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Su1958 Argon Plasma Coagulation for the Treatment of Weight Regain Following Gastric Bypass: Predictors of Response
*denotes p-value <0.05
Su1958 Argon Plasma Coagulation for the Treatment of Weight Regain Following Gastric Bypass: Predictors of Response Allison Schulman, Walter W. Chan, Christopher C. Thompson Introduction: Weight regain after Roux-en-Y gastric bypass (RYGB) is correlated with dilated gastrojejunal anastomosis (GJA). Serial use of argon plasma coagulation (APC) has demonstrated to be effective in reducing the diameter of the GJA and reverse weight regain postRYGB. Aims: To identify predictors of weight loss at 3 and 6 months following APC for therapy of weight regain in post-RYGB patients. Methods: All patients undergoing APC for weight regain after RYGB were prospectively enrolled and eligible to participate. APC was initiated just prior to contacting the mucosa with the catheter in an attempt to create scarring and fibrosis in deeper tissues. This technique was performed at 45 watts and a flow of 0.8 ml in a concentric ring pattern around the margin of the GJA. Additional sessions were carried out every 8-12 weeks as needed for optimal GJA size of 8-10 mm ( figure 1). Primary outcomes included percent excess weight loss (%EWL) and percent weight regained lost at 6 months. Multivariable regression analysis was performed to determine whether pre-procedure BMI, GJA or %EWL after initial bypass procedure predicted weight loss following treatment. Proportions were compared using fisher's exact test. Means and medians for continuous data were compared with Student's t-test or Wilcoxon based on normality of the data, respectively. All statistics are reported as mean ± SEM. A p-value of 0.05 was considered significant. Results: 53 patients (age 49.0 ±1.3 yr, 195F / 28M) had pre-RYGB BMI of 52.1± 10.7 kg/m2. Postoperative nadir BMI was 29.6 ±1.1 kg/m2. APC was performed 8.6 ±3.4 years after RYGB, with weight regain resulting in BMI of 35.4 ±1.1 kg/m2 at time of APC. Mean GJA aperture was 16.1 ± 3.7 mm. Following APC, median %EWL was 13.5[IQR 19.3] and 9.7[IQR 28.3] at 3 and 6 months, respectively. Mean number of sessions was 1.3. Multivariable regression suggested that only %EWL after initial bypass procedure (p=0.05) was an independent predictors of %EWL at 6 months when adjusting for pre-procedure BMI and GJA size (Table 1). Conclusions: This prospective series demonstrated that only %EWL after initial bypass procedure predicted weight loss following serial use of APC. With longer-term durability data and newer approaches and devices being developed, predictive algorithms will be important to determine whether patient characteristics may predict weight loss following specific outlet reduction procedures. Table 1: Factors predicting percent excess weight loss following TORe based on a multivariable logistic regression model
Daikenchuto enhances intestinal motility.
Su1960 Analysis of Inhibitory Action of Glucagon Like Peptide-1 (GLP-1) Receptor Agonist on Gastrointestinal Motility Using Capsule Endoscopy Mitsunori Maeda, Yasuyuki Saifuku, Hideyuki Hiraishi Background and Aim Incretin enhancers and mimetics are diabetes therapeutic drugs include Dipeptidyl peptidase-4 (DPP-4) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonists(GLP-1RA). GLP-1RA bind to a membrane GLP receptor and increase insulin release from the pancreatic beta cells. GLP-1RA often show inhibitory actions on gastrointestinal motility (including small intestine) on animal experiments; however, this actions have not been demonstrated in human. We measured gastrointestinal (GI) transit time using a capsule endoscopy (CE) before and after administration of GLP-1RA and evaluated GI motility. Patients and Methods Our subjects included 11 patients (mean age: 57.9±13.7 years, males: 9, females: 2) with type 2 diabetes who have not previously been treated with a incretin enhancers and mimetics between June 2013 and March 2015. We analyzed CE finding and measured GI transit time using CE before and around 3 weeks after administration of GLP1RA (Liraglutide 0.9mg or lixisenatide 20µg) . This study was approved by the Ethics Committee for Dokkyo medical university (protocol no. 26016) and all patients consented to participate. For statistical analysis, paired t-test or Wilcoxon signed-rank test was performed, with a p value of less than 0.05 considered to indicate statistical significance. Results One of 11 cases was excluded from this study before administration of GLP-1RA because CE failed to reach colon. Before and after administration of GLP-1RA, the average values for gastric transit time were 69.06±60.52(min) and 224.45±307.07(min) (P=0.138), and the average values for small bowel transit time were 4.15±0.90(h) and 6.75±2.81(h) (P= 0.028). Correspondingly, the average values for GI transit time (from the esophagus to the ileocecum) were 5.17±0.81(h) and 10.81±4.18(h) (P=0.002). Both small bowel transit time and GI transit time after administration of GLP-1RA were significantly longer than those before administration of GLP-1RA. There were no difference in CE findings before and after administration of GLP-1RA. Conclusions This prospective study showed that GLP-1RA inhibited action on GI motility in humans.
95% C.I. = 95% confidence interval. *denotes p-value <0.05, NS denotes non-significance.
Su1961 Figure 1: Dilated gastrojejunal anastomosis (A) followed by APC therapy (B) with significant improvement in size of outlet (C).
The Role of Insulin-like Growth Factor 1 (IGF1) in Polycystic Ovarian Syndrome in Patients With Non-Alcoholic Fatty Liver Disease (NAFLD) Michael-Angelo P. Orciga, Zahra Younoszai, Kuan Yao, Maria Keaton, Ancha Baranova, Aybike Birerdinc, Zobair M. Younossi
Su1959
Background and Aim: Obesity continues to be a growing epidemic of the 21st century with a variety of metabolic, cardiovascular and reproductive consequences. Polycystic ovarian syndrome (PCOS) is found in more than 30% of obese women, and 70% of PCOS patients have insulin resistance. Given the lack of diagnostic biomarker for early detection of this disorder and its frequent co-occurrence with NAFLD, we sought to characterize the levels of IGF1, a hepatocyte secreted growth factor, and its receptor in obese NAFLD patients with PCOS and non-PCOS. Methods: We included 34 biopsy-proven NAFLD patients with PCOS (n=17) and or without PCOS (n=17). Both groups were matched for age and BMI and had corresponding sera and visceral adipose tissue. Compared groups were selected to include equal number of patients with diabetes mellitus (DM). IGF1R expression and serum levels of IGF1 were quantified along with other metabolic and inflammatory related genes and proteins. Results: PCOS patients with DM had significantly lower expression of IGF1R than non-PCOS with DM (p<.04). In PCOS patients, a trend to have lower IGF1R expression was noted (NS) as compared to the non-PCOS group. When non-DM patients with PCOS were compared to that with no PCOS, no significant differences were seen in adipose IGF1R expression or in circulating levels of IGF1. However, ADRA2A, a sympathetic receptor
Daikenchuto Enhances Intestinal Motility and Reduces Circulating Endotoxin Levels Hiroshi Yamamoto, Akitoshi Inoue, Akira Furukawa, Makoto Kadowaki, Tohru Obata, Sachiko Kaida, Tsuyoshi Yamaguchi, Satoshi Murata, Masaji Tani (Background) Recently, the concept of metabolic endotoxemia has been introduced, in which a bacterial component (endotoxin) derived from intestinal microbiota may contribute to develop metabolic syndrome. We previously reported a rapid improvement of glucose tolerance with changes of microbiota and markedly increased intestinal motility after LSG (PLOS one, 2013). In addition, our preliminary study showed that circulating endotoxin levels decreased after LSG. Thus, we hypothesized that increased intestinal motility after LSG, leading to changes of microbiota and decreased circulating endotoxin levels, may be the upstream of improvement of glucose tolerance. Daikenchuto, a Japanese herbal medicine, enhances intestinal motility in animal experiment. However, effect of Daikenchuto on human intestinal motility has not been established. In the present study, we investigated the effects of Daikenchuto on intestinal motility using cine MRI and on circulating endotoxin levels in
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human volunteers. (Materials and Methods) In this study, healthy 10 male volunteers took either Daikenchuto or control (lactose at dose of 5g) with double blind. Each volunteer underwent two MR examinations with Daikenchuto or control on separate days. The frequency of bowel contraction was assessed using cine MRI by two radiologists who are blind to information about administrated medicine. Circulating small amount of endotoxin levels were measured by using ESP (Endotoxin Scattering Photometry; Shock, 2013) before and after administration of Daikenchuto. (Results) Daikenchuto significantly increased the frequency of bowel contraction (p<0.05). Daikenchuto decreased circulating endotoxin levels compared to control with marginally difference in the same volunteers. (Conclusion) Cine MRI is feasible method to assess pharmacological effect on intestinal motility. Daikenchuto enhances intestinal motility and decreases circulating endotoxin levels.
Su1958 Argon Plasma Coagulation for the Treatment of Weight Regain Following Gastric Bypass: Predictors of Response Allison Schulman, Walter W. Chan, Christopher C. Thompson Introduction: Weight regain after Roux-en-Y gastric bypass (RYGB) is correlated with dilated gastrojejunal anastomosis (GJA). Serial use of argon plasma coagulation (APC) has demonstrated to be effective in reducing the diameter of the GJA and reverse weight regain postRYGB. Aims: To identify predictors of weight loss at 3 and 6 months following APC for therapy of weight regain in post-RYGB patients. Methods: All patients undergoing APC for weight regain after RYGB were prospectively enrolled and eligible to participate. APC was initiated just prior to contacting the mucosa with the catheter in an attempt to create scarring and fibrosis in deeper tissues. This technique was performed at 45 watts and a flow of 0.8 ml in a concentric ring pattern around the margin of the GJA. Additional sessions were carried out every 8-12 weeks as needed for optimal GJA size of 8-10 mm ( figure 1). Primary outcomes included percent excess weight loss (%EWL) and percent weight regained lost at 6 months. Multivariable regression analysis was performed to determine whether pre-procedure BMI, GJA or %EWL after initial bypass procedure predicted weight loss following treatment. Proportions were compared using fisher's exact test. Means and medians for continuous data were compared with Student's t-test or Wilcoxon based on normality of the data, respectively. All statistics are reported as mean ± SEM. A p-value of 0.05 was considered significant. Results: 53 patients (age 49.0 ±1.3 yr, 195F / 28M) had pre-RYGB BMI of 52.1± 10.7 kg/m2. Postoperative nadir BMI was 29.6 ±1.1 kg/m2. APC was performed 8.6 ±3.4 years after RYGB, with weight regain resulting in BMI of 35.4 ±1.1 kg/m2 at time of APC. Mean GJA aperture was 16.1 ± 3.7 mm. Following APC, median %EWL was 13.5[IQR 19.3] and 9.7[IQR 28.3] at 3 and 6 months, respectively. Mean number of sessions was 1.3. Multivariable regression suggested that only %EWL after initial bypass procedure (p=0.05) was an independent predictors of %EWL at 6 months when adjusting for pre-procedure BMI and GJA size (Table 1). Conclusions: This prospective series demonstrated that only %EWL after initial bypass procedure predicted weight loss following serial use of APC. With longer-term durability data and newer approaches and devices being developed, predictive algorithms will be important to determine whether patient characteristics may predict weight loss following specific outlet reduction procedures. Table 1: Factors predicting percent excess weight loss following TORe based on a multivariable logistic regression model
Daikenchuto enhances intestinal motility.
Su1960 Analysis of Inhibitory Action of Glucagon Like Peptide-1 (GLP-1) Receptor Agonist on Gastrointestinal Motility Using Capsule Endoscopy Mitsunori Maeda, Yasuyuki Saifuku, Hideyuki Hiraishi Background and Aim Incretin enhancers and mimetics are diabetes therapeutic drugs include Dipeptidyl peptidase-4 (DPP-4) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonists(GLP-1RA). GLP-1RA bind to a membrane GLP receptor and increase insulin release from the pancreatic beta cells. GLP-1RA often show inhibitory actions on gastrointestinal motility (including small intestine) on animal experiments; however, this actions have not been demonstrated in human. We measured gastrointestinal (GI) transit time using a capsule endoscopy (CE) before and after administration of GLP-1RA and evaluated GI motility. Patients and Methods Our subjects included 11 patients (mean age: 57.9±13.7 years, males: 9, females: 2) with type 2 diabetes who have not previously been treated with a incretin enhancers and mimetics between June 2013 and March 2015. We analyzed CE finding and measured GI transit time using CE before and around 3 weeks after administration of GLP1RA (Liraglutide 0.9mg or lixisenatide 20µg) . This study was approved by the Ethics Committee for Dokkyo medical university (protocol no. 26016) and all patients consented to participate. For statistical analysis, paired t-test or Wilcoxon signed-rank test was performed, with a p value of less than 0.05 considered to indicate statistical significance. Results One of 11 cases was excluded from this study before administration of GLP-1RA because CE failed to reach colon. Before and after administration of GLP-1RA, the average values for gastric transit time were 69.06±60.52(min) and 224.45±307.07(min) (P=0.138), and the average values for small bowel transit time were 4.15±0.90(h) and 6.75±2.81(h) (P= 0.028). Correspondingly, the average values for GI transit time (from the esophagus to the ileocecum) were 5.17±0.81(h) and 10.81±4.18(h) (P=0.002). Both small bowel transit time and GI transit time after administration of GLP-1RA were significantly longer than those before administration of GLP-1RA. There were no difference in CE findings before and after administration of GLP-1RA. Conclusions This prospective study showed that GLP-1RA inhibited action on GI motility in humans.
95% C.I. = 95% confidence interval. *denotes p-value <0.05, NS denotes non-significance.
Su1961 Figure 1: Dilated gastrojejunal anastomosis (A) followed by APC therapy (B) with significant improvement in size of outlet (C).
The Role of Insulin-like Growth Factor 1 (IGF1) in Polycystic Ovarian Syndrome in Patients With Non-Alcoholic Fatty Liver Disease (NAFLD) Michael-Angelo P. Orciga, Zahra Younoszai, Kuan Yao, Maria Keaton, Ancha Baranova, Aybike Birerdinc, Zobair M. Younossi
Su1959
Background and Aim: Obesity continues to be a growing epidemic of the 21st century with a variety of metabolic, cardiovascular and reproductive consequences. Polycystic ovarian syndrome (PCOS) is found in more than 30% of obese women, and 70% of PCOS patients have insulin resistance. Given the lack of diagnostic biomarker for early detection of this disorder and its frequent co-occurrence with NAFLD, we sought to characterize the levels of IGF1, a hepatocyte secreted growth factor, and its receptor in obese NAFLD patients with PCOS and non-PCOS. Methods: We included 34 biopsy-proven NAFLD patients with PCOS (n=17) and or without PCOS (n=17). Both groups were matched for age and BMI and had corresponding sera and visceral adipose tissue. Compared groups were selected to include equal number of patients with diabetes mellitus (DM). IGF1R expression and serum levels of IGF1 were quantified along with other metabolic and inflammatory related genes and proteins. Results: PCOS patients with DM had significantly lower expression of IGF1R than non-PCOS with DM (p<.04). In PCOS patients, a trend to have lower IGF1R expression was noted (NS) as compared to the non-PCOS group. When non-DM patients with PCOS were compared to that with no PCOS, no significant differences were seen in adipose IGF1R expression or in circulating levels of IGF1. However, ADRA2A, a sympathetic receptor
Daikenchuto Enhances Intestinal Motility and Reduces Circulating Endotoxin Levels Hiroshi Yamamoto, Akitoshi Inoue, Akira Furukawa, Makoto Kadowaki, Tohru Obata, Sachiko Kaida, Tsuyoshi Yamaguchi, Satoshi Murata, Masaji Tani (Background) Recently, the concept of metabolic endotoxemia has been introduced, in which a bacterial component (endotoxin) derived from intestinal microbiota may contribute to develop metabolic syndrome. We previously reported a rapid improvement of glucose tolerance with changes of microbiota and markedly increased intestinal motility after LSG (PLOS one, 2013). In addition, our preliminary study showed that circulating endotoxin levels decreased after LSG. Thus, we hypothesized that increased intestinal motility after LSG, leading to changes of microbiota and decreased circulating endotoxin levels, may be the upstream of improvement of glucose tolerance. Daikenchuto, a Japanese herbal medicine, enhances intestinal motility in animal experiment. However, effect of Daikenchuto on human intestinal motility has not been established. In the present study, we investigated the effects of Daikenchuto on intestinal motility using cine MRI and on circulating endotoxin levels in
S-599
X : 10052$CH01 03-28-16 00:57:27 PDFd : 10052B : o
Page 599
AGA Abstracts
AGA Abstracts
human volunteers. (Materials and Methods) In this study, healthy 10 male volunteers took either Daikenchuto or control (lactose at dose of 5g) with double blind. Each volunteer underwent two MR examinations with Daikenchuto or control on separate days. The frequency of bowel contraction was assessed using cine MRI by two radiologists who are blind to information about administrated medicine. Circulating small amount of endotoxin levels were measured by using ESP (Endotoxin Scattering Photometry; Shock, 2013) before and after administration of Daikenchuto. (Results) Daikenchuto significantly increased the frequency of bowel contraction (p<0.05). Daikenchuto decreased circulating endotoxin levels compared to control with marginally difference in the same volunteers. (Conclusion) Cine MRI is feasible method to assess pharmacological effect on intestinal motility. Daikenchuto enhances intestinal motility and decreases circulating endotoxin levels.