent anastomoses confirmed radiologically, and magnet passage in 100.0% of patients. There were 64 AEs, most were CDC grade I and II, significantly fewer in the MagDI-after-SG group (p<0.001). There were no device-related AEs including anastomotic leakage, bleeding, obstruction, infection, or death.

The MagDI-after-SG group experienced six-month mean weight loss of 8.0±2.5 kg (p<0.01), 17.4±5.0% EWL and the MagDI+SG group had significantly greater weight loss (34.2±1.6 kg, p<0.001), 66.2±3.4% EWL.

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Effect of Primary Versus Revisional One Anastomosis Gastric Bypass (OAGB) on Fatty Acid Profile

Researchers from the Medical University of Gdansk, Gdansk, Poland, have reported that primary OAGB (pOAGB) and revisional OAGB (rOAGB) improved the profile of most fatty acids (FA), leading to a decrease in in very long-chain FAs (VLCFAs) and an improvement in branched-chain FAs (BCFAs).

Writing in Obesity Surgery, the researchers compared the FA profile in serum in 85 patients (pOAGB n=68; rOAGB n=17) to identify potential post-surgical FA alterations. The percentage of excess BMI loss (% EBMIL) after pOAGB was 73.5 ± 2.47% vs 45.9 ± 4.15% in the rOAGB group (p<0.001). In contrast to the lack of effect of rOAGB on most polyunsaturated FAs, in the pOAGB group, there was a decrease in eicosapentaenoic acid, and eicosatetraenoic and docosahexaenoic acid levels (p<0.001). They also found a decrease in VLCFAs and an increase in BCFAs after both types of OAGB procedure.

They concluded that there is a need to further investigate the possibility of n-3 polyunsaturated FA supplementation after pOAGB, due to the large decrease in these FAs after pOAGB.

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Evaluating Metabolic and Bariatric Surgery Fellows’ Attitudes Toward Their Training

The surgical fellows who attended the American Society of Metabolic and Bariatric Surgeons (ASMBS) Leadership Academy were very pleased with their fellowship experience and most would choose to do a MIS/bariatric fellowship again, according to US researchers.

The ASMBS Leadership Academy is conducted at the ASMBS Weekend to prepare surgeons for practice, while in their fellowship. The authors sought to gather the views of current fellows in training on issues regarding practice patterns and career development. The online survey was conducted at the last two ASMBS Leadership Academy Meetings at the ASMBS Weekend. There were 14 questions and 61 respondents (24 fellows surveyed at the Leadership Academy in November 2022 and 37 in January 2022).

The findings, published in SOARD, revealed that 58% of attendees were interviewing for employment after their fellowship with 3.64% were already employed. Eighteen percent had secured employment after their fellowship. From the academic fellows, 29.1% believe that private practice will no longer exist in 2030 and 10.9% of attendees believe that Medicare for all will exist by 2030. Fellows in academic programs ranked their fellowship as either “best decision of my life” or “great” (96.4%) and 3.6% ranked it as “useless (not good/not bad).” Ninety-three percent of attendees said they would do a bariatric fellowship again.

Interestingly, those that said they would not were all from a robotic fellowship program. Of those that would do a bariatric fellowship again, 80% stated they would do so at the same institution.

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Duodenal–Jejunal bypass improves metabolism and re-models extra cellular matrix through modulating ceRNA network

Duodenal-jejunal bypass (DJB) can remodel extra cellular matrix (ECM) and improve the energy metabolism through the circular RNAs (circRNAs) regulatory network, according to Chinese researchers writing in the journal Geonomics.

This study compared the long non-coding RNAs (lncRNAs), circRNAs and messenger RNAs (mRNAs) expression in adipose tissues between the sham group and the DJB group. They identified 2,219 differentially expressed mRNAs (DEmRNAs), 722 differential expression of lncRNAs (DElncRNAs) and 425 differential expression of circRNAs (DEcircRNAs). GO terms and KEGG pathways analysis of the DEmRNAs implied that the dysregulated adipose mRNAs were associated with lipid, amino acid metabolism, insulin resistance and extra cellular matrix (ECM)-related pathways.

Through analysing ceRNA regulatory networks of DElncRNAs and DEcircRNAs, 31 hub DE mRNAs, especially Mpp7, 9330159F19Rik, Trhde, Trdn, Sorbs2, were found on these pathways.

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