Dan Eisenberg

Standardized outcomes reporting in metabolic and bariatric surgery

ASMBS, SOARD, outcome reporting standards Standardized outcomes reporting in metabolic and bariatric surgery Stacy A. Brethauer, MD*, Julie Kim, MD, Maher el Chaar, MD, Pavlos Papasavas, MD, Dan Eisenberg, MD, Ann Rogers, MD, Naveen Ballem, MD, Mark Kligman, MD, Shanu Kothari, MD for the ASMBS Clinical Issues Committee Bariatric and Metabolic Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio Department of Surgery, Tufts University, Boston, Massachusetts Department of Surgery, St. Luke’s Hospital, Allentown, Pennsylvania Department of Surgery, Hartford Hospital, Hartford, Connecticut Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California Department of Surgery, Penn State University, Hershey, Pennsylvania Center for Advanced Surgical Weight Loss, Montclair, New Jersey Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland Department of Surgery, Gundersen Health System, La Crosse, Wisconsin Received February 2, 2015; accepted February 2, 2015

A Survivin Gene Signature Predicts Aggressive Tumor Behavior

Gene signatures that predict aggressive tumor behavior at the earliest stages of disease, ideally before overt tissue abnormalities, are urgently needed. To search for such genes, we generated a transgenic model of survivin, an essential regulator of cell division and apoptosis overexpressed in cancer. Transgenic expression of survivin in the urinary bladder did not cause histologic abnormalities of the urothelium. However, microarray analysis revealed that survivin-expressing bladders exhibited profound changes in gene expression profile affecting extracellular matrix and inflammatory genes. Following exposure to a bladder carcinogen, N-butyl-N-(4-hydroxybutyl) nitrosamine (OH-BBN), survivin transgenic animals exhibited accelerated tumor progression, preferential incidence of tumors as compared with premalignant lesions, and dramatically abbreviated survival. Conversely, transgenic expression of a survivin Thr34-->Ala dominant-negative mutant did not cause changes in gene expression or accelerated tumor progression after OH-BBN treatment. Therefore, survivin expression induces global transcriptional changes in the tissue microenvironment that may promote tumorigenesis. Detection of survivin or its associated gene signature may provide an early biomarker of aggressive tumor behavior before the appearance of tissue abnormalities.

Standardized outcomes reporting in metabolic and bariatric surgery.

When appropriate for the study design, the percentage of patients comprising the original study group who complete each follow-up period reported for the study should be reported (i.e., report the numerator and denominator available for follow-up at each time point reported). For prospective studies, percent follow-up should represent the percentage of patients from the original study group(s) who remained in the study until the study endpoint(s) are reached or for the final reported follow-up interval. The reasons for patient attrition from the study should be reported when possible. For

ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management.

ASMBS position statement ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management Julie Kim, M.D.*, Dan Azagury, M.D., Dan Eisenberg, M.D., Eric DeMaria, M.D., Guilherme M. Campos, M.D., on behalf of the American Society for Metabolic and Bariatric Surgery Clinical Issues Committee Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts Department of Surgery, Stanford University School of Medicine, Stanford, California Department of Surgery, Bon Secours DePaul Medical Center, Norfolk, Virginia Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia

Metabolic consequences of bariatric surgery.

Obesity has gained prominence as a main cause of preventable illness and death in the developed world. Surgical therapy for obesity is extremely effective in terms of weight reduction and amelioration of comorbidities. Bariatric procedures are not simply cosmetic operations, however, and involve considerable manipulation of the gastrointestinal tract to induce weight loss. The metabolic consequences of these procedures can be severe if not preempted with relatively simple postoperative precautions on the part of the patient and surgeon. Modern bariatric procedures are much safer than their predecessors, but nutritional and metabolic changes must be anticipated and compensated to fully realize the benefits of surgery. The metabolic consequences of the now outdated jejunoileal bypass, and the more modern Roux-Y gastric bypass, gastroplasty, and biliopancreatic diversion, are presented here, along with specific considerations of patient populations.

Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity.

Laparoscopic sleeve gastrectomy was found to be a safe and effective stand-alone procedure for severe, morbid, and super obese patients in a high-risk veteran population.

Portal vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity.

A high index of suspicion is necessary to diagnose portal vein thrombosis following laparoscopic bariatric procedures.

Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes

Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost. Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed. Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, P < 0.001). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively. Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings.

Short-term medication cost savings for treating hypertension and diabetes after gastric bypass

BACKGROUND The cost of medication for the treatment of hypertension and diabetes in the morbidly obese is a significant economic healthcare burden. In the present study, we assessed the effect of gastric bypass surgery on the average annual costs for hypertension and diabetes medication. METHODS A prospective database of gastric bypass patients at the Palo Alto Veterans Affairs Health Care System was reviewed. The preoperative and postoperative medication requirements to treat hypertension and diabetes were identified before surgery and at 1 year postoperatively. Comparisons were made between the annual costs of the antihypertensive and diabetic medications before and after bariatric surgery using the Student paired t test. RESULTS Of 106 patients who had undergone gastric bypass, 90 (85%) had either hypertension or diabetes. Of these 90 patients, 88 (98%) had hypertension and 60 (67%) had diabetes before surgery. Complete remission of hypertension occurred in 44% and remission of diabetes in 80% at 1 year after surgery. The annual cost of medications to treat hypertension was reduced by 65% at 1 year after surgery (

Telephone follow-up by a midlevel provider after laparoscopic inguinal hernia repair instead of face-to-face clinic visit.

63.52 compared with