Endoluminal procedures like EGPR and ROSE aim to treat weight regain after gastric bypass through minimally invasive techniques. EGPR uses tissue fasteners to reduce the gastric pouch size and narrow the stoma, resulting in 15.5 lb weight loss on average in 6 months. ROSE uses expandable anchors to similarly reduce pouch size and stoma diameter, stopping weight regain in 88% of patients. Both procedures appear safe and can produce near 50% loss of regained weight, though long-term durability is still unknown. Success may depend on factors like a patient's initial weight loss after gastric bypass.
The Skinny on he Role of Endoscopy in Bariatric SurgeryPatricia Raymond
Obesity epidemic; so where does endoscopy fit in with current bariatric surgery in preoperative assessment and management of complications, and what's under development for primary endoscopic bariatric techniques-- get the skinny here!
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
Duodenal Switch surgery is a very useful bariatric surgery for patients suffering from obesity. Approximately, the patients of DS lose around 60 to 80% of their surplus body weight and they experience nominal weight regain. For the patients of BMI greater than 50 this very surgery is very effective.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
Sleeve gastrectomy surgery is the best option for weight loss.Dr.Ramesh is an icon in the field of medical science. He has a lot of experience in the field of surgery.
The Skinny on he Role of Endoscopy in Bariatric SurgeryPatricia Raymond
Obesity epidemic; so where does endoscopy fit in with current bariatric surgery in preoperative assessment and management of complications, and what's under development for primary endoscopic bariatric techniques-- get the skinny here!
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
Duodenal Switch surgery is a very useful bariatric surgery for patients suffering from obesity. Approximately, the patients of DS lose around 60 to 80% of their surplus body weight and they experience nominal weight regain. For the patients of BMI greater than 50 this very surgery is very effective.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
Sleeve gastrectomy surgery is the best option for weight loss.Dr.Ramesh is an icon in the field of medical science. He has a lot of experience in the field of surgery.
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
Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
Flyer for one day seminar for surgeons and gastroenterologists showcasing innovative technologies in endosurgery and robotic surgery
Sept 19, 2011 New Delhi
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
How to Give Better Lectures: Some Tips for Doctors
Innovations in endoluminal bariatric surgery
1. New Horizons in Bariatric Surgery –
endoluminal treatments for weight
regain after gastric bypass:
Elliot R Goodman
MD
Bariatric Surgery
Service
Beth Israel Medical
Center
New York, NY
2. Background
150,000-200,000 bariatric operations done a year
Weight loss of 67-75% EBWL in 80% of patients in 2
years
14 year follow up study: 95% of patients maintained
at least 50% EBWL
Pories WJ, Swanson MS, MacDonald KG. Who would have thought it? An operation proves
to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:339-
350.
3. Background
Estimated 10% - 20% will regain some weight at 5 and 10 years
Usually a nadir weight is reached at 2 years
Weight regain
Mean 10-20% weight gain above nadir weight
Many patients dropping below 50% of % EBWL after primary
surgery
12% incidence of revision after gastric bypass surgery for
weight regain
Gagner M., et al. Laparoscopic Reoperative Bariatric Surgery : Experience from 27
consecutive patients. Obes Surg, (12) 254-260, 2002.
5. Background
Review of Literature on Reoperative Bariatric Surgery
838 patients - open reoperation
118 major complications (14%)
11 deaths (1.3%)
64 patients - laparoscopic reoperation
6 major complications (9%)
Average OR time 4.5 hours
Jones KB. Revisional bariatric Surgery-potentially safe and effective. SOARDS 1 (2005) 599-603
6. Background:
2008 ASMBS Member Survey
• What is the weight loss expectation for an
endoluminal revisional procedure
• 76% felt 10-20% EWL at 12 months with safety
equivalent to that of a therapeutic endoscopy was
acceptable
Brethauer SA, Pryor AD, Chand B et al Endoluminal procedures for bariatric
patients: expectations among bariatric surgeons (2009) Surg Obes Relat Dis
Mar-Apr;5 (2): 231-6
8. Endoluminal Gastric Pouch Reduction
StomaphyXTM
(EndoGastric Solutions, Redmond WA)
FDA approved in the United States for endoluminal
tissue approximation
CE marked in Europe
Patients who want further weight loss
Patients with rapid gastric emptying or dumping
syndrome associated with diarrhea
9. Endoluminal Gastric Pouch Reduction
Procedure
Average 20-40 3-0 polypropylene fasteners per case
Start 1 cm proximal to stoma- 12-16 fasteners
1-2 cm proximal to first row- another 12-16 fasteners
Additional fasteners until 1cm below GE junction reached
16. Beth Israel Medical Center results
2008-9 (N=64)
Age (years) 47.5 (24-66)
Female / Male 92% female / 8% male
Height (inches) 65
Median BMI Pre-Gastric Bypass 48.7
Median BMI Post-Gastric Bypass
(nadir)
31.3
Median BMI Post-GB(nadir) 31.3
Median time(years) after Gastric
bypass surgery
5 (2-10)
17. Median BMI before
StomaphyX
39.85 (25.9-54.9)
Median BMI post
Stomaphyx
37.75(25.1-55.2)
Median follow
up(months)
6(1-13)
No. Patients Weight
loss
43(67%)
No. Patients no weight
loss
14(21%)
No follow up weight
available
7(12%)
18. Median weight loss
(lbs.) post StomaphyX
15.5(3.3-67)
Median OR time 50 (35-130)
Median reduction in
gastric pouch length
33%(0-67)
Median # of fasteners 23(10-40)
20. Endoluminal Gastric Pouch Reduction
3 patients underwent repeat procedure
due to unsatisfactory results.
Maximum weight loss: 67 lbs
Postprandial diarrhea/GERD resolved.
Slowed gastric emptying
Obliteration of the gastrocolic
reflex
New valve created just distal to GE
junction
21. Latest data pooled
from 3 large US centers
(BIMC, OSU and Alvarado Hospital):
124 patients underwent EGPR at three
centers
94% female mean age 49(+/-10)yrs
mean pre-EGPR BMI 39(+/-8)
Mean 126lbs EWL after GB with 59lbs
regained 7.1 (+/-3.7) yrs after GB
Followed for 6 months (+/-4 SD) after
EGPR
22. Latest data (con):
EGPR reduced pouch length by 50(+/-
24)%
Mean number of plications 22(+/-9)
Mean weight loss 25lbs – 18% EWL or
43% RWL
Weight loss range - 23lbs gain to
183lbs loss
23. Predictive factors:
Weight loss after EGPR significantly
correlated with weight loss after initial
GB (p=0.001)
Lower pre-EGPR BMI predicted better
weight loss after EGPR (p=0.009)
27. ROSE Registry | Design, DemographicsROSE Registry | Design, Demographics
AGE TIME WEIGHT
≥18 Years old and < 65 Years old ≥ 2 years post
Roux-en-Y Bypass
Achieved ≥ 50% of EWL after initial
RYGB surgery
1 3 6 12
Clinical/Nutritional Follow-Up X X X X
EGD Follow-Up X X
INCLUSION CRITERIA: Broadly defined to collect clinical experience across the full spectrum of revision patients
STUDY DESIGN:
• Screening EGD to evaluate for pouch and/or stoma dilatation
• Procedure performed under general anesthesia
• Routine gastroscopy done pre- and post-procedure to document pouch and stoma measurements
PATIENT DEMOGRAPHICS:
Gender 101 females (87%) / 15 males
(13%)
Mean Age 46 years
Mean BMI pre-
ROSE
40
28. ROSE Registry | Safety FindingsROSE Registry | Safety Findings
Intra-Op
No significant intra-op complications
Early in the experience:
3 patients (<3%) with mucosal esophageal tear intra-operatively
All resolved spontaneously within 24 hours
Discharge
Sore Throat (41%)
Nausea/Vomiting (12%)
85% discharged the same day
Long-Term
12 month EGDs (N=66) documented absence of stricture or ulcer
29. ROSE Registry | Acute ProceduralROSE Registry | Acute Procedural
SuccessSuccess
Cases Completed 97% (112/116)
Mean Final Stomal Diameter 11.5 mm
Mean % Stomal Reduction 50%
Mean Final Pouch Length 3.3 cm
Mean % Pouch Reduction per
Case
44%
Mean # Total Anchors per Case 5.9
Mean O.R. Time 87 min
PRE-PROCEDURE
2.6 cm
POST-PROCEDURE
0.5 cm
INTRA-OP STOMA CHANGE
30. Patient Initials: 02
•Patient has lost 0 lbs after 3 months
•Stoma Diameter: 12mm x 20mm
•Pouch length: 7cm
•We counted about 15 T-Tags present
•Surgeon reported that he fired about 40 T-
Tags
Patient Initials: 01
•Patient has lost 0 lbs after 3 months
•Stoma Diameter: 25mm
•Pouch length: 6.5cm
•Only a couple of T-Tags were apparent
•Surgeon reported that he fired 15-20 T-
Tags
StomaphyX Case Study: 90 day EGD
31. Results-6 Month Weight Loss
6 Month Endpoint (N=96) Mean for
Total Registry
Max for
Individual
Subject
Weight Loss (kg) 6.5kg 30kg
%EWL* 18% 84%
% Regained Weight Lost
(RWL)
32% 300%
*based on target BMI 25kg/m2
32. Expandable Tissue Anchors
Durability
Preclinical Research demonstrated tissue remodeling
mechanism
Clinical Experience confirmed long term anchor
durability in multiple applications
Anchors visible on 92% (61/66) of 12 month EGDs
post ROSE Procedure
12 month EGD
post-ROSE
12 month EGD post-
gastrotomy closure
33. Grouped Variable Analysis
6 month ROSE Data
Best Positive Group Predictors for %EWL at 6
months*
*using linear regression modeling
¥
p<.05 statistically significant
Predictive Grouping P-value¥
%EWL from original bypass 0.0015
# of total anchors placed 0.0267
Female >50 0.0399
Pre-ROSE procedure pouch length 0.3187
34. Analysis/Discussion
Success post-bypass predicted ROSE
success at 6 months (p=.006)
• Top 20% RYGB pts (based on initial weight
loss) lost 29% EWL at 6 months with ROSE
ROSE stopped weight regain in 88%
(84/96) of patients at 6 months
35. Patient Initials: MR
Anchors in stoma: 2
Anchors in pouch: 2
Weight: 230 lbs
Weight lost since ROSE: 20 lbs
Estimated pouch length: 4.0 cm
Estimated stoma diameter: 0.6 cm
Estimated pouch length: 6.0 cm
Estimated stoma diameter: 0.8 cm
Patient Initials: KL
Anchors in stoma: 5
Anchors in pouch: 3
Weight: 260 lbs
Weight lost since ROSE: 21 lbs
ROSE: 90 day EGD
37. Endoluminal Gastric Pouch Reduction
Mechanism of Weight
loss
Reduction in size
of pouch
Reduction in size
of stoma
Reduce
compliance of
pouch
Slowed gastric
emptying
38. Conclusions:
EGPR procedures are safe and can produce
almost 50% loss of regained weight after 6-12
months
Long term durability still unknown
Pouch size reduction and stomal narrowing
appears to treat dumping and GERD in most
patients
Behavioral issues still play a major role in
determining success after EGPR