bluuebunny/crossref_metadata_2025_split huggingface dataset:
1130 Bariatric Surgery Is Associated With a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults <50 Years of Age: A 2006-2013 National Analysis
Authors: Hussan Hisham , Patel Arsheya , Porter Kyle , Lieberman David , Ahnen Dennis 
Published: October 2019

INTRODUCTION:
The incidence rates of early-age onset colorectal cancer (CRC) are rapidly rising in the United States. In parallel, evolving evidence suggests an unexpected increase in long-term risk of CRC after bariatric surgery (BRS). BRS utilization expanded in the past three decades, however limited knowledge exists regarding the impact of BRS on age-stratified trends of obesity-related gastrointestinal cancers (OGCs) including that of CRC.

METHODS:
We queried the 2006-2013 National Inpatient Sample (NIS), the largest publicly available all-payer data repository, to identify patients who underwent resections for OGCs. We investigated patients with morbid obesity (body mass index ≥ 40 kg/m2) and those with prior BRS. In a separate analysis, we also looked at non-BRS/non-obese individuals. We divided OGCs into two groups: CRC and non-CRC OGCs (esophageal, gastric, liver, gallbladder and pancreatic cancers combined). Joinpoint regression analysis was used to calculate the average annual percent change (AAPC) in patients undergoing cancers resections across age groups (age < 50 and ≥ 50 years old).

RESULTS:
We identified 28,041 patients with morbid obesity and 2,238 patients with a prior BRS who had resections for OGCs in 2006-2013. BRS patients were younger, with more females and fewer comorbidities (Table 1). The yearly number of morbidly obese and BRS patients who underwent CRC resections concurrently increased across all age groups (Figures 1 and 2). When stratified by age, the steepest rise in CRC was observed in BRS patients <50 years of age (AAPC +18.7%, P < 0.001). Conversely, non-CRC OGCs did not go up after BRS, while number of morbidly obese patients undergoing non-CRC OGCs increased in patients ≥50 years of age (AAPC +18.1%, P = 0.004). Finally, in a supplementary analysis, the number of non-BRS/non-obese patients with CRC resections, decreased in 2006-2013 [AAPC -3.3 (P = 0.002) and -3.4 (P < 0.001) for patients < and ≥50 respectively].

CONCLUSION:
Our results identify a recent paradoxical increase in CRC resections after bariatric surgery, most pronounced for early-age onset CRC. Other obesity-related gastrointestinal cancers did not increase after bariatric surgery, suggesting a low probability of referral bias leading to our findings. Further research is warranted to elaborate on these trends and provide biological context.
1132 Establishment and Validation of a New Protocol and Normative Values for the Evaluation of Gastric Emptying and Gastric Accommodation in Bariatric Surgery Patients
Authors: Wang Xiao Jing , Vargas Eric J. , Breen-Lyles Margaret , Nord Sara Linker , Burton Duane , Camilleri Michael 
Published: October 2019

INTRODUCTION:
Increasing rates of obesity have led to increased numbers of bariatric surgeries performed world-wide. However, some patients do not achieve significant weight loss or develop weight regain following these procedures. Other than estimating the size of the gastric remnant at endoscopy or transaxial imaging, there are limited approaches to quantitate the function of the post-surgical stomach in order to evaluate the disparate weight patterns, or to develop strategy for future treatments, e.g., pharmacotherapy or endoscopic intervention. We hypothesize that altered gastric function in the pre- and post-surgical periods may offer an explanation. Studies performed thus far are difficult to interpret due to heterogeneity in approaches to diagnostic evaluation. The aims of this project were: to assess the feasibility of a new protocol for simultaneous evaluation of gastric accommodation and gastric emptying in the post-bariatric state; and to report normative values in healthy volunteers.

METHODS:
Methods: We utilized single photon emission computed tomography (SPECT) and gamma scintigraphy to concurrently study postprandial gastric accommodation responses and gastric emptying rates of a limited size meal designed for subsequent use in post-bariatric patients. The standard meal consisted of 1 egg and 1 extra egg yolk scrambled with 111Indium-activated charcoal (∼130kcal, 9.5g fat) and 120mL 2% milk (130kcal, 4.4g fat). Gastric accommodation was measured using 99mTechnetium-SPECT. SPECT imaging was obtained concomitant with gastric emptying of the 111In-labeled meal. Anterior and posterior scans of the abdomen were obtained for estimating gastric emptying parameters every 15 minute until 90 minutes, and then in 30-minute intervals until 240 minutes or complete emptying.

RESULTS:
Data on 28/30 healthy volunteers (35.7% men; 67% Caucasian) with completed studies to date are shown in the Table 1 (data presented as mean ± standard deviation). Gastric emptying proportion at 1, 2, and 4 hours, T1/2, and gastric volumes including accommodation are graphically depicted in Figures 1 and 2, respectively.

CONCLUSION:
Discussion: This study has demonstrated feasibility of simultaneous measurement of gastric emptying and accommodation and provides normal values; this sets the stage for future baseline and post-operative scans on patients undergoing sleeve gastrectomy.
1133 Bariatric Surgery Is Associated With Post-Operative Constipation
Authors: Lin Elissa , Persily Jesse , Arbit David , Sidhu Sharnendra , Popov Violeta , Saunders John , Parikh Manish , Ren-Fielding Christine 
Published: October 2019

INTRODUCTION:
Bariatric surgery has become a common therapeutic approach to obesity. However, bariatric procedures may affect bowel habits due to changes in dietary intake as well as altered anatomy. To date, few studies have evaluated the impact of bariatric surgery on post-operative constipation. The aim of this study is to determine if patients experience a greater rate of constipation after bariatric surgery compared to non-bariatric controls.

METHODS:
A retrospective chart review at New York Langone Hospital (NYU) was performed on 160 bariatric surgery patients who had surgery in the year 2012 and 160 control patients with BMI < 30 kg/m2 seen in primary care in 2012. Reports of constipation were recorded up until November 2018. Exclusion criteria included those with inflammatory bowel disease or hereditary colorectal cancer syndromes prior to age 50. The primary outcome was diagnosis of post-operative constipation. Secondary outcomes included rates of constipation according to surgical procedure. Presence of constipation was recorded if listed on the problem list or if medications for constipation were prescribed. Logistic regression and chi-squared testing was used to assess differences in groups.

RESULTS:

Table 1 shows patient characteristics of the study population. The average age of bariatric surgery patients was 64.1 years compared to 69.8 in the control group. Overall, 20% of bariatric patients were diagnosed with constipation compared to 15% of controls (P = 0.239). Constipation rates post-bariatric surgery were 17.9% in lap band, 20.6% in sleeve gastrectomy, and 7.1% in gastric bypass patients (P = 0.256). A logistic regression controlling for age, sex, and Charlson co-morbidity index was performed between controls and post-surgery subjects. This revealed no significant difference in rates of constipation between the two groups (OR 1.158, 95% CI 0.790 – 1.696 P-value = 0.45). There was, however, a significant difference in constipation rates between the bariatric group pre-surgery (13.8%) and post-surgery (17.5%) (P = < 0.001) (Table 2).

CONCLUSION:
Bariatric surgery patients experience significantly higher rates of constipation after surgery compared to prior to surgery, but similar rates to controls without obesity. Constipation impairs quality of life and is associated with significant health care costs. Further studies investigating the mechanisms underlying this increase in constipation after bariatric surgery and effective measures to treat it are warranted.
1134 Bariatric Surgery Type Impacts the Risk for Gastrointestinal, Liver, and Pancreatic Diseases Admissions Within 1 Year From Surgery
Authors: Patel Arsheya , Dayyeh Barham Abu , Balasubramanian Gokulakrishnan , Hinton Alice , Krishna Somashekar , Hussan Hisham 
Published: October 2019

INTRODUCTION:
Bariatric surgery (BRS) is an effective weight loss method that should, in theory, improve many gastrointestinal, liver, and pancreatic (GILP) diseases seen with obesity. At the same time, there is an increased morbidity related to BRS’s gastrointestinal alterations. Thus, we examined the short-term impact of BRS type on admission rates of various GILP diseases.

METHODS:
We queried the 2012-2014 Nationwide Readmission Database to identify obese patients who underwent vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or, as a control, hernia repair surgery (HR). Our primary aim was to compare rates of GILP diseases within 6 months post- and 6 months pre-surgery in the VSG, RYGB, and HR cohorts. In a time to event analysis we evaluated readmission rates up to 11 months post-BRS.

RESULTS:
We identified a total of 140,103 patients in the VSG cohort, 132,253 patients in the RYGB cohort, and 12,436 patients in the HR cohort. HR patients were slightly older with a higher percentage of Medicare insurance carriers in contrast to VSG and RYGB (Table 1). RYGB was associated with a 33-fold increased risk of intestinal obstructions compared to pre-RYGB (P < 0.001). Other notably increased GILP diseases after RYGB from highest to lowest risk (Table 2): C. difficile infection [adjusted odds ratio (aOR): 12.52, P < 0.001], GI hemorrhage (aOR: 10.95, P < 0.001), biliary disease (aOR: 4.15, P < 0.001) and functional/motility disorders (aOR: 3.57, P < 0.001). In contrast, post- versus pre-VSG patients were most frequently admitted for acute pancreatitis (aOR: 6.26, P < 0.001), followed by C. difficile infection (aOR: 4.86, P < 0.001), biliary disease (aOR: 3.14, P < 0.001), noninfectious gastroenteritis (aOR: 3.05, P < 0.001) and functional/motility disorders (aOR: 2.74, P < 0.001). No increase in admissions was observed in the control HR cohort for any of these diseases. In our time to event analysis, the probability of being admitted was most notable for intestinal obstructions within 30 days after RYGB while functional disorders predominate afterwards (Figure 1). Similarly, patients were more frequently admitted for functional disorders following VSG.

CONCLUSION:
The type of BRS has a differential impact on GILP admissions after surgery. There may be a limited impact of weight loss on functional disorders that seem to dominate irrespective of BRS type. This data can help better inform patients on the choice of surgery to pursue, however more data are warranted.
1137 C. difficile Infection (CDI) in Bariatric Patients: A Case Series and Brief Review
Authors: Schopis Michael , Advani Rashmi , Patel Sneha , Brandt Lawrence 
Published: October 2019

INTRODUCTION:
Abdominal operations are known to be associated with a higher risk of CDI, although no current studies explore the association of post-operative CDI and patients who undergo bariatric surgery. We aimed to analyze the clinical characteristics and outcomes of morbidly obese patients who developed CDI after bariatric surgery.

METHODS:
This is a retrospective case series in which we describe 7 patients who underwent gastric bypass surgery from January 2012 to January 2016 and who developed CDI within 30 days after surgery.

RESULTS:
Mean patient age was 36.5 years. 100% of patients were female and mean body mass index (BMI) was 47.6kg/m2. 3 of 7 (42.8%) patients had controlled Type 2 Diabetes Mellitus (Table 1). All 7 patients had undergone laparoscopic Roux-en-Y gastric bypass. 4 of 7 (57.1%) patients were on proton pump inhibitors after gastric bypass. 3 of 7 (42.8%) patients developed non- C. difficile-related complications after their procedure, primarily intra-abdominal and abdominal wall abscesses that required antibiotics. None of the patients developed complications related to CDI and all patients had clinical resolution of symptoms on follow up within one month (Table 2).

CONCLUSION:
While numerous articles have characterized complications from bariatric surgery, many have not reported CDI as a potential complication. Given the ubiquity of studies demonstrating change in the intestinal microbiota population of obese patients, and the subsequent change of fecal microbiota after bariatric surgery, we believe further study into CDI after bariatric surgery is warranted. In this limited case series, all patients who developed CDI had undergone a laparoscopic Roux-en-Y gastric bypass. No major complications related to CDI were observed in this surgical cohort and clinical resolution was achieved by one month. We propose the need for larger, randomized control trials in future analysis of the association between various types of bariatric surgery, risk of post-operative CDI, and the impact on subsequent morbidity and mortality.
1140 Endoscopic Sleeve Gastroplasty versus Laparoscopic Sleeve Gastrectomy: A Meta-Analysis
Authors: Jacobs Chelsea , Banerjee Debdeep , Westerveld Donevan , Ayzengart Alexander L. , Draganov Peter V. , Yang Dennis 
Published: October 2019

INTRODUCTION:
Bariatric surgery remains the most effective and durable treatment for obesity; yet, less than 2% of eligible candidates undergo surgery. Endoscopic sleeve gastroplasty (ESG) is a restrictive procedure that simulates the anatomical changes associated with laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric procedure. We performed a meta-analysis to compare clinical outcomes between ESG and LSG.

METHODS:
Comprehensive search of multiple databases (PubMed, EMBASE, Cochrane, Web of Science) since the inception of ESG (2013) to April 2019. Studies were included if they reported data needed for calculation of post-intervention percentage total body weight loss (%TBWL) and adverse events. Pooling was conducted by using either fixed or random-effects model depending on heterogeneity across studies.

RESULTS:
A total of 5822 studies were initially identified, of which 18 studies (1446 ESG and 2071 LSG patients) were included. The pooled mean %TBWL at 6 months was lower in the ESG group (14.3; 95% CI: 12.8-15.9) when compared to LSG (25.5; 95% CI:23.9-27.2) (P < 0.001). Similarly, the estimated mean %TBWL at 12 months was lower for ESG (15.7; 95% CI:13.5-17.9) versus LSG (29.5; 95% CI:27.3-31.7) (P < 0.001). The pooled rate for adverse events was significantly higher in patients who underwent LSG (7.8%; 95% CI: 4.3-12.1) compared to ESG (1.9%; 95% CI: 0.7-3.7) (P < 0.001).

CONCLUSION:
ESG achieves less weight loss at 6 and 12 months when compared to LSG, but LSG is associated with more adverse events. ESG is an acceptable minimally invasive approach for non-surgical candidates or for those seeking alternatives besides conventional bariatric surgery.
1141 12-Month Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis
Authors: Mohan Babu P. , Asokkumar Ravishankar , Khan Shahab R. , Kotagiri Rajesh , Sridharan Gurusaravanan Kutti , Chandan Saurabh , Ravikumar Naveen , Ponnada Suresh , Jayaraj Mahendran , Adler Douglas G. 
Published: October 2019

INTRODUCTION:
Endoscopic sleeve gastroplasty (ESG) is a novel moderately-invasive technique in endo-bariatrics, with a theoretical potential to replace laparoscopic sleeve gastrectomy (LSG). We aimed at doing a meta-analysis to study its efficacy and safety.

METHODS:
We searched multiple databases from inception through March 2019 to identify studies that reported on ESG and LSG in the treatment of obesity. Our goals were to assess the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1-month, 6-month, and 12-month with ESG. The 12-month outcomes with LSG was used as a comparator group.

RESULTS:
7 studies each on ESG (1569 patients) and LSG(2179 patients) were analyzed. Baseline population characteristics were comparable between the groups, except for the mean range of BMI(33.3 to 38.9 in ESG-cohort and 37.4 to 48 in LSG-cohort). The pooled rates of %TWL at 1m, 6m, and 12m were 8.5 (7.7-9.3, I2 = 87.9), 15.4 (13.8-16.9, I2 = 94.7), and 17.5 (14.7-20.3, I2 = 94), respectively. The pooled rates of %EWL at 1m, 6m, and 12m were 30.1 (22.1-38.2, I2 = 96.6), 57.8 (48.6-66.9, I2 = 93.5), and 64.4 (50.3-78.5, I2 = 92.7), respectively. The pooled rates of BMI at 1m, 6m, and 12m were 32.6 (30.4-34.8, I2 = 97.5), 30.9 (29.1-32.6, I2 = 96.7), and 31.3 (27.5-34.9, I2 = 98), respectively. At 12-months, the pooled rates of %TWL, %EWL, and BMI with ESG were 17.5 (14.7-20.3, I2 = 94), 64.4 (50.3-78.5, I2 = 92.7), and 31.3 (27.5-34.9, I2 = 98), respectively; and with LSG were 30.3 (26.6-34.1, I2 = 97), 69.2 (59.7-78.8, I2 = 99), and 29.2 (26.6-31.9, I2 = 98.9), respectively. LSG demonstrated statistically superior %TWL when compared to ESG (P = 0.001), whereas %EWL and BMI at 12-months were comparable (P = 0.57 and 0.38, respectively). The pooled rate of all adverse events with ESG was 3.2% (2-5, I2 = 0) and with LSG was 11.8%(8.4-16.4, I2 = 80), with statistical significance, P = 0.001. The pooled rate of GERD with ESG was 0.5% (0.2-1.7, I2 = 7.3) and with LSG was 5.4%(3.1-9.3, I2 = 73), with statistical-significance, P = 0.001. The mean range of procedure time with ESG was 45 to 80 minutes and with LSG was 60 to 120 minutes. The hospital length of stay with ESG was 1-2 days and with LSG was a mean of 5 to 9 days.

CONCLUSION:
ESG appears to be an effective alternative option to LSG in the treatment of obesity. ESG has a faster procedure time, shorter hospital length of stay, and better safety profile. Overall, LSG resulted in superior total weight loss compared to ESG at 12-months.
1143 Prevalence of Eosinophilic Esophagitis Among Patients With Cystic Fibrosis: A Web-Based Survey
Authors: Kherallah Nizar , Maheshwari Anshu , Benson Jeffery , Kang Ian , Gupta Sandeep 
Published: October 2019

INTRODUCTION:
Cystic Fibrosis (CF) is a multi-system disease including gastrointestinal (GI) manifestations such as growth failure, chronic/recurrent abdominal pain and gastroesophageal reflux disease. Eosinophilic Esophagitis (EoE) is an atopic condition characterized by infiltration of the esophageal mucosa by eosinophils and associated with symptoms of esophageal dysfunction such as dysphagia, vomiting and feeding difficulties. The prevalence of EoE in the general population is estimated at 0.5-1 in 2000. EoE prevalence in individuals with CF is not well determined.

OBJECTIVE:
To assess the prevalence of EoE in pediatric and adult CF patients, to explore the healthcare provider’s awareness of this disease, and to evaluate the availability of resources for reliable investigations and diagnosis.

METHODS:
We conducted a web-based survey of CF care centers in the United States. The survey was sent to 234 CF care center directors (CDs). Responses were gathered from May 7 to May 30, 2019. A combination of open- and closed-ended questions was used.

RESULTS:
The survey was completed by 8.1% (19/234) of the contacted CDs/designees (9 pediatric, 3 adult and 7 combined programs) (Table). 68% (13/19) of respondents had at least one suspected EoE case in the previous 24 months; a total of 18 confirmed EoE cases was reported out of total of 2395 patients with CF. All centers reported access to appropriate GI service with expertise in EoE. The prevalence of EoE among the CF patients was found to be 7/1000 (9/1295), 8.5/1000 (3/355), and 8/1000 (6/745) in the pediatric, adult and combined programs respectively. The total prevalence in all age groups was estimated at 7.5/1000.

CONCLUSION:
This study indicates high awareness of EoE among US CF care centers. Appropriate GI services with expertise in the diagnosis and management of EoE was available to all providers who responded to this survey. The prevalence of EoE among individuals with CF regardless of age is approximately 0.75% which is 7-14 times higher than that of the general population. There was no significant difference in the prevalence of EoE in pediatric versus adult CF populations. These results deserve more studies into the pathogenesis of EoE in CF, the reasons behind increased prevalence, and further characterization of CF patients with EoE.
1146 The Use of Liver Biopsy to Determine the Severity of Nonalcoholic Fatty Liver Disease in Children Across the United States
Authors: Ascher Bartlett Johanna M. , Gutierrez Sanchez Helena Luz , Kabbany Mohammad Nasser , Mittal Naveen , Shah Jay , Alkhouri Naim 
Published: October 2019

INTRODUCTION:
Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease. Determining the severity of NAFLD using the presence of nonalcoholic steatohepatitis (NASH) and stage of liver fibrosis is important, yet liver biopsy remains the gold standard despite limitations to its use. This study surveyed pediatric gastroenterologists across the United States to determine which guidelines are used to determine the severity of NAFLD in children, which patients undergo liver biopsy, and how these guidelines compare to each other and to clinical practice.

METHODS:
140 pediatric gastroenterologists were surveyed electronically regarding current diagnostic practices for NAFLD. Responses were reviewed in Survey Monkey and compared to current North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), American Association for the Study of Liver Diseases (AASLD) and European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines regarding liver biopsy for evaluation of NAFLD.

RESULTS:
140 surveys were distributed with 54 responses, a 38.6% response rate. Participants included pediatric gastroenterologists, hepatologists and transplant hepatologists. 96.2% reported familiarity with NASPGHAN guidelines, 22.6% with ESPGHAN and 39.6% with AASLD. 88.7% of responders desired a generalized consensus regarding proper diagnosis. Pediatric gastroenterologists referred obese patients with abnormal liver enzymes suspected to have NAFLD 22% of the time, pediatric hepatologists 27.2%, and transplant hepatologists 39.9% (one-way ANOVA with P-value of 0.324). 61.5% of responders reported using Fibroscan and 59.6% used MR elastography to assess severity of NAFLD and presence of liver fibrosis when not pursuing liver biopsy. 92.5% of responders believed the presence of autoimmune antibodies was important in deciding when to proceed to liver biopsy, as well as 88.7% using abnormal screening labs and 75.5% using imaging suggestive of liver fibrosis.

CONCLUSION:
Comparison between the criteria that providers believed warranted a liver biopsy versus those included in society guidelines differed. The presence of autoimmune antibodies, abnormal screening labs, and liver fibrosis suggested on imaging all appeared to be important factors regardless of current guidelines. Providers also seem to rely on Fibroscan and MR elastography over liver ultrasound despite the lack of validated cutoff values in children.