P60

Abstracts: Poster Session 2006 / 2 (2006) 310 –347

is related to leptin levels and if surgical weight loss will improve this form of SDB. PII: S1550-7289(06)00400-X

P59.

A COMPREHENSIVE CASE MANAGEMENT TOOL FOR THE MANAGEMENT OF GASTRIC BYPASS SURGERY PATIENTS. Garry Welch, PhD, Cheryl Wesolowski, RD, Bernadette Piepul, RN, Jennifer Frederici, MA, Richard Kedziora, MBA, Baystate Medical Center, Springfield, MA. Background: Case management systems are used to enhance use of evidence-based practice guidelines and foster patient self-management but have not yet been applied to gastric bypass surgery. We developed a case management tool built from an existing Java Oracle application for diabetes. Case management systems typically involve computerized databases and patient registries, systematic tracking for laboratory results and clinical findings using evidence based recommendations, alerts and decision support, reminders, and documentation of patient goals, treatment plan, and education activities. Methods: Interviews were conducted with experienced team clinicians to create content, algorithms, and alerts for salient clinical areas. Clinical literature was used to determine lab value cut-offs. Results: Weight change (BMI, % excess weight), vitamin and mineral deficiencies, anemia, metabolic syndrome, sleep apnea, GERD, arthritis, asthma, and post-surgical complications were included, some assessed by lab or clinical data and some by automated telephone survey of questionnaires. Psychosocial and self management measures include: (i) target lifestyle behaviors; (ii) emotional distress related to lifestyle adjustment; (iii) weight related symptoms: (iv) depression; (v) alcohol abuse; (vi) smoking; (vii) hunger; (viii) pain; (ix) social support; (x) health rating; (xi) benefits of weight loss. Algorithms for psychosocial and self management alerts were developed. Data feeds from wireless home monitoring of weight, blood pressure, and blood glucose devices will capture daily patient clinical status and functioning over time. Conclusion: We adapted the technological framework of a diabetes case management tool and developed content, clinical algorithms, and new patient report measures as necessary to comprehensively track patient functioning after gastric bypass surgery. PII: S1550-7289(06)00401-1

P60.

ARE SERUM METABOLIC VALUES RELIABLE IN DETECTING ABNORMALITIES IN SKELETAL AND MUSCLE MASS IN PATIENTS UNDERGOING GASTRIC BYPASS? Dimitrios Stefanidis, MD, PhD, Timothy S. Kuwada, MD, Yuri W. Novitsky, MD, Zerey Marc, MD, James M. Coumas, MD, Keith S. Gersin, MD, Todd B. Heniford, MD, Ron F. Sing, MD, Carolinas Medical Center, Charlotte, NC. Background: Serum metabolic markers are commonly used in gastric bypass patients to detect skeletal and muscle mass loss. Our

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objective was to determine the utility of serum calcium, parathyroid hormone (PTH) and albumin in detecting abnormalities in bone mineral density (BMD) and lean body mass (LBM) in gastric bypass patients. Methods: Review of prospectively collected data on 23 patients awaiting surgery and 22 patients who had undergone gastric bypass matched for age, preoperative weight, and gender. Serum calcium, PTH and albumin levels were compared to BMD and LBM as measured by dual energy x-ray absorptiometry (DEXA). Pearson’s correlation and T-test were used for statistical analysis; results are reported as mean ⫾ s.d. Results: At 17⫾7 months after gastric bypass, patients had lost 62⫾16% of their excess weight. Serum calcium and PTH did not correlate with BMD, nor did albumin with LBM, both pre and postoperatively. While the postoperative patients had a lower BMD and LBM compared to the preoperative group, no differences were noted in serum metabolic markers (table). Conclusion: Serum metabolic markers (calcium, PTH, and albumin) are inadequate in providing an accurate assessment of skeletal and muscle mass in the morbidly obese prior to, and following, gastric bypass surgery. DEXA exams in the pre and postoperative period are beneficial in accurately assessing skeletal and muscle mass changes in this patient population. Calcium (corrected) mg/dl PTH (pg/ml) Bone mineral density (g/cm2) Albumin (g/dl) Lean body mass (kg)

Postoperative

Preoperative

P-value

9.5 ⫾ 0.3 58 ⫾ 20 1.24 ⫾ 0.08 3.8 ⫾ 0.4 47.8 ⫾ 10.6

9.5 ⫾ 0.2 57 ⫾ 21 1.39 ⫾ 0.12 3.9 ⫾ 0.2 53.8 ⫾ 7.9

n.s. n.s. ⬍0.001 n.s. ⬍0.05

PII: S1550-7289(06)00402-3

P61.

ENDOSCOPIC SCLEROTHERAPY OF DILATED GASTRO-JEJUNOSTOMY AS AN ALTERNATIVE TREATMENT FOR PATIENTS WITH WEIGHT REGAIN. Sergio J. Bardaro, MD, Dennis Hong, MD, Laura July, MD, Jay Jan, MD, Emma Patterson, MD, Legacy Health System, Portland, OR. Background: Gastric bypass is a highly effective bariatric operation, but failures may occur. Some patients (10-20%) may present inadequate weight loss or weight regain after a few years, and dilatation of the gastro-jejunal anastomosis is one of the explanations for this phenomenon, although the data is sparse. Endoscopic injection of a sclerosing agent in the muscular layer has been reported to produce a stricture in those patients, which was a desired outcome in the circumstance of a dilated gastro-jejunal anastomosis. Methods: After informed consent, endoscopic sclerotherapy of dilated gastro-jejunostomy were performed in 3 patients with weight regain after adequate weight loss. Six intramuscular injections of 1 ml of 5% sodium morrhuate were placed circumferentially around the dilated gastro-jejunostomy in order to achieve a diameter of 10 - 12 mm. Weight loss was recorded at 2 months after the procedure. Results: One patient experienced pain immediately after the injections that quickly resolved. No dysphagia was reported. All three patients reported a subjective reduction in hunger and volume intake and initially resumed their weight loss (3,7 and