Salameh, Yara

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with significant morbidity, mortality, and healthcare costs. Many patients undergo early endoscopy despite the absence of active bleeding. PillSense is a novel Food and Drug Administration (FDA)-cleared ingestible capsule that rapidly detects the presence of blood in the upper GI tract and may optimize triage decisions. Methods: We conducted a retrospective study evaluating the impact of PillSense on the management of suspected UGIB in an academic center. The primary outcome was the association between capsule results and clinical decision-making, including endoscopy deferral, prioritization, outpatient scheduling, and airway protection. Secondary outcomes included transfusion requirements, time-to-endoscopy, endoscopic intervention, and 30-day adverse events. Results: A total of 28 patients (mean age 64.4 ± 17.9 years, 82.7% male) were included. Compared with negative results, positive results were associated with higher transfusion requirements (median 3 (IQR 3–6) vs. 2 (IQR 1–3.25) units; p = 0.041) and shorter time-to-endoscopy (median 0.2 (IQR 0.01–1) vs. 2 (IQR 1–15.5) days; p = 0.017). In high-risk for sedated endoscopy patients, negative results were associated with EGD deferral in 53.8%, with no subsequent adverse events within 30 days. Endoscopic intervention was performed in 62.5% of positive-result patients versus 9.5% of negative-result patients. Conclusions: The PillSense results were associated with differences in triage and management of high-risk patients with suspected UGIB. Its rapid, accurate, and non-invasive results may reduce unnecessary urgent endoscopy procedures, improve resource utilization, and enhance patient safety, particularly in the highest-risk populations.

Background: Metabolic and bariatric surgery (MBS) is an established treatment for severe obesity and its related comorbidities. While long-term outcomes are often emphasized, early postoperative complications remain a critical metric of safety and resource utilization. Large database studies have reported national trends in MBS outcomes but are limited by lack of granularity, inconsistent definitions, and inclusion of heterogeneous surgical experience. This study aimed to provide a detailed analysis of 30-day postoperative complications following sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) over a 17-year period at a single high-volume quaternary academic center. Materials and Methods: A retrospective cohort study of adult patients who underwent primary laparoscopic SG, RYGB, or DS between 2008 and 2024. All procedures were performed by fellowship-trained, minimally invasive bariatric surgeons. Complications occurring within 30 days postoperatively were identified through comprehensive chart review and classified using the Clavien-Dindo grading system. Primary outcomes included incidence, severity, and type of complications, as well as rates of readmission, reoperation, and reintervention. Multivariable logistic regression was used to identify predictors of overall and major complications. Results: Of 2190 patients included, 413 (18.9%) experienced at least 1 early complication, totaling 467 discrete events. DS had the highest complication rate (29.3%), followed by RYGB (18.4%) and SG (17.5%). RYGB was associated with a high burden of major complications, including anastomotic strictures, GI bleeding, and reoperations for obstruction or leak. The 30-day rates of readmission (2.0%) and reoperation (1.3%) were low across all groups. Independent predictors of major complications included venous stasis (aOR=3.22), renal insufficiency (aOR=2.65), and type 2 diabetes (aOR=1.96); both RYGB (aOR=2.25) and DS (aOR=2.77) carried higher risk than SG. Conclusion: This study provides a granular, procedure-specific profile of early complications after SG, RYGB, and DS. While all 3 procedures demonstrated acceptable safety profiles, DS had the highest overall complication rate, and RYGB carried the greatest burden of major complications. These findings underscore the variability in early postoperative outcomes by procedure type and reflect the value of institutional experience in characterizing complication profiles.

ABSTRACT Weight recurrence is a late complication after Roux-en-Y gastric bypass. The transoral outlet reduction (TORe) emerged as an endoscopic alternative to revisional surgery for weight recurrence due to a dilated and incompetent gastrojejunal anastomosis. The procedure has been documented as safe and effective in clinical trials and other high-quality medical literature. Several cases of squamous metaplasia of the gastric pouch after repeated TORe procedures using argon plasma coagulation have been reported. We present a case of a late-onset adenocarcinoma of the gastrojejunal anastomosis after a TORe procedure performed using argon plasma coagulation and suturing.

Obesity is a major global health challenge associated with significant metabolic and gastrointestinal comorbidities. While metabolic and bariatric surgery remains the gold standard for durable weight loss, the desire for additional options has fueled the development of endoscopic bariatric therapies (EBTs) as another tool for weight loss. This review examines established EBTs, including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGBs), and transoral outlet reduction (TORe), alongside emerging therapies such as duodenal mucosal resurfacing (DMR), incisionless anastomosis creation, and fully automated endoscopic gastric remodeling systems. ESG has demonstrated durable weight loss, favorable safety, and superior cost-effectiveness compared to pharmacotherapy alone, while combination strategies using EBTs and anti-obesity medications (AOMs), particularly GLP-1 receptor agonists, have resulted in greater total-body weight loss than either modality alone. Genetic variation, particularly within the leptin–melanocortin pathway, may predict response to endoscopic interventions and guide personalized treatment selection. Novel investigational procedures such as DMR, automated or robotic gastric remodeling, and magnetic or ultrasound-assisted gastric bypass show promising early results. Endoscopic therapies are poised to become increasingly central to the personalized, scalable management of obesity and related metabolic diseases.

AbstractEndoscopic sleeve gastroplasty (ESG) is an effective treatment for obesity but typically is not covered by insurance. It is not known whether patients with financial investment in their endoscopic procedure are more likely to achieve and/or maintain weight loss as compared with those who have no financial buy-in. We aimed to compare treatment adherence and outcomes between patients paying out-of-pocket (OOP) and those who underwent ESG as part of any clinical trial where costs were covered by a study protocol (no payment; NP).Data were collected via retrospective chart review. One hundred sixty-four patients who had an ESG with at least 6 months of follow-up were included. Repeated measures with generalized linear model were used to evaluate weight loss at different time points after ESG and labs values at baseline and 1-year follow-up to assess for comorbidity improvement between cohorts. Compliance was evaluated by comparing exercise adherence rates.The pattern of weight loss and change in laboratory values was not different over time between the OOP group (n = 139) and NP group (n = 25). Patients lost an average of 14% (12.2–15.9) and 12.9% (9.3–16.5) of total body weight over all time points, respectively, in both groups (6, 12 and 24 months). Treatment adherence also did not differ between the groups.Having “skin in the game” by paying for ESG OOP does not correlate with better outcomes or treatment adherence, which further supports broad insurance coverage for this procedure.

Background Obesity is intricately associated with type-2 diabetes (T2D) and other cardiovascular conditions, increasing morbidity, mortality, and health care costs. Metabolic and bariatric surgeries (MBS) have shown promising results in significant weight loss and T2D remission, but existing predictive scores for post-MBS diabetes remission do not consider insulin dosage, potentially overlooking a critical factor. Methods A retrospective analysis of patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The study focused on insulin dosage impact, divided into quartiles, on remission rates post-MBS. The effectiveness of RYGB vs SG was compared within insulin dose quartiles with up to 5 years of follow up. Results A total of 508 patients (64% female, 94.9% White, mean age 53.5 ± 10.5 years, BMI (46.0 ± 8.3 kg/m 2 ) were included in the analysis. This study demonstrates a profound association between insulin dosage quartiles and T2D remission after MBS. Patients with lower insulin requirements showed superior remission rates; those in the lowest quartile had remission rates of 73%, 70%, and 62% at 1, 3, and 5 years, respectively, compared to 34%, 37%, and 36% in the highest quartile ( P < 0.001 across all intervals). RYGB surgery showed a significantly better remission in the second and third insulin quartiles, suggesting its effectiveness over SG for patients with mid-range insulin requirements. Conclusion This study underscores the importance of considering insulin dosage when predicting T2D remission post-MBS. The findings advocate for a more nuanced selection of MBS procedures based on individual insulin profiles, potentially enhancing diabetes remission outcomes.

SummaryMetabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin‐treated type 2 diabetes (T2D) patients over a 5‐year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin‐treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin‐treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin‐treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG.