Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success.

BACKGROUND AND STUDY AIMS: Bariatric endoscopy has emerged as an aid in the nonsurgical treatment of obesity. The objective of this study is to critically provide the results and follow-up of endoscopic sleeve gastroplasty 1 year after the procedure. PATIENTS AND METHODS: Prospective single-center follow-up study of 25 patients (5 men, 20 women) who underwent flexible endoscopic suturing for endoluminal gastric volume reduction. A multidisciplinary team provided post-procedure care. Patient outcomes were recorded at 1 year after the procedure. Linear regression analysis was done to evaluate the variables associated with best results at 1 year of follow-up. RESULTS: Mean body mass index (BMI) was 38.5 ±â€Š4.6 kg/m(2) (range 30 - 47) and mean age 44.5 ±â€Š8.2 years (range 29 - 60). At 1 year, 22 patients continued with the follow-up (2 dropped out at 6 months and 1 at 3 months). There were no major intra-procedural, early, or delayed adverse events. Mean BMI loss was 7.3 ±â€Š4.2 kg/m(2), and mean percentage of total body weight loss was 18.7 ±â€Š10.7 at 1 year. In the linear regression analysis, adjusted by initial BMI, variables associated with %TBWL involved the frequency of nutritional (ß = 0.563, P = 0.014) and psychological contacts (ß = 0.727, P = 0.025). The number of nutritional and psychological contacts were predictive of good weight loss results. CONCLUSIONS: Endoscopic sleeve gastroplasty is a feasible, reproducible, and effective procedure to treat obesity. Nutritional and psychological interaction are predictive of success.

Dual Intragastric Balloon: Single Ambulatory Center Spanish Experience with 60 Patients in Endoscopic Weight Loss Management.

BACKGROUND: Many obese patients fail conventional medical management and decline bariatric surgery. Less invasive weight loss options such as intragastric balloons may provide an opportunity to reach this large number of untreated patients. The aim of this study was to investigate the safety and effectiveness of the Dual Intragastric Balloon (DIGB) in the treatment of obese patients, as well as the impact of degree of obesity, age, and gender. METHODS: The study was conducted at the Bariatric Endoscopy Unit of the Madrid Sanchinarro University Hospital. Sixty patients (11 men, 49 women) underwent endoscopic placement of a DIGB filled with a total of 900 cc of saline (450 cc in each balloon) for at least 6 months, along with regular counseling from a multidisciplinary team. Study outcomes included: change in body weight (TBWL), % of loss of initial body weight (%TBWL), % of excess body weight loss (%EWL), and adverse events. RESULTS: Initial BMI 38.8 kg/m(2) decreased 6.1 units, with mean TBWL, %TBWL, and %EWL of 16.6 kg, 15.4 %, and 47.1 %, respectively. We found no difference in %TBWL between grade of obesity, age or sex, but morbidly obese patients demonstrated greater TBWL, and women and less obese subjects obtained higher %EWL. The DIGB was generally well tolerated, with one early removal for patient intolerance, one early deflation without migration, and one gastric perforation. Fourteen patients had small, clinically insignificant ulcers or erosions noted at the time of removal. CONCLUSIONS: The present study shows that the DIGB was easy to use, resulted in significant weight loss, safe, and well tolerated.

Endoscopic Sleeve Gastroplasty: How I Do It?

BACKGROUND: Primary endoscopic weight loss therapies are of interest for access, simplicity, and economy. The objective of this manuscript is to describe the endoscopic sleeve gastroplasty used in 50 patients. METHODS: The goal of this procedure is to reduce the gastric lumen into a tubular configuration, with the greater curvature modified by a line of sutured plications. General anesthesia with endotracheal intubation is needed. An endoscopic suturing system requiring a specific double-channel endoscope delivers full-thickness sets of running sutures from the antrum to the fundus. Patients are admitted and observed, with discharge planned within 24 h. Post-procedure outpatient care includes diet instruction with intensive follow-up by a multidisciplinary team. Voluntary oral contrast and endoscopy studies are scheduled to assess the gastroplasty at 3, 6, and 12 months. RESULTS: The technique was applied in 50 patients (13 men) with an average body mass index (BMI) of 37.7 kg/m(2) (range 30-47) with 13 having reached 1 year. Procedure duration averaged 66 min during which six to eight sutures on average were placed. All patients were discharged in less than 24 h. There were no major intra-procedural, early, or delayed adverse events. Weight loss parameters were satisfactory, mean BMI changes from 37.7 ± 4.6 to 30.9 ± 5.1 kg/m(2) at 1 year, and mean %TBWL was 19.0 ± 10.8. Oral contrast studies and endoscopy revealed sleeve gastroplasty configuration at least until 1 year of follow-up. CONCLUSION: Endoscopic sleeve gastroplasty is a safe, effective, and reproducible primary weight loss technique.

Susceptibility to severe ulcerative colitis is associated with polymorphism in the central MHC gene IKBL.

BACKGROUND & AIMS: IKBL gene lies telomeric of the tumor necrosis factor cluster in the central major histocompatibility complex and carries a structural polymorphism at position +738. In the Spanish white population, we found the IKBL+738(C) allele in haplotypes carrying either HLA-DRB1(*)1501 or -DRB1(*)0103. Because these HLA class II alleles may confer susceptibility to ulcerative colitis, we investigated an association between IKBL+738(C) and this disease. METHODS: DNA-based techniques were used to type individual alleles of HLA-DRB1 and IKBL+738. The frequencies of these alleles were compared among ethnically matched populations comprising 155 patients and 298 controls. RESULTS: IKBL+738(C) allele was exclusively increased in patients with extensive and/or intractable disease. HLA-DRB1(*)0103 was the only HLA-DRB1 allele to be significantly increased in frequency in patients with UC compared with controls. It was found in patients with extensive and distal disease. In the HLA-DRB1(*)0103-negative population, patients with extensive disease still had a significant association with IKBL+738(C). The difference between the 2 groups of patients was statistically significant (13.7% vs. 1.7% in patients with distal disease; odds ratio, 9.25; P = 0.01). CONCLUSIONS: HLA-DRB1(*)0103 is associated with susceptibility to ulcerative colitis, and IKBL+738(C) marks a propensity to extensive and more severe disease.

Nuevas formas de complicaciones hepatobiliares en la enfermedad inflamatoria intestinal crónica / New types of hepatobiliary lesions in inflammatory bowel disease

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Amino acid polymorphism at residue 71 in HLA-DR beta chain plays a critical role in susceptibility to ulcerative colitis.

The association of ulcerative colitis with distinct HLA-DRB1 alleles has not been easy to ascertain. Recent studies show that among HLA-DR2 alleles, DRB1*15 but not DRB1*16, is associated with the disease. Similarly, in the HLA-DR1 group, only DRB1*0103 is increased in ulcerative colitis patients. The aim of our study was to identify critical DRB1 residues that might account for these differences. We typed 121 patients with ulcerative colitis and 275 controls using gene amplification and sequence-specific oligonucleotide probing for HLA-DRB1 and DRB3. We observed a strong negative association between HLA-DRB1 alleles that encode lysine at position 71 in their beta-chain and susceptibility to ulcerative colitis. Differences in the prevalence among other alleles differing only in the third hypervariable region suggested a hierarchy of susceptible and protective class II alleles related to the presence of an acidic, neutral, or basic amino acid residue at position 71. These data implicate most strongly the amino acid residues in the third hypervariable region of the DRbeta chain, especially DRbeta71, in the association between ulcerative colitis and HLA. However, this does not exclude the contribution of other parts of the molecule and other immunoregulatory genes.

Pancolitis and genetic markers in the Spanish population.

BACKGROUND: although the etiology of ulcerative colitis disease remains an enigma, the importance of the major histocompatibility complex genes has been described, as in many other autoimmune diseases. AIM: we investigated the contribution of HLA-DRB1, DQA1 and DQB1 genes (HLA region) in patients with pancolitis. METHODS: we studied a total of 89 patients diagnosed as having ulcerative colitis (34 pancolitis and 55 left colitis) and 275 healthy control subjects. Complete information on sex, age, family history, age of onset, localization, complications, surgery and treatment was obtained from all patients. DNA was extracted from peripheral blood leukocytes and all individuals were HLA-DRB1 genotyped. RESULTS AND CONCLUSIONS: there was an association between pancolitis and the presence of DR4-Val86 (p = 0.009; OR = 3.3) and DRB1*0103 (p = 0.02; OR = 5.1) alleles. In patients with left colitis an association with DRB1*1501 (p = 0.03; OR = 1.9) and DRB1*0103 alleles (p = 0.03; OR = 3.8) was observed. We conclude that a strong association between DR4-Val86 and pancolitis exists.

HLA-DR2 gene and Spanish patients with ulcerative colitis.

BACKGROUND: An association with class II MHC genes has been described in ulcerative colitis, as in other diseases with immunological pathogenesis. Heterogeneous results have been reported, depending on the studied population. OBJECTIVE: To study the importance of these genes in our population, mainly the alleles of group HLA DR2 (gene HLA-DRB1). PATIENTS AND METHODS: We studied a total of 107 patients diagnosed of ulcerative colitis and 200 unaffected controls. Complete information about sex, age, family antecedent, age of onset, localization, complications, surgery and treatment was obtained from these patients. DNA was extracted from peripheral blood leukocytes and all the individuals were HLA-DRB1 genotyping. RESULTS AND CONCLUSIONS: We conclude that a positive association exists between DR15 and ulcerative colitis (p < 0.05). This positive association was characterized and various clinical parameters were analyzed, being concluded that DR1501 is more frequent in this disease (p < 0.05) and in benign manifestations; the frequency of the allele DR1502 was also found to be elevated in severe manifestations.

Positive and negative associations of distinct HLA-DR2 subtypes with ulcerative colitis (UC).

In UC, as in many other diseases with a suspected autoimmune etiology or pathogenesis, an association with certain HLA class II specificities has been investigated. In the Japanese, several studies have shown a positive association with DR2, but in Caucasian populations the results are conflicting. Therefore we undertook a study of HLA class II gene association with UC in a large group of white Madrid patients and ethnically matched controls, using molecular biology techniques to investigate whether any allelic subspecificity within the HLA-DR2 group is associated with susceptibility to or protection against UC. Patients with ulcerative colitis (n = 107) and 200 controls were typed using molecular, DNA-based techniques for HLA-DRB1, DQA1 and DQB1 alleles. Those HLA-DR2+ were then specifically typed for the individual alleles within the HLA-DR2 group. We observed a positive association with HLA-DR15 (P=0.021) and its subtype DRB1*1501 (P=0.018). HLA-DRB1*1502 was also increased, although its frequency both in patients and controls was very low. When the HLA-DR2+ population was studied, HLA-DRB1*1601 was significantly decreased in patients (P=0.026). Both HLA-DR3 (P=0.002) and HLA-DQB1*02 (P=0.001) were also negatively associated with the disease, the latter especially with pancolitis. Therefore, HLA class II association with UC is complex, and separate alleles confer either susceptibility or resistance. Conflicting results with HLA-DR2 appear to be due to the presence in this group of both positively associated (HLA-DRB1*1501 and DRB1*1502) and negatively associated (HLA-DRB1*1601) subspecificities. Moreover, HLA-DR3 and HLA-DQB1*02 are associated negatively.