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Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study.

Abstract：

BACKGROUND:Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery. MATERIALS AND METHODS:Between 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). RESULTS:Patient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05). CONCLUSION:Endobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.

journal_name

Obes Surg

journal_title

Obesity surgery

authors

Younus H,Chakravartty S,Sarma DR,Patel AG

doi

10.1007/s11695-018-3322-9

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

3020-3027

issue

eissn

0960-8923

issn

1708-0428

pii

10.1007/s11695-018-3322-9

journal_volume

pub_type

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Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study.