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M1354 Abdominal Obesity vs. Total Body Obesity: Specific Risk Factors
M1356
Abdominal Obesity vs. Total Body Obesity: Specific Risk Factors Joel H. Rubenstein, Hal Morgenstern, Joan E. Kellenberg, Tal Kalish, Philip S. Schoenfeld, John M. Inadomi
Endoscopic Revision of Dilated Gastrojejunostomy in Gastric Bypass Patients Experiencing Weight Regain: A Matched Cohort Comparison of Transoral Sutured Revision Versus Sclerotherapy Versus Controls Marvin K. Ryou, Barham K. Abu Dayyeh, Song Yu, Ian T. Greenwalt, David B. Lautz, Christopher C. Thompson
Background: Abdominal obesity (characterized by increased waist to hip ratio, WHR) is associated with diabetes, cardiovascular disease, fatty liver disease, and various cancers. Increased WHR is associated with gender and race. Little is known about what behavioral factors may be associated with this body fat distribution. Methods: 283 men aged 50-79 years undergoing colonoscopy for colon cancer screening underwent body measurements and answered questionnaires regarding dietary habits and physical activity. We estimated Pearson and Spearman correlations between measures of obesity and various behaviors, and used linear regression models of the behaviors for body mass index (BMI per 1 kg/m2), waist circumference (per 1 cm), hip circumference (per 1 cm), and WHR (per 0.01), both unadjusted, and adjusted for each other. Results: Mean BMI was 30.4 kg/m2 (standard deviation, SD = 5.9), waist 109cm (SD = 15), hip 109cm (SD = 12), and WHR 1.00 (SD = 0.06). Waist was very closely correlated with BMI (rho = 0.93), as was hip (rho = 0.92), but WHR was only moderately correlated with BMI (rho = 0.45). Correlations with each measure of obesity are shown in Table 1. Linear regressions results for obesity, adjusted for each factor and for BMI or WHR, are shown in Table 2. Conclusions: WHR appears to measure a construct distinct from waist circumference or BMI. The association between the ratio of fat to carbohydrate intake and WHR may be due to the increased capacity of visceral fat for taking up fatty acids. The inverse association of frequent moderate exercise with WHR may be due to the increased sensitivity of visceral fat to catecholamines for lipolysis. Age is also associated with WHR. These findings may direct future research aimed at reducing the risk of sequelae from abdominal obesity. Table 1: Correlations (rho)
Background: Dilation of the gastrojejunostomy (DGJ) is a potential mechanism for weight regain after gastric bypass (RYGB). Transoral suturing and serial sclerotherapy (up to 3 sessions) are the two most commonly performed endoscopic techniques for DGJ revision. However, the relative efficacy of these techniques is unknown. Aim: To assess the 6 month weight trends associated with transoral sutured revision versus sclerotherapy versus control group in a matched cohort study design. Methods: From our institution, 243 consecutive transoral sutured revisions, 89 consecutive sclerotherapy revisions, and 1018 consecutive RYGB patients were restrospectively evaluated. Ultimately, 45 sutured revisions, 45 sclerotherapy revisions, and 45 control patients were selected and matched based on age, sex, diabetes, % excess weight loss (EWL) following RYGB, and time since RYGB. Sutured revisions and sclerotherapy revisions were additionally matched for amount of weight regain and pre-procedural pouch and gastrojejunostomy measurements. Given variable loss to follow-up, a time-to-weight regain analysis was performed using the Kaplan-Meier productlimit method, and survival distributions were compared using the log-rank test. Patients were censored when they returned to baseline weight or, in the case of sutured patients only, if they underwent a second procedure. An average of 2.4 sclerotherapy sessions per patient occurred during this time frame and repeat injection was not censored. Results: At 6 months, 76% of sutured revisions were at or below their baseline weight compared to 75% of sclerotherapy revisions and 50% of matched controls. By log rank test, there was a significant difference across the 3 groups (P < 0.0001). Specifically, suture vs controls (P<0.0001) and sclerotherapy vs controls (P=0.0023) were significant. The difference between suture vs sclerotherapy was not significant (P=0.4622). Conclusion: Transoral sutured revisions and sclerotherapy revisions lead to significant weight loss/stabilization at 6 months compared to patients who do not undergo revisions. A single suturing session appears equivalent to ongoing sclerotherapy at 6 months.
Table 2: Linear Regression Adjusted for Each Factor and Obesity (β [p-value])
M1357 Racial Differences in Bariatric Surgery Outcomes in the U.S.: An Analysis of the Nationwide Inpatient Sample Octavia E. Pickett-Blakely, Mary Margaret Huizinga, Jeanne M. Clark
M1355
Background: Although underrepresented minority groups are disproportionately affected by morbid obesity, these groups are less likely to undergo bariatric surgery. Differences in bariatric surgery outcomes by race have been reported, however, studies are limited by small sample sizes and single center experiences. Methods: We performed a retrospective, crosssectional analysis of the 1998 and 2007 Nationwide Inpatient Sample (NIS) to compare differences across racial/ethnic groups. The sample included all adults undergoing a bariatric surgery procedure. Our main outcomes were mortality, total hospital charges (U.S. dollars), and length of stay (days). The primary covariate of interest was race. Multivariable linear and logistic regression were used to determine the relationship between race and each outcome of interest after adjustment for sex, age, insurance, median income, co-morbidities and weight loss surgery type. Survey weights were utilized to generate national estimates. Results: Overall, mortality decreased over the 9-year study period from 0.8% (SE 0.5) in 1998 to 0.1% (SE 0.05) in 2007. Mortality was non-significantly higher in Whites compared to non-Whites in 1998 (OR 1.09; CI: 0.23, 5.1); however, in 2007 it was statistically significantly lower in Whites compared to non-Whites (OR 0.17; CI: 0.04,0.70). Length of stay in the overall bariatric surgery population also decreased over time (5.1 [SE 0.002] in 1998 to 2.3 days [SE 0.09] in 2007, and there was no significant difference in length of stay between Whites and non-Whites at any time point. Total charges increased overall from 1998 to 2007. In 1998, total charges for Whites were on average $1,190 lower than nonWhites (CI: -3630,1248) which was not statistically significant. However, in 2007 the average total charges for Whites were $6,590 less than non-Whites (CI:-12029,-1151), after adjustment. Conclusions: Mortality and total charges with bariatric surgery were significantly lower in Whites compared to non-Whites in 2007, while length of stay was not. Further studies are needed to better elucidate the causes of these racial differences.
Predictors of Weight Regain After Roux-en-Y Gastric Bypass Barham K. Abu Dayyeh, Christopher C. Thompson Background: Weight regain after Roux-en-Y gastric bypass (RYGB) occurs in 20%-30% of patients and is associated with significant morbidity and mortality. Risk factors for this costly complication are poorly defined. The purpose of this study is to specifically evaluate if increased gastrojejunal (GJ) stoma diameter is a risk factor for weight regain after RYGB, and to develop a prediction model that includes GJ diameter for weight regain after RYGB surgery. Methods: Data from all patients referred to a tertiary care bariatric center for upper endoscopy post RYGB, over the past 3 years, were analyzed. 100 consecutive patients with recorded GJ diameter and know postsurgical weight profile were included. Linear regression analysis was performed to determine the association between the GJ diameter and continuous weight regain. Adjustments were made for age, gender, diabetes status, postoperative complications, amount of weight loss after RYGB surgery, time between RYGB surgery and GJ stoma diameter measurement, and gastric pouch length. Results: The average age of the population was 44 years, 92% females, 16% with diabetes, 22% with known marginal ulcers or erosions. Average weight loss after RYGB surgery was 111 lbs, and the average weight regain from nadir weight was 37 lbs. The average GJ stoma diameter was 20mm and the average length of the gastric pouch was 50 mm. The average time between the RYGB surgery and endoscopic measurement of the GJ stoma was 5 years. GJ stoma diameter was significantly associated with weight regain after RYGB surgery in univariate analysis (p = 0.05) with larger stoma diameters predicting more weight regain (β = 1). This association remained significant after adjusting for the above covariates and confounders (standardized β = 0.16, p = 0.03). Other significant predictors of weight regain include amount of weight loss after the RYGB (standardized β = 0.35, p < 0.0001), time from initial RYGB surgery (standardized β = 0.48, p < 0.0001), and presence of stomal ulceration (standardized β = - 0.16, p = 0.013). A linear regression model that included all the above significant predictors has an R2 of 0.6 (p < 0.0001) in predicting weight regain after RYGB surgery. Conclusion: Enlarged GJ stoma diameter is a risk factor for weight regain after RYGB, and larger diameters appear to predict greater weight gain. A model that includes GJ stoma diameter, amount of weight loss after RYGB, time from RYGB, and presence of stomal ulceration significantly predicts weight regain.
S-387
AGA Abstracts
AGA Abstracts
M1354
Abdominal Obesity vs. Total Body Obesity: Specific Risk Factors Joel H. Rubenstein, Hal Morgenstern, Joan E. Kellenberg, Tal Kalish, Philip S. Schoenfeld, John M. Inadomi
Endoscopic Revision of Dilated Gastrojejunostomy in Gastric Bypass Patients Experiencing Weight Regain: A Matched Cohort Comparison of Transoral Sutured Revision Versus Sclerotherapy Versus Controls Marvin K. Ryou, Barham K. Abu Dayyeh, Song Yu, Ian T. Greenwalt, David B. Lautz, Christopher C. Thompson
Background: Abdominal obesity (characterized by increased waist to hip ratio, WHR) is associated with diabetes, cardiovascular disease, fatty liver disease, and various cancers. Increased WHR is associated with gender and race. Little is known about what behavioral factors may be associated with this body fat distribution. Methods: 283 men aged 50-79 years undergoing colonoscopy for colon cancer screening underwent body measurements and answered questionnaires regarding dietary habits and physical activity. We estimated Pearson and Spearman correlations between measures of obesity and various behaviors, and used linear regression models of the behaviors for body mass index (BMI per 1 kg/m2), waist circumference (per 1 cm), hip circumference (per 1 cm), and WHR (per 0.01), both unadjusted, and adjusted for each other. Results: Mean BMI was 30.4 kg/m2 (standard deviation, SD = 5.9), waist 109cm (SD = 15), hip 109cm (SD = 12), and WHR 1.00 (SD = 0.06). Waist was very closely correlated with BMI (rho = 0.93), as was hip (rho = 0.92), but WHR was only moderately correlated with BMI (rho = 0.45). Correlations with each measure of obesity are shown in Table 1. Linear regressions results for obesity, adjusted for each factor and for BMI or WHR, are shown in Table 2. Conclusions: WHR appears to measure a construct distinct from waist circumference or BMI. The association between the ratio of fat to carbohydrate intake and WHR may be due to the increased capacity of visceral fat for taking up fatty acids. The inverse association of frequent moderate exercise with WHR may be due to the increased sensitivity of visceral fat to catecholamines for lipolysis. Age is also associated with WHR. These findings may direct future research aimed at reducing the risk of sequelae from abdominal obesity. Table 1: Correlations (rho)
Background: Dilation of the gastrojejunostomy (DGJ) is a potential mechanism for weight regain after gastric bypass (RYGB). Transoral suturing and serial sclerotherapy (up to 3 sessions) are the two most commonly performed endoscopic techniques for DGJ revision. However, the relative efficacy of these techniques is unknown. Aim: To assess the 6 month weight trends associated with transoral sutured revision versus sclerotherapy versus control group in a matched cohort study design. Methods: From our institution, 243 consecutive transoral sutured revisions, 89 consecutive sclerotherapy revisions, and 1018 consecutive RYGB patients were restrospectively evaluated. Ultimately, 45 sutured revisions, 45 sclerotherapy revisions, and 45 control patients were selected and matched based on age, sex, diabetes, % excess weight loss (EWL) following RYGB, and time since RYGB. Sutured revisions and sclerotherapy revisions were additionally matched for amount of weight regain and pre-procedural pouch and gastrojejunostomy measurements. Given variable loss to follow-up, a time-to-weight regain analysis was performed using the Kaplan-Meier productlimit method, and survival distributions were compared using the log-rank test. Patients were censored when they returned to baseline weight or, in the case of sutured patients only, if they underwent a second procedure. An average of 2.4 sclerotherapy sessions per patient occurred during this time frame and repeat injection was not censored. Results: At 6 months, 76% of sutured revisions were at or below their baseline weight compared to 75% of sclerotherapy revisions and 50% of matched controls. By log rank test, there was a significant difference across the 3 groups (P < 0.0001). Specifically, suture vs controls (P<0.0001) and sclerotherapy vs controls (P=0.0023) were significant. The difference between suture vs sclerotherapy was not significant (P=0.4622). Conclusion: Transoral sutured revisions and sclerotherapy revisions lead to significant weight loss/stabilization at 6 months compared to patients who do not undergo revisions. A single suturing session appears equivalent to ongoing sclerotherapy at 6 months.
Table 2: Linear Regression Adjusted for Each Factor and Obesity (β [p-value])
M1357 Racial Differences in Bariatric Surgery Outcomes in the U.S.: An Analysis of the Nationwide Inpatient Sample Octavia E. Pickett-Blakely, Mary Margaret Huizinga, Jeanne M. Clark
M1355
Background: Although underrepresented minority groups are disproportionately affected by morbid obesity, these groups are less likely to undergo bariatric surgery. Differences in bariatric surgery outcomes by race have been reported, however, studies are limited by small sample sizes and single center experiences. Methods: We performed a retrospective, crosssectional analysis of the 1998 and 2007 Nationwide Inpatient Sample (NIS) to compare differences across racial/ethnic groups. The sample included all adults undergoing a bariatric surgery procedure. Our main outcomes were mortality, total hospital charges (U.S. dollars), and length of stay (days). The primary covariate of interest was race. Multivariable linear and logistic regression were used to determine the relationship between race and each outcome of interest after adjustment for sex, age, insurance, median income, co-morbidities and weight loss surgery type. Survey weights were utilized to generate national estimates. Results: Overall, mortality decreased over the 9-year study period from 0.8% (SE 0.5) in 1998 to 0.1% (SE 0.05) in 2007. Mortality was non-significantly higher in Whites compared to non-Whites in 1998 (OR 1.09; CI: 0.23, 5.1); however, in 2007 it was statistically significantly lower in Whites compared to non-Whites (OR 0.17; CI: 0.04,0.70). Length of stay in the overall bariatric surgery population also decreased over time (5.1 [SE 0.002] in 1998 to 2.3 days [SE 0.09] in 2007, and there was no significant difference in length of stay between Whites and non-Whites at any time point. Total charges increased overall from 1998 to 2007. In 1998, total charges for Whites were on average $1,190 lower than nonWhites (CI: -3630,1248) which was not statistically significant. However, in 2007 the average total charges for Whites were $6,590 less than non-Whites (CI:-12029,-1151), after adjustment. Conclusions: Mortality and total charges with bariatric surgery were significantly lower in Whites compared to non-Whites in 2007, while length of stay was not. Further studies are needed to better elucidate the causes of these racial differences.
Predictors of Weight Regain After Roux-en-Y Gastric Bypass Barham K. Abu Dayyeh, Christopher C. Thompson Background: Weight regain after Roux-en-Y gastric bypass (RYGB) occurs in 20%-30% of patients and is associated with significant morbidity and mortality. Risk factors for this costly complication are poorly defined. The purpose of this study is to specifically evaluate if increased gastrojejunal (GJ) stoma diameter is a risk factor for weight regain after RYGB, and to develop a prediction model that includes GJ diameter for weight regain after RYGB surgery. Methods: Data from all patients referred to a tertiary care bariatric center for upper endoscopy post RYGB, over the past 3 years, were analyzed. 100 consecutive patients with recorded GJ diameter and know postsurgical weight profile were included. Linear regression analysis was performed to determine the association between the GJ diameter and continuous weight regain. Adjustments were made for age, gender, diabetes status, postoperative complications, amount of weight loss after RYGB surgery, time between RYGB surgery and GJ stoma diameter measurement, and gastric pouch length. Results: The average age of the population was 44 years, 92% females, 16% with diabetes, 22% with known marginal ulcers or erosions. Average weight loss after RYGB surgery was 111 lbs, and the average weight regain from nadir weight was 37 lbs. The average GJ stoma diameter was 20mm and the average length of the gastric pouch was 50 mm. The average time between the RYGB surgery and endoscopic measurement of the GJ stoma was 5 years. GJ stoma diameter was significantly associated with weight regain after RYGB surgery in univariate analysis (p = 0.05) with larger stoma diameters predicting more weight regain (β = 1). This association remained significant after adjusting for the above covariates and confounders (standardized β = 0.16, p = 0.03). Other significant predictors of weight regain include amount of weight loss after the RYGB (standardized β = 0.35, p < 0.0001), time from initial RYGB surgery (standardized β = 0.48, p < 0.0001), and presence of stomal ulceration (standardized β = - 0.16, p = 0.013). A linear regression model that included all the above significant predictors has an R2 of 0.6 (p < 0.0001) in predicting weight regain after RYGB surgery. Conclusion: Enlarged GJ stoma diameter is a risk factor for weight regain after RYGB, and larger diameters appear to predict greater weight gain. A model that includes GJ stoma diameter, amount of weight loss after RYGB, time from RYGB, and presence of stomal ulceration significantly predicts weight regain.
S-387
AGA Abstracts
AGA Abstracts
M1354