Journal watch 20/07/2022

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 a report that endoscopic sleeve gastroplasty with the OverStitch Sx device is an effective and well-tolerated procedure especially for primary obesity treatment, a study comparing eating disorders (ED) and eating behaviours in adults with and without type 2 diabetes prior to bariatric surgery, a paper looking at serum and adipose tissue levels of asprosin in patients with severe obesity, how weight stigma impacts patients with obesity and a paper exploring the impact of opioid-free anaesthesia (OFA) on pain score and opioid consumption in patients undergoing bariatric surgery(please note, log-in maybe required to access the full paper).


Safety of Endoscopic Sleeve Gastroplasty with a Single-Channel Endoscope

French researchers, writing in Obesity Surgery, have concluded that endoscopic sleeve gastroplasty (ESG) is a safe minimal invasive approach with the OverStitch Sx device (Apollo EndoSurgery) and can be considered an effective and well-tolerated procedure especially for primary obesity treatment.


Their single-centre study, which evaluated the safety of endoscopic sleeve gastroplasty (ESG) using the new suturing device OverStitch, included over 190 patients between January 2019 and December 2020. The analysed variables were adverse effects and change in body weight at six and 12 months of follow-up.


The researchers reported that there were no major intra-procedure adverse events and two postprocedural complications (1.04%). The %TWL recorded was 22.4% for 84 patients (43.9%, six months’ follow-up) and 18.7% for 69 patients (36.1%, 12 months’ follow-up) with the mean EWL of 41.6% and respectively 34.7%. A total of 59 patients (30.9%) were lost follow-up and 12 patients underwent revisional bariatric procedure. Overall, according to ASGE definition, 53.8% (n=71) reached >25% of EWL.


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Comparison of eating disorders and eating behaviors in adults with and without type 2 diabetes prior to bariatric surgery

Investigators from the Iran University of Medical Sciences, Tehran, Iran, who compared eating disorders (ED) and eating behaviours in adults with and without type 2 diabetes prior to bariatric surgery, have reported that people with Class III obesity are more cautious about their diet for blood glucose control if they have type 2 diabetes.


The study, reported in the Journal of Eating Disorders, included 284 participants with class III obesity who were placed into 2 groups - patients with type 2 diabetes and control patients without type 2 diabetes (142 patients each). Loss of eating control, binge eating disorder (BED) and Bulimia nervosa, night eating syndrome and eating behaviours and psychosocial factors were screened with standard questionnaires.


They found that there was a significant difference between participants with and without type 2 diabetes in case of BED (76.3% vs. 47.3%, p=0.001). The logistic regression model has shown that participants without type 2 diabetes had lower odds of exhibiting BED (OR = 0.28, 95% CI 0.142–0.552). Among participants without type 2 diabetes, men had 65% high odds of BED (OR = 1.65, 95% CI 1.13–2.53) in compare with women. Participants with and without type 2 diabetes with high school degree (OR = 5.54, 95% CI 2.46–9.45, P = 0.0001 and OR = 6.52, 95% CI 3.15–10.56, respectively) and moderate depression level (OR = 2.03, 95% CI 0.98–3.95 and OR = 3.12, 95% CI 2.12–4.56, p=0.0001) had higher odds of BED.


The authors said that future studies are recommended to follow up these patients after surgery to compare weight loss and blood sugar control in patients with and without type 2 diabetes.

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Investigation of serum and adipose tissue levels of asprosin in patients with severe obesity undergoing sleeve gastrectomy

Investigators from Kafkas University Faculty of Medicine, Kars, Turkey, have reported that asprosin (fibrillin-1) levels in adipose tissue were considered a potential independent risk factor in obesity etiopathogenesis.


Writing in the journal Obesity, they authors sought to reveal the relationship between obesity and asprosin in patients undergoing bariatric surgery and to investigate the role of asprosin in obesity etiopathogenesis. The study included 37 patients who underwent laparoscopic sleeve gastrectomy for severe obesity and 37 patients who underwent laparoscopic cholecystectomy for cholelithiasis. Blood samples were collected from the patients in the preoperative period and at six months postoperatively to compare their pre- and post-operative serum asprosin levels.


The found a significant intergroup difference in terms of mean asprosin levels in adipose tissue (p=0.001). A comparison of pre-operative and post-operative six-month serum asprosin levels in the study group showed significant differences (p=0.021). The area under the curve of asprosin tissue levels was 78.1% and the cutoff value was 217.34ng/g of protein, with a sensitivity and specificity of 73.0%. Tissue levels of asprosin were found to increase the risk of obesity by a factor of 1.018 (odds ratio; 95% CI: 1.008-1.027).


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Weight Stigma in Patients With Obesity and Its Clinical Correlates: A Perspective From an Indian Bariatric Clinic

Indian researchers have reported an association between stigma and certain clinical variables that maintain and worsen obesity and comorbid psychiatric diagnoses, highlighting the importance of an assessment of mental health and stigma in general practice when dealing with patients with obesity.


Reporting in the journal Cureus, the investigators wanted to identify the obstacles in treatment-seeking, so stigma could be adequately addressed to improve clinical outcomes. Utilising the weight self-stigma questionnaire (WSSQ), demographic and clinical data were collected for 146 patients with obesity.


Female patients (73%) had higher stigma scores and a multivariate analysis revealed an association between stigma with multiple dysfunctional eating patterns like bingeing, overeating, and grazing and psychiatric diagnosis.


The authors concluded that the underlying psychiatric comorbidities and addressing unhealthy eating behaviours can help reduce self-stigma, as stigma is a barrier to treatment-seeking that needs to be addressed in the community.


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Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of Randomized Controlled Studies

Researchers from the Chi Mei Medical Center, Tainan City, Taiwan, have concluded that opioid-free anaesthesia improved pain outcomes immediately and at 24 h after surgery without a beneficial impact on opioid consumption at postoperative 24 h.


Their meta-analysis, published in Obesity Surgery, explored the impact of opioid-free anaesthesia (OFA) on pain score and opioid consumption in patients undergoing bariatric surgery (BS).

Literature search identified eight eligible trials. Forest plot revealed a significantly lower pain score (mean difference (MD) =  − 0.96, p = 0.0002; 318 patients), but not morphine consumption (MD =  − 5.85 mg, p=0.1; 318 patients) at postoperative 24 h in patients with OFA than in those without.


The pooled analysis also showed a lower pain score (p=0.002), morphine consumption (p=0.0003) in the post-aesthetic care unit and risk of postoperative nausea/vomiting (p=0.0003) in the OFA group, compared to the controls.


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