Efecto metabólico de la  manga gástrica Camilo Boza MD FACS Assitant Professor of Surgery Pontificia Universidad Católica ...
Background <ul><li>Obesity  ↔  Diabetes </li></ul>OBESIDAD: Ono T, Guthold R, Strong K, WHO Global Comparable Estimates, 2...
clinicaltrials.gov Bariatric surgery for the treatment of Diabetes
Diabetes Resolution
Co-morbid conditions after Gastric Bypass BMI >35 n:1500 Preoperative (%) 1 year (Res/Imp)  5 year (Res/Imp)  Hypertension...
Restrictives techniques Weight loss Weight loss Hormonal effect AGB Sleeve
Wilcoxon Sign-Rank Test—Geometric mean (interquartile range). Dixon et al.  Diabetes Care . 2002;25:358-363 .
Resolution of Diabetes Metanalysis n: 22.400 Total LAGB GBP BPD/DS % Resolved 82.1 55.3 80.5 99.4 % Resolved or Improved 1...
Boza et al, Surgical endoscopy 2009
Boza et al, Surgical endoscopy 2009
Sleeve gastrectomy Restriction Fast gastric emptying Rise in gut hormones Role of Ghrelin
% Diabetes Resolution Vidal, Lacy , Obesity Surgery 2007 BMI:49
% Diabetes Resolution Sleeve gastrectomy versus Bypass  Boza et al, ASMBS 2010
Sleeve gastrectomy versus Bypass  Boza et al, ASMBS 2010 Bypass Sleeve Pre Res Imp Pre Res Imp Chol ≥ 200 mg/dL 44,2 71,2 ...
Diabetes Resolution Basso, Surg Endosc 2009
% Diabetes Resolution Basso, Surgical endoscopy 2009
% Diabetes Resolution Shaa, SOARD 2009 36 months after surgery
% Sleeve Gastrectomy and Diabetes Shaa, SOARD 2009 36 months after surgery
% Sleeve Gastrectomy and Diabetes Shaa, SOARD 2009 36 months after surgery
Why ?
% Melissas Vaciamiento Melissas, Obesity Surgery 2007 T1/2 Gastric Emptying
PYY after Sleeve and Bypass Valderas, 2009 SOARD 2009 Bypass  Sleeve  Med Treat
Glp1 Melissas Vaciamiento Peterli, Annals of Surgery 2007 Bypass Sleeve
GLP1 after Sleeve and Bypass Valderas, Boza 2010 Bypass  Sleeve  Med Treat
AUC for GLP1 after Sleeve and Bypass Valderas, Boza 2010
Sleeve gastrectomy as a Metabolic Surgery Camilo Boza MD FACS Assitant Professor of Surgery Pontificia Universidad Católic...
Guess the BMI BMI 42. No metabolic Syndrome
Guess the BMI BMI 30. Metabolic Syndrome and Diabetes
Sleeve gastrectomy for the treatment of T2DM in patients with BMI 30-35 n:12 Age (years) 47,4 (21-59) Male Gender (%) 9 (7...
Sleeve gastrectomy for Diabetes in BMI 30-35 n:12 Preop 1 año Postop ∆ p BMI (kg/m 2 ) 33,7 (32,1-34,6) 27,5 (21,8-30)  - ...
12 Month Diabetes resolution Resolution (HbA1c normal sin medicación) 70% Better control 13,3 % No change 16,7%
BMI evolution for Sleeve 30-35
Bypass versus Sleeve for Diabetes  BMI 25-35 BMI 25-35 Lee, 2012
Conclusion <ul><li>Restrictive procedures help to control Diabetes </li></ul><ul><li>LAGB achieves a 40-50% resolution of ...
 
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Manga metabólica

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Transcript of "Manga metabólica "

  1. 1. Efecto metabólico de la manga gástrica Camilo Boza MD FACS Assitant Professor of Surgery Pontificia Universidad Católica de Chile
  2. 2. Background <ul><li>Obesity ↔ Diabetes </li></ul>OBESIDAD: Ono T, Guthold R, Strong K, WHO Global Comparable Estimates, 2005 DIABETES: IDF Diabetes Atlas, 4th ed.International Diabetes Federation, 2009
  3. 3. clinicaltrials.gov Bariatric surgery for the treatment of Diabetes
  4. 4. Diabetes Resolution
  5. 5. Co-morbid conditions after Gastric Bypass BMI >35 n:1500 Preoperative (%) 1 year (Res/Imp) 5 year (Res/Imp) Hypertension 35.8 60/32 60/30 T2 Diabetes 11.5 76/20 80/20 Insulin resistance 60.4 88/11 100/0 Dyslipidemia 55 87/12 93/7
  6. 6. Restrictives techniques Weight loss Weight loss Hormonal effect AGB Sleeve
  7. 7. Wilcoxon Sign-Rank Test—Geometric mean (interquartile range). Dixon et al. Diabetes Care . 2002;25:358-363 .
  8. 8. Resolution of Diabetes Metanalysis n: 22.400 Total LAGB GBP BPD/DS % Resolved 82.1 55.3 80.5 99.4 % Resolved or Improved 100.0 – 100.0 – % Improved 20.4 – 20.4 – % Unchanged 0.3 – 0.0 0.7 Insulin (pml/L) -98.0 -99.6 -40.2 -125.0 HbA1c (%) -2.1 -1.4 -2.2 – Glucose (mmol/L) -4.4 -2.5 -3.9 -5.4
  9. 9. Boza et al, Surgical endoscopy 2009
  10. 10. Boza et al, Surgical endoscopy 2009
  11. 11. Sleeve gastrectomy Restriction Fast gastric emptying Rise in gut hormones Role of Ghrelin
  12. 12. % Diabetes Resolution Vidal, Lacy , Obesity Surgery 2007 BMI:49
  13. 13. % Diabetes Resolution Sleeve gastrectomy versus Bypass Boza et al, ASMBS 2010
  14. 14. Sleeve gastrectomy versus Bypass Boza et al, ASMBS 2010 Bypass Sleeve Pre Res Imp Pre Res Imp Chol ≥ 200 mg/dL 44,2 71,2 0,0 41,9 47,1 0,0 Trygl ≥ 150 mg/dL 40,7 71,4 0,0 42,0 65,7 0,0 IR 47,3 93,5 5,5 33,6 81,0 16,2 Arterial Hyp 26,8 58,2 22,3 23,5 57,5 34,8 T2DM 5,5 86,6 6,6 3,9 90,9 9,1
  15. 15. Diabetes Resolution Basso, Surg Endosc 2009
  16. 16. % Diabetes Resolution Basso, Surgical endoscopy 2009
  17. 17. % Diabetes Resolution Shaa, SOARD 2009 36 months after surgery
  18. 18. % Sleeve Gastrectomy and Diabetes Shaa, SOARD 2009 36 months after surgery
  19. 19. % Sleeve Gastrectomy and Diabetes Shaa, SOARD 2009 36 months after surgery
  20. 20. Why ?
  21. 21. % Melissas Vaciamiento Melissas, Obesity Surgery 2007 T1/2 Gastric Emptying
  22. 22. PYY after Sleeve and Bypass Valderas, 2009 SOARD 2009 Bypass Sleeve Med Treat
  23. 23. Glp1 Melissas Vaciamiento Peterli, Annals of Surgery 2007 Bypass Sleeve
  24. 24. GLP1 after Sleeve and Bypass Valderas, Boza 2010 Bypass Sleeve Med Treat
  25. 25. AUC for GLP1 after Sleeve and Bypass Valderas, Boza 2010
  26. 26. Sleeve gastrectomy as a Metabolic Surgery Camilo Boza MD FACS Assitant Professor of Surgery Pontificia Universidad Católica de Chile
  27. 27. Guess the BMI BMI 42. No metabolic Syndrome
  28. 28. Guess the BMI BMI 30. Metabolic Syndrome and Diabetes
  29. 29. Sleeve gastrectomy for the treatment of T2DM in patients with BMI 30-35 n:12 Age (years) 47,4 (21-59) Male Gender (%) 9 (75%) BMI (kg/m2) 33,7 (32,1-34,6) Glucosa (mg/dl) 137 (83-187) Years of Diabetes 2,5 (1-7) HA1C (%) 7,3 (6,3-8,9)
  30. 30. Sleeve gastrectomy for Diabetes in BMI 30-35 n:12 Preop 1 año Postop ∆ p BMI (kg/m 2 ) 33,7 (32,1-34,6) 27,5 (21,8-30) - 6,2 0,01 Medication % 75 17 - 58 --- Glucosa (mg/dl) 137 (83-187) 93,5 (80-172) - 43,5 0,01 Hb A1c (%) 7,3 (6,3-8,9) 5,8 (4,9-6,9) - 2,4 0,06 Homa - IR 6,46 (1,6-14,2) 1,8 (1,7-6,5) - 4,7 0,06 Insulin 25,4 (9,3-45) 9,9(6,7-16,9) -15,5 0,04
  31. 31. 12 Month Diabetes resolution Resolution (HbA1c normal sin medicación) 70% Better control 13,3 % No change 16,7%
  32. 32. BMI evolution for Sleeve 30-35
  33. 33. Bypass versus Sleeve for Diabetes BMI 25-35 BMI 25-35 Lee, 2012
  34. 34. Conclusion <ul><li>Restrictive procedures help to control Diabetes </li></ul><ul><li>LAGB achieves a 40-50% resolution of diabetes based on weight loss..... </li></ul><ul><li>Sleeve gastrectomy appears to be an attractive option offering restriction with a hormonal effect. </li></ul><ul><li>Sleeve gastrectomy could be offered as a treatment for patients BMI below 35. </li></ul><ul><li>ARE THESE EFFECTS LONG LASTING FOR A CHRONIC DISEASE ??? </li></ul><ul><li>Prospective randomized trials are necessary. </li></ul>

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