Eric Bour

The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity

BACKGROUND Saline-filled intragastric balloon devices are reversible endoscopic devices designed to occupy stomach volume and reduce food intake. OBJECTIVE To evaluate the safety and effectiveness of a dual balloon system plus diet and exercise in the treatment of obesity compared to diet and exercise alone. SETTING Academic and community practice, United States. METHODS Participants (n = 326) with body mass index (BMI) 30-40 kg/m(2) were randomized to endoscopic DBS treatment plus diet and exercise (DUO, n = 187) or sham endoscopy plus diet and exercise alone (DIET, n = 139). Co-primary endpoints were a between-group comparison of percent excess weight loss (%EWL) and DUO subject responder rate, both at 24 weeks. Thereafter DUO patients had the DBS retrieved followed by 24 additional weeks of counseling; DIET patients were offered DBS treatment. RESULTS Mean BMI was 35.4. Both primary endpoints were met. DUO weight loss was over twice that of DIET. DUO patients had significantly greater %EWL at 24 weeks (25.1% intent-to-treat (ITT), 27.9% completed cases (CC, n = 167) compared with DIET patients (11.3% ITT, P = .004, 12.3% CC, n = 126). DUO patients significantly exceeded a 35% response rate (49.1% ITT, P<.001, 54.5% CC) for weight loss dichotomized at 25%EWL. Accommodative symptoms abated rapidly with support and medication. Balloon deflation occurred in 6% without migrations. Early retrieval for nonulcer intolerance occurred in 9%. Gastric ulcers were observed; a minor device change led to significantly reduced ulcer size and frequency (10%). CONCLUSION The DBS was significantly more effective than diet and exercise in causing weight loss with a low adverse event profile.

Reduction in anastomotic strictures using bioabsorbable circular staple line reinforcement in laparoscopic gastric bypass

BACKGROUND Anastomotic stricture remains the most common complication after laparoscopic gastric bypass with a circular-stapled gastrojejunostomy. The present study examined the effect of the use of bioabsorbable circular staple line reinforcement on the incidence of gastrojejunostomy anastomotic strictures as a complication of laparoscopic Roux-en-Y gastric bypass. METHODS A retrospective review was performed of 851 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with circular-stapled gastrojejunostomy. Gore SeamGuard bioabsorbable circular staple line reinforcement was used in 596 consecutive patients subsequent to 255 consecutive patients without anastomotic reinforcement. The incidence of anastomotic stricture was compared after mean follow-up periods of 19 and 22 months for the two groups. RESULTS Anastomotic stricture requiring intervention was identified in 28 patients (2.94%). Only four patients (.67%) in the SeamGuard group developed anastomotic stricture compared with 24 patients (9.41%) in the no SeamGuard group. The use of staple line reinforcement is consistent with a 94% risk reduction in stricture formation. CONCLUSION The results have shown that the use of bioabsorbable circular staple line reinforcement on gastrojejunal anastomoses in laparoscopic Roux-en-Y gastric bypass significantly reduces the incidence of anastomotic stricture. The standard use of the bioabsorbable reinforcement on circular staple line anastomoses could be a part of the solution to the most common complication of laparoscopic gastric bypass.

Joint task force recommendations for credentialing of bariatric surgeons

Joint task force recommendations for credentialing of bariatric surgeons William B. Inabnet III, M.D., Eric Bour, M.D., Arthur M. Carlin, M.D., Ronald Clements, M.D., Jonathan Finks, M.D., Matt Hutter, M.D., Christopher Joyce, M.D., Kim Marley, M.D., Joe Moran, M.D., John Morton, M.D., Kevin Reavis, M.D., William S. Richardson, M.D., Shean Satgunam, M.D. Ichan School of Medicine at Mount Sinai, New York, New York Hillcrest Memorial Hospital, Greenville Health System, Greenville, South Carolina Wayne State University, K-8 Surgery, Detroit, Michigan Vanderbilt University, Nashville, Tennessee University of Michigan, Ann Arbor, Michigan Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts BMI Surgery, New Lenox, Illionois Windber Medical Center, Windber, Pennsylvania The Raleigh Center for Weight Loss Surgery & Rex Healthcare, Raleigh, North Carolina Stanford School of Medicine, Stanford, California Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon Ochsner Clinic, New Orleans, Louisiana Michigan State University, East Lansing, Michigan Received June 14, 2013; accepted June 17, 2013

Assessing the real-world effect of laparoscopic bariatric surgery on the management of obesity-related comorbidities: A retrospective matched cohort study using a US Claims Database.

To evaluate the real‐world effect of laparoscopic bariatric surgery, comprising adjustable gastric banding (LAGB), laparoscopic Roux‐en‐Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), on the management of obesity‐related comorbidities.