Esophageal Cancer from
Fear & Confusion about the Risk of Cancer after Bariatric Surgery
Sleeve & Band vs Risk of Gastric Cancer after Mini-Gastric Bypass
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery, www.CLOS.net www.MiniBypass.net Email: DrR@clos.net
Fear of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FE...Dr. Robert Rutledge
Irrational Fears of CancerGeneral Surgeons Use the Billroth IIBariatric Surgeons FEAR the Billroth II (Mini-Bypass)
Irrational Fear of Gastric Cancer:CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-JejunostomyDr. Robert Rutledge
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-Jejunostomy
** Why is it that GENERAL Surgeons Can Figure this Out;
** While Bariatric Surgeons are Still Confused and in the Dark?
Example:
Publication Title: To Roux or not to Roux…Gastric Cancer. 2015 Sep 23
To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.
World LEADING Gastric Cancer Centers from around the USA!!
** No Fear of Using Billroth II in Gastric Cancer Patients!!
Bariatric Surgeons Fear and Confusion Related to Billroth II for 20 years!!!
General/Trauma and CANCER SURGEONS No Fear of Billroth II
Our study of Bariatric surgeons showed …
The less knowledge of general and cancer surgery =
the greater the fear and criticism of the Billroth II
Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASSDr. Robert Rutledge
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net
Critics of the Mini-Gastric Bypass were Wrong
MGB Results
In Short
By every measure
In every study
By Every Author
MGB Equal to or Better Than any other form of Bariatric Surgery
Critics Wrong
In Short:
Bariatric Surgeons who are well educated in the Basics of General Surgery
Choose the Mini-Gastric Bypass
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:
General Surgery Basics
Rate of Gastric Cancer
Lifetime Risk of Gastric Cancer
Fear of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FE...Dr. Robert Rutledge
Irrational Fears of CancerGeneral Surgeons Use the Billroth IIBariatric Surgeons FEAR the Billroth II (Mini-Bypass)
Irrational Fear of Gastric Cancer:CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-JejunostomyDr. Robert Rutledge
Fear of Bile Reflux and Gastric Cancer after Billroth II Gastro-Jejunostomy
** Why is it that GENERAL Surgeons Can Figure this Out;
** While Bariatric Surgeons are Still Confused and in the Dark?
Example:
Publication Title: To Roux or not to Roux…Gastric Cancer. 2015 Sep 23
To Roux or not to Roux: a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.
World LEADING Gastric Cancer Centers from around the USA!!
** No Fear of Using Billroth II in Gastric Cancer Patients!!
Bariatric Surgeons Fear and Confusion Related to Billroth II for 20 years!!!
General/Trauma and CANCER SURGEONS No Fear of Billroth II
Our study of Bariatric surgeons showed …
The less knowledge of general and cancer surgery =
the greater the fear and criticism of the Billroth II
Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASSDr. Robert Rutledge
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net
Critics of the Mini-Gastric Bypass were Wrong
MGB Results
In Short
By every measure
In every study
By Every Author
MGB Equal to or Better Than any other form of Bariatric Surgery
Critics Wrong
In Short:
Bariatric Surgeons who are well educated in the Basics of General Surgery
Choose the Mini-Gastric Bypass
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:
General Surgery Basics
Rate of Gastric Cancer
Lifetime Risk of Gastric Cancer
Irrational Fears of Cancer Bariatric Surgeons FEAR the Billroth II; General S...Dr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Fear of Gastric Cancer after MGB
Surgeons who repport Fear of Gastric Cancer after MGB
Show evidence of limited knowledge of
Gastric Cancer, General Surgery and Bariatric Surgery
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
Mini Gastric Bypass: initial Experience
British Obesity Metabolic Surgery Society
4 th Annual Scientific Meeting
Jan 23-25, 2013 Glasgow
SPIRE Hospital Southampton
Department of Bariatric Surgery
M Van den Bossche, I Bailey, J Kelly
J Byrne, R Sutherland*
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
Sleeve Gastrectomy and Lap band Appear likely to Lead to Esophageal CancerDr. Robert Rutledge
It appears that Sleeve and Band surgeons Should warn their patients of the Long term risk of GERD and Increased Risk of Esophageal cancer and Institute appropriate follow up planning.
GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITYDr. Robert Rutledge
GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY
1. Bariatric surgery history is replete with failed Primary Gastric Procedures for obesity,
2. Physiologically it is easy to see how an excess of 2, 000 calories a day can be ingested as liquid/soft calories (Coke and Cake) thus “Beating” the operations’ “gastric restriction” Band/Sleeve.
3. Studies in Gastric Cancer patients show that Combined Gastro-Intestinal Procedures outperform Primary Gastric Procedures
4. Primary Gastric Procedures can be predicted to fail even following initial success (see Lap Band(r))
Mini-Gastric BypassShown to be an excellent operation
But Many New Surgeons Do Not Know the Critical Factors to Do the MGB Correctly
One Critical Success Factor:
LONG Gastric Pouch
Irrational Fears of Cancer Bariatric Surgeons FEAR the Billroth II; General S...Dr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Comparison of Revision in Roux-en-Y vs Mini-Gastric BypassDr. Robert Rutledge
Comparison of Revision in
Roux-en-Y vs
Mini-Gastric Bypass
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Fear of Gastric Cancer after MGB
Surgeons who repport Fear of Gastric Cancer after MGB
Show evidence of limited knowledge of
Gastric Cancer, General Surgery and Bariatric Surgery
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
Mini Gastric Bypass: initial Experience
British Obesity Metabolic Surgery Society
4 th Annual Scientific Meeting
Jan 23-25, 2013 Glasgow
SPIRE Hospital Southampton
Department of Bariatric Surgery
M Van den Bossche, I Bailey, J Kelly
J Byrne, R Sutherland*
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
Sleeve Gastrectomy and Lap band Appear likely to Lead to Esophageal CancerDr. Robert Rutledge
It appears that Sleeve and Band surgeons Should warn their patients of the Long term risk of GERD and Increased Risk of Esophageal cancer and Institute appropriate follow up planning.
GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITYDr. Robert Rutledge
GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY
1. Bariatric surgery history is replete with failed Primary Gastric Procedures for obesity,
2. Physiologically it is easy to see how an excess of 2, 000 calories a day can be ingested as liquid/soft calories (Coke and Cake) thus “Beating” the operations’ “gastric restriction” Band/Sleeve.
3. Studies in Gastric Cancer patients show that Combined Gastro-Intestinal Procedures outperform Primary Gastric Procedures
4. Primary Gastric Procedures can be predicted to fail even following initial success (see Lap Band(r))
Mini-Gastric BypassShown to be an excellent operation
But Many New Surgeons Do Not Know the Critical Factors to Do the MGB Correctly
One Critical Success Factor:
LONG Gastric Pouch
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
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Irrational Fears of Cancer in the MGB by Bariatric SurgeonsDr. Robert Rutledge
Irrational Fears of Cancer, General Surgeons Use the Billroth II, Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)
At WORST Lifetime Risk Billroth II is
Less Risky than 2 CATScans or
Eating a Hot Dog!
Surgeons with Greatest Fear =>
Least Well Informed
Gastric Cancer declining rapidly, primarily related to environmental factors; easily modified.
Risk of GCA after B2 related to Ulcer & H. Pylori, if present at all.
Endoscopic screening is not recommended.
While some bariatric surgeons have expressed fears of the B2 causing cancer; General and Oncologic Surgeons continue to routinely use the B2.
Fear of Gastric Cancer \ Bile Reflux
Rational vs. Reptilian Brain Decision Making
Fear of Gastric Cancer \ Bile Reflux
Rational vs. Reptilian Brain Decision Making
Rational Data Analysis vs.Irrational FEAR Gastric Cancer
1. Gastric Cancer Declining Rapidly
2. GC Environmental Causes; Easily Prevented
3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori
4. Many large studies: NO increased risk
5. Endoscopic Screening: Not Recommended
6. General, Trauma & Oncologic Surgeons Use Billroth II
Presentation; Discussion of Herd Behaviour is Erroneous Human Decision Making; PROACT Decision Making Tool; 30 Point Multi-Dimensional assessment tool; Selection of the Best Bariatric Surgey; Discussion of the Lack of Risk of Gastric Cancer and the Billroth II
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
Prediction of Weight Loss Following The Mini-Gastric Bypass: Multivariate Regression Modeling
Robert Rutledge, K Kular, N. Manchanda CLOS Center For Laparoscopic Obesity Surgery, MGB Review Corp
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
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Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
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2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Fear & Confusion about the Risk of Cancer after Bariatric Surgery
1. Esophageal Cancer from
Sleeve & Band
vs
Risk of Gastric Cancer after
Mini-Gastric Bypass
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery
www.CLOS.net www.MiniBypass.net
Email: DrR@clos.net
2. What Happens When General Surgeons
Become Bariatric Surgeons
And Forget Their General Surgery
Training?
Dr Rutledge
The Centers for Laparoscopic Obesity Surgery
www.CLOS.net www.MiniBypass.net
Email: DrR@clos.net
4. MINI-GASTRIC BYPASS
BASED ON SOUND SURGICAL PRACTICE
•Billroth II Performed
over 100 years
•16,000 Billroth II’s
•USA in 2007
•Operation of choice:
Trauma, Ulcers, Cancer
Stomach etc.
6. Fear of Gastric Cancer Bile Reflux
Rational vs. Reptilian Brain Decision Making
Surgeons who Have
Forgotten Their General Surgery
7. STATISTICAL ILLITERACY;
"MANY DOCTORS MISUNDERSTAND MEDICAL
LITERATURE"
• Example: “In the absence of a Roux limb,
the long-term effects of chronic alkaline reflux
are unknown.”
• REALLY? Rational?
• Billroth II >100 years & >1,450 papers on Billroth II
Collins BJ, Miyashita T, Schweitzer M, Magnuson T, Harmon JW., Gastric Bypass; Why Roux-en-Y? A
Review of Experimental Data, Arch Surg. 2007; 142(10):1000-1003.
8. 1. Gastric Cancer; Declining Rapidly
•Gastric cancer
Decreasing in the
•USA & around the world
• Decreased four-fold
since 1930
• Approximately 40
deaths per 1,000,000
people.
9. 1. Gastric Cancer; Declining Rapidly
•
There were approximately 40 deaths from stomach
cancer per 1,000,000 population in USA 2009.
•
73 Median age at death for cancer of the stomach 73
years
•
= 2/3 stomach cancer patients are older than 65
Howlader N,. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009
•
Populations), National Cancer Institute. Bethesda, MD,
http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011
SEER data submission, posted to the SEER web site, 2012.
10. 2. Environmental Causes of Gastric Cancer; Easily Prevented
What Does Cause Gastric Cancer? Its Not Billroth II
• Diet: Fried, Salted, Smoked or Preserved foods
• Nitrites converted to (carcinogens) by bacteria in
the stomach.
• Fruit and Vegetables protects against Cancer
• Stomach cancer: Much more common:
Smoking & Heavy alcohol intake
• H. Pylori,
•No H. Pylori = No Cancer
11. 2. Gastric Cancer; Environmental Causes;
Easily Prevented
•
H. Pylori Treatment Normalizes Risk of Gastric Cancer in
Ulcer Patients.
•
Early treatment of H. Pylori in Gastric Ulcer patients =>
•
Risk of Gastric Cancer decreased to NORMAL!
•
Decrease risk from 1.60 to 1.05 ( = general population);
"Early Helicobacter pylori eradication decreases risk of gastric cancer in
•
patients with peptic ulcer disease." Wu CY,et al. Div of Gastro., Taichung,
Taiwan
12. 2. Environmental Causes of Gastric
Cancer; Easily Prevented
Avoid
ETOH, Tobacco,
Processed & Preserved
Meats,
Salted Foods
Rx H. Pylori,
Eat Fruits & Veggies, Yogurt
Drink Green Tea
Gonzalez CA, Cancer Research, Institut Català d'Oncologia,
Av. Gran Via s/n, km 2.7, 08907 L'Hospitalet, Barcelona,
Spain.
13. 3. Many Large Studies: NO Increased Risk
Gastric Cancer with Billroth II
• Mayo Clinic Study (Example)
• 338 Billroth II patients
• Followed 25-years
• 5,635 person-years
• Only 2 Cancers in
5,000+ pt years of Follow Up
•Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N
Engl J Med. 1983 Nov 17;309
14. 3. Many Large Studies: NO Increased Risk
Gastric Cancer with Billroth II
•Population based study, 338 Billroth II
pts
•Followed 25-years
•5,635 person-years
•Only 2 Cancers Found in 5,000 years
•Predicted 2.6 cancers (relative risk 0.8)
Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J
Med. 1983 Nov 17;309
15. 3. Many Large Studies: NO Increased Risk
Gastric Cancer with Billroth II
• 338 Billroth II pts, Followed 25-years
• 5,635 person-years
• Only 2 Cancers in 5,000 pt years follow
up
• RATE of Gastric Cancer is Declining
• 24 - 50% Expected Decrease from 1983
• Future risk 1 patient / 5,000 pt years
16. 3. Many Large Studies: NO Increased Risk
Gastric Cancer with Billroth II
Many large scale studies;
•
No increased risk of Gastric Cancer after Billroth
•
II
30 yr follow up, over 500 pts,
•
"Risk of gastric cancer is * Not * increased after
•
Billroth II."
Bassily R, J Gastro Hepatl. 2000
•
17. 4. Some studies Small Increase Risk
Gastric Cancer after Billroth II
•
(Confusion Association vs. Causation)
•
Some studies Small Increase Risk of Gastric Cancer
after Billroth II
•
In all of these studies Billroth II used to treat Ulcers
•
H. Pylori is the common Etiological Agent of
Both Ulcers & Gastric Cancer
•
H. Pylori Causes Both Ulcers and Cancer
18. 4. Some studies Small Increased Risk Gastric Ca
after Billroth II; Association vs. Causation
Meta-analysis 12 Studies:
Relation of Billroth II with Gastric Cancer:
Small increased risk; 7 studies
No Increased Risk; 5 studies
Studies that show increased Risk; [Flawed]
Billroth II Surgery was used to treat “Ulcers”
ULCERS increase risk of Gastric Cancer!
Ulcers & Gastric Cancer Common Etiology H. Pylori
19. 4. Some studies Small Increased Risk
Gastric Cancer after Billroth II
ULCERS INCREASE RISK GASTRIC CANCER
• Study 3,078 gastric cancer vs. 89,082 controls
• Ulcer increases risk gastric cancer
= (relative risk 1.53) =
• Same as Increased Risk reported Billroth II
• Many other studies confirm these findings:
• Ulcer Increases Risk Gastric Cancer
• Both Ulcers & Gastric Cancer:
• Common Etiology = H. Pylori
20. BARIATRIC SURGEONS FEAR BILLROTH II
What is the Risk of Gastric Cancer?
• Statistical significance tells us that an observed
difference is reliable, but whether the difference is large
enough to be important cannot be resolved by applying a
statistical formula.
• A STATISTICALLY SIGNIFICANT difference is not
necessarily one that is of CLINICAL SIGNIFICANCE
21. 5. No Endoscopic Screening for Billroth II
Gastric Ca Risk after Billroth II = General Population
•Follow-up study of 1,000 Billroth II patients
•22-30 year follow-up
•196 Endoscopies & Biopsy: No Cancer
•Conclusion in 1983!:
•Endoscopic screening “UNREWARDING”
•Since 1983 Rate Gastric Ca Down 50%!!
•Br J Surg. 1983 Sep;70(9):552-4. Risk of gastric cancer after Billroth II resection for
duodenal ulcer. Fischer AB
22. 5. BARIATRIC SURGEONS FEAR BILLROTH II
GASTROENTEROLOGISTS IGNORE BILLROTH II
Hundreds of thousands of people with Billroth II
If cancer after Billroth II was a clinically important
RISK…
Gastroenterologists
DO NOT Offer Screening Endoscopy for Billroth II
No recommendation for BII follow up screening;
Why? THE RISK IS LOW (Equal General Population)
One Study: 63,000 Pt yrs:
23 cancers = Same General Population
23. 6. BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
•1,490 articles on performance of the
Billroth II
•General/Trauma/Oncologic surgeons
commonly use the Billroth II
•Over 16,000 Billroth II operation
performed in USA 2007
•While Bariatric Surgeons Fear the Billroth
II General Surgeons use the Billroth II
routinely
24. 6. BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
•According to the National Inpatient
Sample from USA, over 16,000 Billroth II
operations were performed in 2007 in the
USA.
•The Nationwide Inpatient Sample (NIS) is a unique and
powerful database of hospital inpatient stays. Researchers and
policymakers use the NIS to identify, track, and analyze
national trends in health care utilization, access, charges,
25. 6. BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
Korea has the Highest Risk of Gastric Cancer in
the World.
In April 2012 two papers by Oncologic Surgeons
from Korea (379 cases) and China (70 cases)
reported
Two series of Laparosocpic
Antrectomy & Billroth II for distal Gastric Cancer.
In the first 3 months of 2012 there
20 other similar papers.
Antrectomy & Billroth II by these cancer surgeons
was a viewed as *reasonable and acceptable*
26. 2012 Study Cancer Surgeon Reports Gastrectomy &
Billroth-II for Gastric Cancer = MINI-GASTRIC BYPASS
J Korean Surg Soc. 2012 Mar;82(3):135-42. Epub 2012 Feb 27. Comparison of laparoscopy-assisted and totally laparoscopic
Billroth-II distal gastrectomy forgastric cancer. Lee J, Kim D, Kim W.
130 Gastric Cancer Patients Rx Billroth II Performed
using technique identical to MGB
27. UNINFORMED SURGEONS FEAR BILLROTH II
GENERAL SURGEONS USE BILLROTH II
•A Billroth II gastro-jejunostomy is a common and
accepted reconstruction after antretomy;
•A Billroth II * IS NOT * an acceptable
reconstruction following total or sub total
gastrectomy because of bile reflux into the
esophagus.
28. UNINFORMED SURGEONS FEAR BILLROTH II
GENERAL SURGEONS USE BILLROTH II
•Billroth II with anastomosis at the junction of the
body and the antrum of the stomach in the Mini-
Gastric Bypass is a *reasonable and acceptable*
surgical choice.
•The OLD Mason Loop Gastric Bypass placed the
Billroth II high on the stomach adjacent to the
esophagus, NOT *reasonable or acceptable* and
could be predicted to fail.
29. UNINFORMED SURGEONS FEAR BILLROTH II
EDUCATED SURGEONS USE BILLROTH II
1. Gastric Cancer Declining Rapidly, > 50%
2. Gastric Cancer Cause/Prevention:
Environmental Factors / Easily Prevented
Diet, Lifestyle changes and Rx of H. Pylori
Avoid Etoh, smoking, processed & salted meats
and foods,
Seek high intake of fruits and vegetables
30. UNINFORMED SURGEONS FEAR BILLROTH II
EDUCATED SURGEONS USE BILLROTH II
3. Many Large Studies:
No Increased Risk
Thousands of patients/followed for Decades
4. Some Billroth II studies:
Slight Increased Risk 20 – 30 years (RR 1.5)
But:
Billroth II performed to Rx Ulcer
Ulcer => Increases Risk Gastric Ca (H. Pylori)
31. UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
5. Endoscopic screening of Billroth II
Not Recommended. Why? Low Risk!
6. General, Trauma and Oncologic surgeons
Routinely use the Billroth II
(Thousands of publications)
2007 16,000 BII procedures performed in USA
32. UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
Billroth II and the Mini-Gastric Bypass
Excellent, Safe and Effective
IF FEAR Gastric Cancer?
Avoid ETOH, Tobacco, Processed & Preserved Meats,
Rx H. Pylori,
Eat Fruits and Veggies, Yogurt and Drink Green Tea
A Billroth II probably makes NO difference
33. Rational Data Analysis vs.
Irrational FEAR Gastric Cancer
1.Gastric Cancer; Declining Rapidly
2. Gastric Cancer Environmental Causes;
Easily Prevented
3. Many large studies:
NO Increased Risk Gastric Cancer after Billroth II
4. Some studies Small Increased Risk
Gastric Cancer Billroth II, Billroth II used to Rx Ulcers;
H. Pylori = Ulcers & Gastric Cancer
(Confusion Association vs. Causation)
5. Endoscopic Screening: Not Recommended
(Clinical Relevance vs. Statistical Significance)
6. General, Trauma & Oncologic Surgeons
Routinely Use Billroth II
34. ? FEAR OF GASTRIC CANCER ?
“ IF ” FEAR Gastric Cancer; ” THEN: ”
1. Avoid: Alcohol, Tobacco,
Processed & Preserved Meats
2. Eat: Fruits & Veggies, Yogurt
3. Rx: H. Pylori
Billroth II Makes NO Difference !!
35. •Rational Review of the Data vs.
•Fear Gastric Cancer / Bile Reflux
•Rational Thinking vs.
•Reptilian Brain
36. FEAR OF GASTRIC CANCER
A Billroth II
Probably Makes
No Difference
37. FEAR OF GASTRIC CANCER
A Billroth II
Probably Makes No Difference
38. Fear of Cancer after Bariatric
Surgery
IS APPROPRIATE!
FEAR ESOPHAGEAL CANCER
AFTER SLEEVE AND BAND
39. Fear of Cancer After Bariatric Surgery?
Acid Reflux Primary Cause of Cancer of
Esophagus
GERD Increases Risk of Cancer of Esophagus. Longer
GERD = More Risk.
GERD can cause Barrett's = even higher risk, from the
American Cancer Society.
JAMA. 2002 Apr 17;287(15):1972-81. Gastroesophageal reflux, barrett
esophagus, and esophageal cancer: scientific review. Shaheen N, Ransohoff
DF. Division of Digestive Diseases and Nutrition, Center for Esophageal
Disease and Swallowing, CB#7080, University of North Carolina-Chapel Hill,
Chapel Hill, NC 27599-7080, USA. nshaheen@med.unc.edu
40. Fear of Cancer After Bariatric Surgery?
Acid Reflux Primary Cause of Cancer of
Esophagus
Treating or Preventing
Gastro Esophageal Reflux Disease
(GERD) can protect & prevent
Barrett's & Esophageal cancer.
41. Fear of Cancer After Bariatric Surgery?
Acid Reflux Primary Cause of Cancer of
Esophagus
Numerous Studies Now Show that the Band
& Sleeve increase acid reflux & Barretts &
Esophageal Caner.
Dis Esophagus. 2011 Jan;24(1):E8-10. Esophageal adenocarcinoma after laparoscopic gastric band placement for
obesity Stauffer JA, Mathew J, Odell JA, Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Ann Surg. 2010 Aug;252(2):319-24. Long-term results of laparoscopic sleeve gastrectomy for obesity. Himpens J, Division
of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan, Dendermonde, Belgium.
Obes Facts. 2011;4 Suppl 1:42-6. Epub 2011 Apr 4. Failure of laparoscopic sleeve gastrectomy--further procedure?
Weiner RA, Theodoridou S, Weiner S. Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt/M, Germany.
rweiner@khs-ffm.de
Surg Obes Relat Dis. 2011 Nov-Dec;7(6):709-13. Epub 2011 Aug 16. Gastroesophageal reflux after sleeve gastrectomy in
morbidly obese patients. Howard DD, Caban AM, Cendan JC, Ben-David K. Department of Surgery, Minimally Invasive,
Gastroesophageal and Bariatric Surgery Service, University of Florida, Gainesville, Florida 32610, USA.
Obes Surg. 2010 Feb;20(2):244-6. Epub 2009 Dec 8, Barrett's esophagus: a late complication of laparoscopic adjustable
gastric banding, Varela JE., Minimally Invasive and Bariatric Surgery, Washington University, 660 South Euclid, Box 8109,
St Louis, MO 63110, USA. varelae@wudosis.wustl.edu
42. Sleeve & Band:
20-30% New Onset GERD
GERD =>
Increased Risk of
Esophageal Cancer
Dr. Rutledge
•
43. Gastroesophageal reflux disease and
sleeve gastrectomy USA
•Postoperatively, 49% complained of immediate
(within 30 d) GERD symptoms,
•47.2% had persistent GERD symptoms that
lasted >1 month after LSG, and
•33.8% of patients were taking medication
specifically for GERD after LSG.
•Surg Obes Relat Dis. 2011 Gastroesophageal reflux disease and
sleeve gastrectomy. Carter PR LaGrange, IL USA.
44. Gastroesophageal reflux disease and
sleeve gastrectomy USA
•Many studies designed to evaluate the
outcome of reflux symptoms following
conventional and surgical treatment of
obesity.
•Among bariatric procedures, gastric sleeve
& band have been shown to worsen reflux
symptoms in the postoperative setting.
•Curr Gastroenterol Rep. 2011 Jun, Obesity and GERD:
pathophysiology and effect of bariatric surgery.Tutuian R.
Bern, Switzerland.
45. Gastroesophageal reflux disease and
sleeve gastrectomy USA
•We Know Esophageal Cancer Dangerous
Deadly and Rising Rapidly
•We Know That Acid Reflux (GERD) Is
Most Important Causative Factor in
Esophageal Cancer
•Numerous Studies Including the Sleeve
Consensus Conference Show Band &
Sleeve Cause 20-30% New Onset GE
Reflux
•The Sleeve & Band Pre-cancerous
Lesions In Up To 1/4 -1/3 Patients
46. Imagine; Your Post Op
Sleeve or Band Patient
Post Op Patient Visit"
•
"Dr. I found out the operation that you
•
performed on me may cause cancer,
esophageal cancer.
You did not tell me this."
•
Your answer?
•
We need to warn our patients!
•
47. Fear of Cancer after Bariatric
Surgery
IS APPROPRIATE!
FEAR ESOPHAGEAL CANCER
AFTER SLEEVE AND BAND